Osteomyelitis of the Jaws – Review Flashcards

A set of 50 Q&A style flashcards covering definitions, pathogenesis, classifications, clinical/radiologic features, special varieties, investigations, and management principles of osteomyelitis of the jaws.

What is the Latin and Greek derivation of the term “osteomyelitis”?

Osseous (Latin for bone) + osteon (Greek for bone) + myelos (marrow) + itis (inflammation).

Give Laskin’s 1989 definition of osteomyelitis.

An extensive inflammation of a bone involving the cancellous portion, bone marrow, cortex, and periosteum.

Which systemic conditions may compromise host immunity and predispose to osteomyelitis?

Leukemia, severe anemia, malnutrition, AIDS, IV-drug abuse, chronic alcoholism, febrile illnesses, malignancy, autoimmune disease, diabetes mellitus, arthritis, agranulocytosis.

Name two bone disorders that alter vascularity and predispose to osteomyelitis.

Osteoporosis and Paget’s disease (others: fibrous dysplasia, bone malignancy, prior radiation).

List five common etiologic sources of jaw osteomyelitis.

Odontogenic infections, trauma, orofacial infections, hematogenous spread, compound jaw fractures.

According to Marx et al. (1992) which unusual bacteria were identified in refractory osteomyelitis?

Actinomyces, Eikenella, and Arachnia species.

Outline the basic pathogenesis sequence of osteomyelitis.

Bacterial invasion → pus formation → spread → ↑ intramedullary pressure & blood flow → inflammatory response → ↑ periosteal pressure → chronic phase → granulation tissue → bone lysis → sequestrum formation.

What is a ‘sequestrum’?

A piece of devitalized (necrotic) bone separated from the living bone during osteomyelitis.

Hudson’s historic classification divides acute osteomyelitis into which three categories?

Contiguous focus (trauma, surgery, odontogenic), progressive (burns, sinusitis, vascular insufficiency), and hematogenous (metastatic, developing skeleton).

What is Garre’s osteomyelitis?

A chronic, non-suppurative proliferative periostitis with subperiosteal new bone formation, typically in children and young adults.

State two radiographic hallmarks of acute intramedullary osteomyelitis.

Early thinning/blurring of trabeculae and later multiple radiolucencies with irregular (“moth-eaten”) margins.

Which nerve deficit commonly accompanies mandibular acute osteomyelitis?

Paresthesia or loss of sensation of the lower lip due to inferior alveolar nerve involvement.

Describe the classic radiographic appearance of chronic osteomyelitis.

Moth-eaten bone destruction, dense sequestra, and possible “fingerprint” or “orange-peel” subperiosteal new bone.

What is the ‘onion-skin’ appearance and in which condition is it seen?

Multiple periosteal laminations parallel to cortex; characteristic of Garre’s osteomyelitis.

Differentiate focal from diffuse sclerosing osteomyelitis by age predilection.

Focal: mainly children/young adults around mandibular molar; Diffuse: more common in older, often edentulous mandibles.

Which radiographic pattern is typical of diffuse sclerosing osteomyelitis?

Diffuse patchy sclerosis with a “cotton wool” appearance, often bilateral and poorly defined borders.

How is infantile osteomyelitis (maxillitis of infancy) usually acquired?

Trauma to mucosa during delivery, sinus infection, nasal infection, or hematogenous spread by streptococci/pneumococci.

Give two key clinical signs of infantile osteomyelitis.

Edema of eyelids and swelling/redness below the inner canthus, followed by palatal/alveolar swelling with pus discharge.

List three infectious agents causing specific varieties of osteomyelitis of the jaws.

Mycobacterium tuberculosis (tuberculous), Treponema pallidum (syphilitic), Actinomyces israelii (actinomycotic).

Why does actinomycotic osteomyelitis mimic a parotid tumor?

It presents as firm tissue masses with purplish/red areas and draining sinuses near the mandible, resembling parotid swellings.

Name four conventional imaging modalities used to evaluate jaw osteomyelitis.

Intraoral periapical radiograph (IOPA), occlusal radiograph, orthopantomogram (OPG), lateral oblique view.

Which advanced imaging technique can distinguish reparative activity from infection in pediatric osteomyelitis follow-up?

