Osteomyelitis and Radiation-Induced Bone Changes Lecture Notes

100 vocabulary flashcards covering the definition, symptoms, radiographic features, differential diagnosis, and management of acute and chronic osteomyelitis, as well as radiation-induced bone changes.

Osteomyelitis

An inflammation of bone that can spread through the marrow, cortex, cancellous portion, and periosteum.

Sequestrum

A hallmark of osteomyelitis consisting of a segment of bone that has become necrotic due to ischemic injury caused by the inflammatory process.

Acute Osteomyelitis

One end of a continuum of bone inflammation characterized by rapid onset and inflammatory infiltrate predominantly of neutrophils.

Chronic Osteomyelitis

A long-standing, persistent bone infection characterized by bone destruction, sclerosis, and sequestration.

Garré’s osteomyelitis

An exuberant periosteal response to inflammation, also known as proliferative periostitis.

Diffuse sclerosing osteomyelitis

A chronic form of osteomyelitis characterized by a pronounced sclerotic response and a shift in bone metabolism toward increased formation.

Endosteal surface destruction

A process in patients with osteomyelitis where bacteria and their products stimulate an inflammatory reaction in bone.

Acute suppurative osteomyelitis

A synonym for the acute phase of osteomyelitis characterized by infection spreading to the bone marrow.

Pyogenic osteomyelitis

A synonym for the acute phase of osteomyelitis.

Subacute suppurative osteomyelitis

A synonym for the acute phase of osteomyelitis representing a stage in the inflammatory continuum.

Periostitis Ossificans

A synonym for Garré's osteomyelitis, describing the proliferative periosteal reaction.

Proliferative periostitis

A condition where inflammation stimulates massive new bone formation, often appearing as several lines or an onion-skin appearance.

Acute phase inflammatory infiltrate

Consists predominantly of neutrophils and, to a lesser extent, mononuclear cells within medullary spaces.

Periapical lesion

The most common source of infection leading to osteomyelitis in the jaws, usually from a nonvital tooth.

Hematogenous spread

A route through which infection can reach the bone, other than trauma or local spread.

Mandible

The jaw bone more commonly affected by acute osteomyelitis, possibly due to a poorer vascular supply.

Acute osteomyelitis symptoms

Rapid onset, pain, swelling of adjacent soft tissues, fever, lymphadenopathy, and leukocytosis.

Teeth mobility

A clinical sign in acute osteomyelitis where associated teeth may be mobile and sensitive to percussion.

Third division of the fifth cranial nerve

The distribution where paresthesia of the lower lip may occur in osteomyelitis patients.

Technetium bone scan

A nuclear medicine study where a positive result indicates increased bone metabolic activity.

Gallium citrate scan

A nuclear medicine study where a positive result indicates an inflammatory cell infiltrate.

Computed tomography (CT)

The imaging method of choice for acute and chronic osteomyelitis to detect internal structure and sequestra.

Posterior body of the mandible

The most common location for acute osteomyelitis to occur.

Acute osteomyelitis periphery

Most often presents as an ill-defined periphery with a gradual transition to normal trabeculae.

Loss of sharpness of trabeculae

The first radiographic evidence of the acute form of osteomyelitis, reflecting slightly decreased bone density.

Radiolucency in osteomyelitis

The result of profound bone destruction in focal areas or scattered regions.

Island of nonvital bone

The radiographic appearance of a sequestrum within a region of radiolucent bone destruction.

Acute osteomyelitis effects on periosteum

Inflammatory exudate can lift the periosteum and stimulate bone formation, appearing as a thin radiopaque line.

Onion-skin appearance

A radiographic pattern of several lines of periosteal new bone formation, seen more often in children.

Fibrous dysplasia

A condition included in the differential diagnosis of acute osteomyelitis where new bone is manufactured on the inside of the mandible.

Malignant neoplasia

Entities like osteosarcoma or squamous cell carcinoma that may be difficult to differentiate from acute osteomyelitis.

Langerhans’ cell histiocytosis

A lesion causing lytic, ill-defined bone destruction that rarely stimulates a sclerotic bone reaction.

Leukemia and lymphoma

Malignancies that may stimulate a periosteal reaction similar to osteomyelitis.

Antimicrobial treatment

The mainstay of treatment for acute osteomyelitis, along with establishing drainage.

Surgical incision and drainage

A management technique for osteomyelitis that may include removing a tooth or performing root canal therapy.

Bacterial invasion

The primary cause leading to the chronic inflammatory response in the chronic phase of osteomyelitis.

SAPHO syndrome

A complex including synovitis, acne, pustulosis, hyperostosis, and osteitis.

Synovitis

The 'S' in SAPHO syndrome, referring to inflammatory arthritis.

Acne

The 'A' in SAPHO syndrome, specifically acne pustulosa.

Pustulosis

The 'P' in SAPHO syndrome, relating to psoriasis or palmoplantar pustulosis.

Hyperostosis

The 'H' in SAPHO syndrome, which is acquired in nature.

Osteitis

The 'O' in SAPHO syndrome, referring to osteomyelitis.

Chronic Recurrent Multifocal Osteomyelitis (CRMO)

A nonpurulent osteomyelitis with negative cultures, commonly affecting children's long bones, clavicle, and mandible.

Chronic phase periphery

Characterized by a gradual transition between normal trabecular bone and a dense granular pattern.

Chronic osteomyelitis internal structure

Shows areas of greater and lesser radiopacity compared to normal bone, sometimes appearing similar to cortical bone.

Dead bone

Another term for sequestra found within small radiolucent areas in chronic lesions.

