Diagnostics
First of all, a medical history (anamnesis) and an examination of the affected area by a doctor (preferably an ENT specialist or dentist) are necessary. In the acute stage of osteomyelitis, an elevated blood cell sedimentation rate (BSG) and a large number of white blood cells in the blood count (leukocytosis) play a major role in the diagnosis of osteomyelitis. Both forms of osteomyelitis can be detected in X-rays, although in some cases they are detected quite late.
As a rule, computer tomography (CT), magnetic resonance imaging (MRI) or even bone scintigraphy are better. However, all these methods are also more expensive and more complex, which is why they are only used if the suspicion could not be confirmed beforehand. The diagnosis can only be confirmed with a tissue sample (biopsy) of the affected region. An important differential diagnosis to osteomyelitis in the jawbone is a bone tumor.
Therapy
The therapy depends on the severity of the disease.Sometimes, in the early stages, conservative therapy with an appropriate antibiotic is sufficient and should usually be carried out over about three weeks. Bisphosphonates, which help to prevent the breakdown of bone substance, are also a drug option. If the conservative treatment does not promise any improvement or has already been tried without success, a surgical intervention can also be performed.
In this procedure, sequesters and dead pieces of bone are removed. Sometimes some teeth have to be removed. In addition, the outermost bone layer can be removed (decortication) to ensure better blood circulation in the bone. Here too, however, consistent continuation of antibiotic therapy is extremely important. The last option is always the (partial) resection of jaw bone, which can be replaced with plates or grafts if necessary.
Operation
Osteomyelitis in the jaw should always be treated conservatively at first, if the condition still allows it. Since it is an inflammation, an antibiotic should be administered first to stop the inflammation and thus prevent the progression of osteomyelitis. In addition, hyperbaric oxygen therapy can be used to kill bacteria that only survive in conditions without oxygen (anaerobes).
Often, however, osteomyelitis in the jaw is so advanced that only surgery can help. In this operation, the jawbone that has died as a result of the advanced osteomyelitis must be removed, as well as the outermost bone layer, so that the still intact remaining jawbone thus receives improved blood circulation (vascularization). In particularly severe cases, however, a complete part of the jaw may have to be removed because the bone area is already dead.
This is called partial jaw resection. Even if this is a drastic procedure, it is still possible because otherwise the inflammation can progress further and further and not only the jawbone but also other bones of the skull can be affected. This must be avoided at all costs. To “fill up” the jaw with bone again, either bone grafts or plates must be inserted to stabilize the jaw.
