The term OSTEOMYELITIS means inflammation of ‘the boric marrow, Cl micallv. . osteomyelitis usnallv implies.an lnfvrtion of the lx ine. It usuallv hegins in the medullary involving the cancellous bone: then it extends and preads to the cortical hone and to the periosteum. Invasion cancel- 10m bone, which causes inflamrnauon edema in the pace results in cornprevslon ot the blood essols ill the bone.and subsequent severe comprorr se of t ht, blood suppl y. The fai Iure of microci rculation ill the cancellous bone is a critical factor in the qahlishment of osteomyel itis, because the involved area becomes ischemic bone becomes necrotic. Bacteria can then , proliferate, because normal blood-borne dctvnsvs do not reach the tissue, and the ostcomyelitrs spread, until it is stopped by medical and surgical therapy.
Considering the opportunities that bacteria have to enter into the cancellous bone, osteomyelitis of, the mandible rarely occurs if the body’s host defenses are reasonably intact. The major predisposing factors for osteomyelitis of the jaws are preceding odontogenic infections and fractures of the mandible, (Fig. 16-15). Even these two events rarely cause infections of the bone unless the host defenses are suppressed by ‘problems such as the alcoholism malnutritional syndrome, diabetes, intravenous illicit drug use, and myeloproliferative diseases, such as the leukemias, sickle cell disease, and chem other apytreated cancer.
Acute suppurative osteomyelitis shows little or no radiographic change, because 10 to 12 days are required for lost bone to be detectable radiographically. Chronic osteomyelitis usually demonstrates bony destruction in the area of infection. The appearance is one of increased radiolucency, which may be uniform in its pattern or patchy
Osteomyelitis of the mandible is a severe infection that may result in 105sof a large portion of the mandible. Therefore a clinician who has the training and experience to handle the problem expeditiously should manage this infection. In addition, it is likely that medical consultation will be required to help correct any underlj .lg compromise of host defenses.