PET/CT scan (proved superior to MRI in Warmann 2011 study).

Outline the pillars of conservative management for osteomyelitis.

Bed rest, rehydration, pain control, and appropriate antimicrobial therapy.

Give three examples of local antibiotic delivery mentioned for osteomyelitis.

Erythromycin, neomycin irrigants, and antibiotic-impregnated beads.

List four common surgical procedures for chronic osteomyelitis.

Incision & drainage, sequestrectomy, saucerization, decortication (others: trephination, resection).

What duration of postsurgical parenteral antibiotics has traditionally been used for chronic osteomyelitis, and why is it questioned?

4–6 weeks; evidence does not prove superiority and penetration into necrotic bone may be limited (Haidar et al. 2010).

Define osteoradionecrosis (ORN).

Exposure of non-viable, non-healing, non-septic irradiated bone that fails to heal without intervention.

List three factors that increase risk for osteoradionecrosis.

High radiation dose (>60 Gy), irradiating a surgical site before healing, combination of external radiation with intraoral implants (plus poor oral hygiene).

Explain the pathogenesis triad leading to ORN (Marx).

Radiation → endarteritis obliterans → hypovascularity, hypoxia, hypocellularity.

Name two key clinical features of osteoradionecrosis.

Persistent exposed bone with painful trismus and foul odor; pathologic fracture may occur in mandible.

What preventive dental measures are recommended BEFORE head-and-neck radiotherapy?

Extract hopeless teeth, restore restorable teeth, fluoride trays, oral hygiene instruction, rounding sharp cusps, eliminate tobacco/alcohol habits.

How often should post-radiotherapy dental evaluations be scheduled?

Every 3–4 months with prophylaxis and topical fluoride applications.

State two contraindications for hyperbaric oxygen therapy (HBO).

Untreated pneumothorax and severe COPD (others: acute viral URTI, uncontrolled seizures, malignancy).

How long is a typical HBO ‘dive’ session for ORN management?

90 minutes per session, usually 5 days per week for 30–60 dives.

Which dinosaur provides paleopathologic evidence of osteomyelitis?

Allosaurus fragilis.

Radiographically, which appearance differentiates focal sclerosing osteomyelitis from periapical rarefying lesions?

Intact lamina dura with widened PDL space and smooth sclerotic border blending into surrounding bone.

What is a ‘cloaca’ in chronic osteomyelitis?

A channel through which pus and sequestra drain, seen radiographically as a dark tract through sclerotic bone.

Why are antibiotics alone often insufficient in chronic osteomyelitis?

Bacteria reside in avascular, necrotic bone (sequestra) inaccessible to systemic antibiotics and host defenses.

Which histologic finding is diagnostic of acute osteomyelitis?

Dense infiltration of marrow spaces by polymorphonuclear leukocytes and empty lacunae in sequestrum.

What complication can chronic subperiosteal osteomyelitis of the mandible lead to?

Loss of much of the mandibular body due to poor central blood supply and sequestration.

Name two radiologic differential diagnoses for chronic osteomyelitis involving periosteal bone.

Paget’s disease and fibrous dysplasia (others: osteosarcoma).

How does bisphosphonate therapy benefit diffuse sclerosing osteomyelitis?

Reduces pain and analgesic need; may produce long-term symptomatic remission (Kuijpers 2011 study).

What is ‘saucerization’ in osteomyelitis surgery?

Removal of overlying cortical bone to create a saucer-shaped defect, allowing drainage and access for debridement.

Why is mandibular osteomyelitis more common than maxillary?

Denser cortical bone and relatively poorer blood supply make the mandible less capable of combating infection.

Which feature distinguishes syphilitic osteomyelitis clinically?

Progressive course with poor response to standard pyogenic osteomyelitis treatments and potential massive sequestration.

What is the recommended first-line IV antibiotic for infantile osteomyelitis?

High-dose intravenous penicillin, adjusted after culture and sensitivity.

Which imaging modality best depicts early marrow changes in osteomyelitis?

MRI due to high sensitivity for bone marrow edema.

Define ‘involucrum’.

A shell of new bone formed around a sequestrum in chronic osteomyelitis.

What does the Zurich classification of osteomyelitis incorporate?

Clinical picture, radiology, and etiology to guide diagnosis and management.