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CHIR IV > CHAP 3-INFECTIONS OF THE MAXILLARY BONES > Flashcards

CHAP 3-INFECTIONS OF THE MAXILLARY BONES Flashcards

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1
Q

ALV E O L A R O S T E I T I S
SYMPTOMS

A
  • PAIN (irradiated to ear)
  • Abscence of the blood clot
  • Occurs between the first and fourth day
  • May last 1 - 2 weeks
  • Halitosis, malaise and anorexia
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2
Q

ALV E O L A R O S T E I T I S
Anatomoclinic forms

A

Dry Socket==>Empty socket + intense pain
Suppurative alveolar osteitis==>Remains of blood clot + pus, less pain.
Marginal alveolitis==>Intermediate situation between the two previous
Phlegmon-like==>Invasion of adjacent sockets

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3
Q

OSTEITIS

A

Circumscribed lesions with no
tendency to produce bone
sequestrum

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4
Q

OSTEOMYELITIS

A

Diffuse lesions with sequestrum
formation

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5
Q

OSTEOPERIOSTITIS
CLINICAL FORM

A

1)ACUTE (AXHAUSEN )
2)CHRONIC

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6
Q

OSTEITIS

A

1)ACUTE (suppurative)
2)CHRONIC ( sclerosing or condensing )

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7
Q

OSTEOMYELITIS

A

1)INFANTS
2)ACUTE
3)CHRONIC
4)GARRE’S

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8
Q

localisation
MAX-MAND

A

Max 1 MAND 10

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9
Q

Rarefaction Stage

A

Osteolytic (by decreasing Ph) and osteoclastic occurrences

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10
Q

Necrosis Stage

A

Etiologic agents: Vascular and compressive occurrences
and toxins.
Sequestrate formation

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11
Q

Condensation Stage

A

Condensing osteitis: reparative action
Periosteum condensing reaction forms “Involucrum”
around sequestrate
(foramina of Troja: small holes into).

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12
Q

ACUTE OSTEOPERIOSTITIS

A

Axhausen’s osteoperiostitis
1) Children ( mandible )
2) Etiology==>dental infections
3) Exudate that separates the periosteum from the bone
4) Lack of clinical and radiological correlation
5) Swelling , pain , fever ? , fistulae

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13
Q

CHRONIC OSTEOPERIOSTITIS

A

1) After acute forms (inadequate treatment)
2) Low virulent infections
3) Slight symptoms
4) DIAGNOSIS RADIOLOGY
(Onion layers)
5) Pseudotumoral or pseudosarcomatous
forms (when it’s strictly localized )

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14
Q

ACUTE OSTEITIS (SUPPURATIVE)

A

1) IN MAXILLA OR MANDIBLE
2) CIRCUMSCRIBED INFECTION
3) ETIOLOGY: GRANULOMAS PERICORONITIS
POST-EXTRACTION ALVEOLAR FRACTURES
4) SIGNS AND SYMPTOMS: LOCALISED SWELLING + INTENSE PAIN
5) Rx: SIMULATE CYSTS (lytic area well defined but no sclerosed in the boundary)
6) CORTICAL BONE OSTEITIS OF DECHAUME
(Secondary to localized mucosal or cutaneous processes that spread by contiguity)

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15
Q

CHRONIC OSTEITIS

A

▪ Sclerosing or condensing
▪ Stimulation of osteoblasts
▪ Few symptoms
▪ NEURALGIFORM PAIN (few cases)
▪ X rays CONDENSATIONS NEAR THE APEX
independent from radicular cement

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16
Q

ACUTE OSTEOMYELITIS

A

▪ Etiology odontogenic infection
▪ Pain, trismus, fever, asthenia.
▪ Swelling in the mandibular region
▪ Tooth mobility
▪ Vincent’s sign +
▪ Patients with systemic diseases,
malnutrition
▪ Rx LARGE SEQUESTRUM

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17
Q

Symptoms of Actue osteomyelitis

A

1-Initial phase
2-infection phase
3-Sequestrum phase
4-Recovery phase

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18
Q

1) INITIAL PHASE

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A

Periodontitis (Enlarged tooth sensation)
Pericoronitis
Pain+Fever+Trismus : 2 or 3 days