Granular bone pattern

A radiographic feature in chronic osteomyelitis that may obscure individual trabeculae.

Draining fistula

A clinical feature that may develop in chronic osteomyelitis lesions.

Paget’s disease

A differential diagnosis that typically affects the entire mandible and lacks sequestra or periosteal new bone.

Osteosarcoma radiographic features

Typically shows bone destruction and a spiculated, sunray-like periosteal response.

Sequestrectomy

A surgical option for managing chronic osteomyelitis involving the removal of necrotic bone segments.

Decortication

A surgical procedure used in chronic osteomyelitis treatment, often combined with antibiotics for better outcomes.

Nonpurulent osteomyelitis

A form of osteomyelitis like CRMO that lacks pus and has negative microbiologic cultures.

Anti-inflammatory agents

Medications like steroids or NSAIDs used when antibiotics are ineffective and inflammation is the primary issue.

Bisphosphonate therapy

A systemic treatment that has shown recent therapeutic success in managing chronic osteomyelitis.

MRI (Magnetic Resonance Imaging)

An imaging modality using T2 or T1 with gadolinium to detect soft tissue edema in infections.

Soft tissue edema

An inflammatory sign detectable by MRI in infections of the soft tissues.

Abnormal fascial planes

A sign of soft tissue infection identifiable on a CT scan with IV contrast.

Fat streaking

A CT finding indicating inflammation or infection in the fat surrounding soft tissues.

Gas collections

Signs of specific bacterial activity in soft tissue infections identifiable by CT imaging.

Abscess radiographic appearance

Low-density areas with enhanced borders that become visible as soft tissue contrast fades.

Therapeutic radiation effects

Can cause cell death, cellular injury with recovery, arrested division, or abnormal repair leading to neoplasia.

Immature bone radiation effect

Leads to growth retardation, with greater severity occurring at earlier stages of development.

Mature bone radiation effect

Damages osteoblasts, reduces matrix formation, and affects blood vessels.

Ischemic injury

The cause of necrotic bone development in the process of osteomyelitis.

Neutrophils

The predominant inflammatory cell found in the medullary spaces during the acute phase of osteomyelitis.

Leukocytosis

An increase in white blood cell count, common as a systemic sign of acute osteomyelitis.

Purulent drainage

The discharge of pus that may be present in acute inflammatory bone lesions.

Technetium-99m scan

A specific radiopharmaceutical used in bone scans to identify areas of increased metabolic activity.

Gallium-67 scan

A nuclear medicine study used to localize inflammatory cell infiltrates.

Ill-defined border

The radiographic characteristic of active disease in chronic osteomyelitis.

Bone window CT

A specific CT imaging setting superior for detecting internal structures and sequestra in dense bone.

Resection

A major surgical procedure involving removal of a portion of the bone, used for severe chronic osteomyelitis.

Hyperbaric oxygen therapy

A treatment that has shown limited success in treating the sclerotic mandible due to poor blood supply.

Soft tissue contrast

An imaging factor that may fade over time, revealing the borders of an abscess.

Tuberculosis lymphadenopathy

A condition where lymph node enlargement can be visualized on MRI and CT in the context of soft tissue infection.

Cortex

One of the portions of bone through which the inflammatory process of osteomyelitis spreads.

Marrow

The soft tissue inside bone where inflammatory infiltrate accumulates in the acute phase of osteomyelitis.

Periosteum

The thin layer of vascular connective tissue that can be lifted by inflammatory exudate to form new bone.

Cancellous portion

The spongy, lattice-like internal part of the bone affected by osteomyelitis.

Paresthesia

An abnormal sensation, such as tingling, which may occur in the lower lip due to nerve involvement in osteomyelitis.

Radiopaque island

The visual appearance of a larger segment of nonvital bone found within a radiolucency.

Sunray-like periosteal response

A spiculated bone formation characteristic of osteosarcoma rather than osteomyelitis.

Nonvital tooth

A tooth with a dead pulp that serves as a common source for periapical infection leading to bone inflammation.

Spiculated response

A type of periosteal reaction with bone spikes, typically seen in malignant tumors like osteosarcoma.

Medullary spaces

The areas within bone that contain inflammatory infiltrate in osteomyelitis.

Bone destruction

A core component of both acute and chronic osteomyelitis, resulting in radiolucencies on X-rays.

Sclerosis

The hardening or increase in density of bone, common in chronic osteomyelitis.

Continuum

The concept that acute and chronic osteomyelitis represent two ends of a single inflammatory process.

Focal area radiolucency

A localized region of bone destruction seen in the internal structure of acute osteomyelitis.

Bone metabolic activity

The physiological process measured by a technetium scan to confirm inflammatory bone lesions.

Inflammatory exudate

Fluid that builds up during inflammation and can physically lift the periosteum from the bone surface.

Thin radiopaque line

The initial radiographic appearance of periosteal new bone formation.

Outer cortex thinning

A feature of fibrous dysplasia where the lesion is contained within a thinned outer layer of bone.

Bone window axial CT

An imaging view used to see bone density increases and new periosteal bone formation in chronic cases.

Secondary infection

A complication where a malignancy like SCC is infected via an oral ulcer, complicating the radiographic diagnosis.

NSAIDs

Non-steroidal anti-inflammatory drugs that may be beneficial in treating osteomyelitis when cultures are negative.

Systemic steroids

Anti-inflammatory agents that may be used in management when antibiotic therapy is ineffective.

IV contrast CT

A specific CT technique used to identify signs of soft tissue infection like skin thickening or fat streaking.

Osteoblast damage

A consequence of radiation on mature bone that leads to reduced matrix formation.