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Case - 1

A 20-year-old female patient, Archana, presented with maligned teeth and a history of a road accident leading to a mandibular fracture. Examination revealed facial asymmetry, pus discharge from the buccal vestibule, and inflamed gingiva, leading to a provisional diagnosis of chronic suppurative osteomyelitis and chronic generalized periodontitis. The treatment plan includes scaling and mandibular osteotomy, with a discussion on the etiology, pathogenesis, and principles of treatment for osteomyelitis.

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0 views35 pages

Case - 1

A 20-year-old female patient, Archana, presented with maligned teeth and a history of a road accident leading to a mandibular fracture. Examination revealed facial asymmetry, pus discharge from the buccal vestibule, and inflamed gingiva, leading to a provisional diagnosis of chronic suppurative osteomyelitis and chronic generalized periodontitis. The treatment plan includes scaling and mandibular osteotomy, with a discussion on the etiology, pathogenesis, and principles of treatment for osteomyelitis.

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kaypee.pareek
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CASE PRESENTATION

OSTEOMYELITIS
PRESENTED BY- DR. KANAK PAREEK (I YEAR MDS, OMR)
ST

GUIDED BY-Dr. Tulika Sharma (Reader Dept. OMR)


CO-GUIDED BY- DR. SABA KHAN (PROF. & HEAD DEPT.
OMR)
DEMOGRAPHIC DATA
OPD NO :1701065
Name :Archana

Age : 20/F

Occupation : Student

Address: Udaipur city


CHIEF COMPLAINT :

Patient complains of maligned teeth since 1 year.


HISTORY OF PRESENT ILLNESS :
- H/O road accident 1 yrs ago.

- Fracture of mandible and got treatment for

same.

PAST DENTAL HISTORY : Treatment for


mandible # 1 yr ago.
MEDICAL HISTORY : NRH
FAMILY HISTORY: NRH
PERSONAL HISTORY

 Oral hygiene habits : toothpaste and brush

 No deleterious habits reported


GENERAL EXAMINATION

Concious, cooperative and well oriented to


time, place and person.
Gait: Normal
Nourishment & Built: Moderate

Cyanosis,Jaundice,Edema,Clubbing,Pallor
:-Absent

Skin, Nails: NAD

Vital Signs: Under Normal limits


EXTRAORAL EXAMINATION
 Facial asymmetry
 Extraoral bony hard

swelling present on
right lower 1/3 of
face since last 1yr
after the accident.
 No associated pain

with the swelling.


 Muscles of

mastication : NAD
EXTRA ORAL EXAMINATION

TMJ: No deviation
No clicking sound
No tenderness

SALIVARY GLANDS: NAD

LYMPH NODES: Non palpable & Non tender


submandibular, submental, cervical, post &
preauricular lymph nodes.
Intraoral examination

SOFT TISSUE EXAMINATION

Labial mucosa: upper and


lower
Buccal mucosa: right and left
Tongue: dorsum surface,
lateral borders, ventral surface NAD
Floor of the mouth
Hard palate
Soft palate and uvula
Gingiva & Periodontal Assessment:

 Color: Gen. Red, Inflammed


 Consistency: Flabby and Non Resilient
 Contour: Edematous
 Position: Above CEJ
 SURFACE TEXTURE: Stippling Absent
 Bleeding On Probing: Present
 Exudation From Gingival Sulcus: Absent
 Pockets: Furcation Involvement: Grade I Grade 2 Grade 3: NAD
 Mobility: Grade 1grade 2 Grade 3: NAD
INTRA ORAL
HARD TISSUES :
Dentition: Permanent
Missing: 15, 31, 41
Recession : 35
Pus draining sinus in buccal vestibule wrt 35
Exposure of screw in buccal vestibule wrt 45
Pus drainage on palpation wrt exposed screws.
CASE SUMMARY

 A 20 year old girl, Archana came to dept. of OMR


with chief complain of maligned teeth since 1
year.
 h/o road accident>fracture mandible >open
reduction and fixation 1 year ago.
 Extraoral examination revealed facial asymmetry
 Intra oral examination revealed pus discharge
from buccal vestibule wrt 35 and 45, exposed
screw wrt 45.
 Inflamed gingiva with bleeding on probing, and
maligned teeth.
PROVISIONAL DIAGNOSIS

 Osteomyelitis
 Chr gen periodontitis
INVESTIGATIONS
 Blood investigations- Normal
 Montoux test- Negative
 Pus culture- not done
 Chest X-Ray- normal

OPG
Increase in bone radiopacity below screws wrt 44,45,46 and intermixed
radiolucency in between suggestive of periosteal reaction.
 External root resorption wrt 45
 Root stumps wrt 15,42,47
 Angular bone resorption wrt 46,36 (mesial)
 Left inferior border of mandible: irregular
True occlussal
IOPA wrt 45
IOPA wrt 35

 Horizontal tooth # : 35
 Root stump wrt 37
FINAL DIAGNOSIS

Chronic suppurative osteomyelitis


Chr gen periodontitis
TREATMENT PLAN

36 31,41
13 24
 Scaling
 Mandibular Osteotomy
DISCUSSION
 Osteomyelitis is an inflammatory process
accompanied by bone destruction and
caused by an infecting microorganism.

 The infection can be limited to a single


portion of the bone or can involve several
regions - bone marrow, haversion system,
periosteum, blood vessels, nerves and
epiphyses.
Etiology

 Odontogenic infection ( periapical,


periodontal and preicoronal )
 compound fracture of Jaw,
 traumatic injury,
 middle ear infection & upper respiratory
tract infection
 furuncle of chin
 peritonsillar abscess.
Pathogenesis –
Organisms once localized in bone

induce inflammatory reaction and cause


cell death.

Bone necrosis within first 48 hours

Bacteria and inflammation spread within


bone and throughout haversian systems
and reach periosteum

sequestrum

Rupture of periosteum - abscess in soft


tissue and formation of draining sinus.
Aerobic –
 Stap.aureus

 Hemolytic streptococcus

Anaerobic –
 Bacteroids

 Anaerobic streptococcus
Principles of treatment
 Evaluation & correction of host defense deficiencies
 Gram staining, culture and sensitivity
 Imaging to rule out bone tumors
 Adm. of stain guided empirical antibiotics
 Removal of loose teeth & sequestra
 Adm. Of culture guided antibiotics, repeated
cultures
 Possible placement of irrigating drains/ antibiotic
beads
 Sequestrectomy, debridement, decortication,
resection, reconstruction
Recommended antibiotic regimens :

Regimen I
a) Aqueous penicillin 2MU iv 4 hrly
b) Oxacillin 1gm iv 4 hrly
c) Penicillin V orally 500mg 4 hrly with Cloxacillin 250
mg ,4 hrly for 2-4 wks

Regimen II: Culture & sensitivity


Oxacillin, cloxacillin, dicloxacillin

 In allergic patients
- Clindamycin: 300-600mg orally 6 hrly
- Cephalosporin: Cefazolin 500mg 8 hrly
Cephalexin 500mg 6 hrly
Erythromycin 2g 6 hrly iv then 500mg 6 hrly orally
 HYPERBARIC OXYGEN –

 Intermittent inhalation of 100% oxygen in


specialized chambers at pressures greater
than that at sea level
Post operative care :
 antibiotics, analgesics, hot saline mouthrinses,
adequate hydration, rest
 THANK YOU

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