19
Q

2) INFECTION PHASE

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A

Increased pain
Increased Septic Fever
Swelling—> Trismus
Inferior Alveolar Nerve Compression : Vincent’s Sign
Mobility of the causing tooth and the adjacent ones
Mucosal and Cutaneous Fistulae

20
Q

3)Sequestrum phase

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A

Not in First day , after some weeks
Duration:weeks, Mouths
No general signs
Trismus
Lower lip anesthesia
Edema and jaw deformation
Fistulae
Mobilization of teeth
X ray (3 weeks) Sequestrum
Slow and Irregular Evolution

21
Q

4) Recovery phase

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A

Bone loss: Gradually Repaired
Deformed bone
Teeth: Stable Outside the Sequestrum
Consequences Retractile Scars
Periosteum is very important for the recovery

22
Q

CHRONIC OSTEOMIELITIS

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A

▪ PRIMARY (Low virulence microorganism) OR
SECONDARY (poor antibiotic treatment)
▪ FEW SYMPTOMS ,only in exacerbations
▪ LARGE BONE SEQUESTRUM
▪ SUPPURATIVE OCCURRENCES
Rx =RADIOLUCENT AREAS AND SEQUESTRUM
=Around sequestrum: Foramina(Cloacae) of Troja

23
Q

Involucrum:

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A

Bone cavity of newly formed bone structureless that
contains a sequestrum

24
Q

Foramina :

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A

Perforations in bone segments, that release pus content from sequestrum or bone cavity around it(Involucrum

