Hostname: page-component-848d4c4894-cjp7w Total loading time: 0 Render date: 2024-06-30T23:33:34.393Z Has data issue: false hasContentIssue false
  • English
  • Français

Tubercular and chronic pyogenic osteomyelitis of cranio-facial bones: a retrospective analysis

Published online by Cambridge University Press:  12 July 2007

A Sethi ,
D Sethi ,
A K Agarwal ,
S Nigam  and
A Gupta
A Sethi*
Affiliation:
Department of ENT & Head and Neck Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
D Sethi
Affiliation:
Department of ENT & Head and Neck Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
A K Agarwal
Affiliation:
Department of ENT & Head and Neck Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
S Nigam
Affiliation:
Department of Pathology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
A Gupta
Affiliation:
Department of Plastic & Maxillofacial Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
*
Address for correspondence: Dr Ashwani Sethi, E-80, Naraina Vihar, New Delhi 110028, India. E-mail: dr_sethi@rediffmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

To analyse current trends in our population with respect to the presentation, diagnosis and management of tubercular and chronic pyogenic osteomyelitis of the cranio-facial bones.

Design:

Retrospective study.

Setting:

Tertiary healthcare centre.

Patients and methods:

The study population comprised 14 patients with tubercular and chronic pyogenic osteomyelitis who were managed in the otorhinolaryngology department between May 2002 and December 2005.

Results:

Odontogenic infections, sinus infections and aural infections were the most commonly identified aetiological factors. Most of the patients presented with swelling, pain and discharging sinus. The diagnosis was established on the basis of clinical evaluation, radiological investigations and histopathological analysis, with six cases diagnosed with tubercular osteomyelitis and eight cases with chronic pyogenic osteomyelitis. All the patients were initially commenced on oral antibiotics, which were continued for two weeks in all cases with chronic pyogenic osteomyelitis. All the patients with pyogenic osteomyelitis underwent surgical management, with one patient requiring repeated surgical interventions. All the patients with tubercular osteomyelitis received anti-tubercular chemotherapy, with complete cure.

Conclusions:

Osteomyelitis of the cranio-facial bones is an uncommon entity which requires a high index of clinical suspicion along with radiological and histopathological investigations in order to establish the diagnosis. Tubercular osteomyelitis is clinically and radiologically indistinguishable from pyogenic osteomyelitis, and the two conditions can be differentiated only on the basis of histopathological evaluation of involved tissue.

Keywords

Facial BonesMandibleMaxillaTuberculosisOsteomyelitis
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 8 , August 2008 , pp. 799 - 804
Copyright
Copyright © JLO (1984) Limited 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Bernier, S, Clermont, S, Maranda, G, Turcotte, JY. Osteomyelitis of the jaws. J Can Dent Assoc 1995;61:441–2, 445–8Google ScholarPubMed
2Marx, RE. Chronic osteomyelitis of the jaws. Oral Maxillofac Surg Clin North Am 1991;3:367–82Google Scholar
3Mercuri, LG. Acute osteomyelitis of the jaws. Oral Maxillofac Surg Clin North Am 1991;3:335–66CrossRefGoogle Scholar
4Bhatia, PL, Agarwal, MK, Gupta, OP, Khanna, S. Tubercular osteomyelitis of facial bones. Ear Nose Throat J 1980;59:310–7Google ScholarPubMed
5Koorbusch, GF, Fotos, P, Goll, KT. Retrospective assessment of osteomyelitis. Etiology, demography, risk factors, and management in 35 cases. Oral Surg Oral Med Oral Pathol 1992;74:149–54CrossRefGoogle ScholarPubMed
6Yeoh, SC, MacMohan, S, Schifter, M. Chronic suppurative osteomyelitis of the mandible: case report. Aust Dent J 2005;50:200–3CrossRefGoogle ScholarPubMed
7Mahindra, S, Bais, AS, Sohail, MA, Maheshwari, HB. Granulomatous osteomyelitis of the maxillary sinus. J Otolaryngol 1979;81:255–8Google Scholar
8Meher, R, Singh, I, Raj, A. Tuberculosis of zygoma. Int J Pediatr Otolaryngol 2003;67:1383–5CrossRefGoogle ScholarPubMed
9Joseph, T, Mishra, HB, Singh, JP. Primary tuberculous osteomyelitis of skull: report of two cases. Br J Neurosurg 1989;3:705–7CrossRefGoogle ScholarPubMed
10Bhandari, B, Mandowara, SL, Joshi, H. Tubercular osteomyelitis of skull. Indian J Pediatr 1981;48:113–15CrossRefGoogle ScholarPubMed
11Adekeye, EO, Cornah, J. Osteomyelitis of the jaws: a review of 141 cases. Br J Oral Maxillofac Surg 1985;23:24–35CrossRefGoogle ScholarPubMed
12Daramola, JO, Ajagbe, HA. Chronic osteomyelitis of the mandible in adults – a clinical study of 34 cases. Br J Oral Maxillofac Surg 1982;20:58–62CrossRefGoogle ScholarPubMed
13Saunders, B. Current concepts in the management of osteomyelitis of the mandible. J Oral Med 1978;33:40–3Google Scholar
14Junquera, L, Rodriguez-Racio, C, Villarreal, P, Garcia-Consuegra, L. Autosomal dominant osteopetrosis and maxillomandibular osteomyelitis. Am J Otolaryngol 2005;26:275–8CrossRefGoogle ScholarPubMed
15Sato, T, Indo, H, Kawabata, Y, Agarie, R, Ishigami, T, Noikura, T. Scintigraphic evaluation of chronic osteomyelitis of the mandible in SAPHO syndrome. Dentomaxillofac Radiol 2001;30:293–5CrossRefGoogle ScholarPubMed
16Hovi, L, Saarineum, UM, Donner, U, Lindquist, C. Opportunistic osteomyelitis in the jaws of children on immunosuppressive therapy. J Pediatr Hematol Oncol 1996;18:90–4CrossRefGoogle Scholar
17Wald, ER. Risk factors for osteomyelitis. Am J Med 1985;78:206–12CrossRefGoogle ScholarPubMed
18Zhiang, H, Duarte, PS, Pourdehand, M, Shnier, D, Alavi, A. Exclusion of chronic osteomyelitis with F-18 flourodeoxyglucose positron emission tomographic imaging. Clin Nucl Med 2000;25:281–4CrossRefGoogle Scholar
19Daniel, MT. Tuberculosis. In: Isselbacher, KJ, Braunwald, E, Wilson, JD, Martin, JB, Fausi, AS, Kasper, DL, eds. Harrisson's Principles of Internal Medicine. New York: McGraw-Hill 1994;174Google Scholar
20Mader, JT, Shirtliff, ME, Bergquist, SC, Calhoun, J. Antimicrobial treatment of chronic osteomyelitis. Clin Orthop Relat Res 1999;360:47–65CrossRefGoogle Scholar
21Bamberger, DM. Osteomyelitis. A commonsense approach to antibiotic and surgical treatment. Postgrad Med 1993;94:177–84CrossRefGoogle ScholarPubMed
22Madder, JT, Adams, KR, Wallace, WR, Calhoun, JH. Hyperbaric oxygen as adjunctive therapy for osteomyelitis. Infect Dis Clin North Am 1990;4:433–40CrossRefGoogle Scholar