25
GARRÉ’ S OSTEOMYELITIS
- Slight irritation or infection - No suppuration - Focal gross thickening of the periosteum - Peripheral reactive bone formation - Exclusive process of the mandible - Young people
26
TREATMENT OST
1. Ant biotherapy (same as Odontogenic Inf. but LONG TERM: ==>3 to 6 months in OM;8-12 days in PO and O)<== 2.Hyperbaric O2-therapy 3.He-Ne Laser 4. Surgical treatment * Remove risk factors * Eradicate the primary infection * Fight the etiological infectious agent * Facilitate drainage of the osteomyelitis focus * Repair the destructive effects of the process
27
SURGICAL TREATMENT
* Drainage * Debridement * Sequestrectomy * Decortication * Saucerization ( marsupialization) * Intralesional antibiotic * Resection * Bone remodulation ( insclerosing forms )
28
ETIOLOGICAL FACTORS
1.- Radiation: > 60 Gy 2.- Localization: 30 - 40% in carcinomas of the floor of the mouth 3.- Anatomical region: Mandible > Maxilla People with teeth 4 > 1 Edentulous 4.- Systemic alterations: Hyperthyroidism Diabetes, Syphilis, Tbc, Arteriosclerosis … 5.- Trauma: mucosa-bone continuity
29
OSTEORRADIONECROSIS PROPHYLAXIS - Pre-radiotherapy extractions
Anterior teeth > 7 days Premolars > 10 days Molars > 12 days Impacted > 20 days
30
OSTEORRADIONECROSIS AFTER RADIOTHERAPY
* Avoid extractions * Treatment of xerostomia/hyposalivation: sialagogues, lysozyme, or substitutes * Discontinuous antibiotic and antifungal administration * Radiological controls (OPG) every six months * Hyperbaric oxygen therapy or laser
31
BISPHOSPHONATES-RELATED OSTEONECROSIS (BRONJ) or Medication-Related ONJ
-Osteoporosis treatment (orally) -To decrease bone fracture -Paget disease -Malign Hipercalcemias due to bone metastasis of lung, breast and prostate cancers (IV) -Multiple Mieloma
32
ONJ TREATMENT
Depending on the patient's clinical stage: Stage 1: CHX mouthwash 0,12% and analgesic treatment in case of pain. Surgical treatment is not recommended Stage 2: CHX, analgesic treatment and Atb (15 days – 2/ 3 months) Stage 3: CHX, analgesic treatment, Atb + Surgical treatment: sequestrectomy or block resection
33
ODONTOGENIC SINUSITIS ETIOLOGY
1- Nasal causes (ENT) 2- Odontogenic Causes 3- Other causes
34
ODONTOGENIC SINUSITIS
➢ Chronic periodontitis (granuloma) Contiguity mechanism / continuity of sinus mucosa and antral teeth Caries --> Necrosis --> Granuloma ➢ Acute suppurative apical periodontitis Acute suppurative apical periodontitis--> Pus breaks into the maxillary sinus--> EMPYEMA ➢ Odontogenic suppurative cellulitis -- } drains into the maxillary sinus ➢ Osteitis and osteomyelitis after extraction ➢ No antral teeth through a subperiosteal abscess ➢ Radicular and dentigerous cysts --- } They usually reject the sinus mucosa: - Sinus mucosa adhesions to the capsule of the cyst - Acute infections- Pus in sinus cavity--> EMPYEMA ➢ Periodontal diseases ➢ Iatrogenic causes (Currently 2º cause)
35
ACUTE MAXILLARY SINUSITIS: CLINICAL SYMPTOMS
- Etiology: allergic, viral and bacterial. Uncommon odontogenic cause. Last 1 month - Pain, irradiation to the orbit, frontal, zygomatic and alveolar region. Headaches - Swelling of the infraorbital soft tissue - Catarrhal purulent secretion: 1º fluid ---- 2º purulent - Rhinoscopy: edema and redness of the nasal turbinates mucopurulent secretions in the middle meatus - Cacosmia - Systemic involvement - If oroantral communication: mucosal prolapse
36
CHRONIC SINUSITIS
- More usual: odontogenic cause. Lasts 3 weeks to 3 months - Slight symptoms - Characteristic nasal syndrome: vasomotor rhinitis: - nasal itching and nasal obstruction of the affected side -paroxysmal sneezing producing watery rhinorrhea - If fistula: - Liquid reflux from the oral cavity - Oral polyps - If the immune status of the patients is good and there is not a rhinogenic component: the evolution is usually asymptomatic (casual diagnosis) - Irregular hyperplastic mucosa: sinus cavity occupation
37
SINUS EMPYEMA
- Purulent accumulation in the maxillary sinus - Obliterated ostium - Cessation of ciliary activity - Sinus pressure increases: ACUTE PAIN - Infraorbital and cheek edema - RX: fluid levels. They change with head movements
38
ODONTOGENIC SINUSITIS TREATMENT
Intranasal antrostomy with endoscopic surgery - Surgical creation of a drainage opening in the sinus - Removal of hyperplastic mucosa, foreign bodies… - Facilitates washings - Samples for culture can be taken Caldwell-Luc - In chronic maxillary sinusitis with irreversible lesions - Wide opening of the anterolateral wall of the sinus - Excision, curettage of the mucosa
39
OROANTRAL COMMUNICATIONS
* Lack of continuity between oral cavity and maxillary sinus. * 3 planes affected: – Sinus mucosa – Maxillary bone and/or palate bone – Oral mucosa * Canal covered by epithelium
40
ETIOLOGY
1)Proximity of the apex 2)Sinus pathologies causing communications 3)Iatrogenic cause 4)Infectious cause
41
TREATMENT
- First: resolution of the maxillary sinusitis. If it is not treated the perforation will recur ▪ - Consists of two phases: ▪ 1- Maxillary sinus intervention ▪ 2- Closure of oroantral communication
42
1- Maxillary sinus intervention
a- Caldwell Luc approach – Indicated in chronic sinusitis, polyps, cysts, mucoceles, communications and trauma b- Cleaning with imaging techniques: sinuscope A micro camera is introduced in the nasoantral meatus and throught an antrostomy of the anterior wall the diseased sinus mucosa is removed.
43
A- Caldwell Luc approach
Removal of diseased sinus mucosa, providing ventilation of the antrum that makes the reepithelialization easier 1-Incision 2-Flap reflection 3-Osteotomy 4-Removal of the sinus mucosa 5-Nasoantral perforation 6-Nasoantral drainage 7-Suture

CHIR IV (5 decks)

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