Osteomyelitis of the jaw bones – colloquially called osteomyelitis of the jaw bones – (osteomyelitis of the jaw bones; ICD-10-GM K10.2: Inflammatory conditions of the jaws) is an inflammation of the bone marrow of the upper or lower jaw. Osteomyelitis is associated with ostitis (synonym: osteitis; inflammation of the bone) and periostitis (inflammation of the periosteum). Osteomyelitis of the jaw bones is clearly different from osteomyelitis of the rest of the skeletal system due to the special conditions of the oral cavity. The differences result, for example, from the microbiologic and immunologic conditions of the oral cavity, the supply of blood vessels, and the involvement of dental alveoli (the bony compartment of the teeth).
Forms of the disease
According to the Zurich classification, osteomyelitis is basically divided into three different forms:
Acute and secondary chronic osteomyelitis.
Acute and secondary chronic osteomyelitis are the same disease, and chronification is assumed after four to six weeks of disease without healing. Acute and secondary chronic osteomyelitis preferentially affects the mandible (lower jaw). This predominance is presumably due to anatomical characteristics such as the lower vascularization (formation of small blood vessels), the lower proportion of spongiosa (bone tubercles; these give the bone its stability, i.e. its resistance to fracture) and a higher content of mineral substance. As a rule, acute or secondary chronic osteomyelitis of the jaws is an exogenously (“external cause”) triggered form of the disease. The cause is a postoperative (“after surgery”) or post-traumatic (“after an injury”) bacterial colonization of the bone. Very rarely, pathogens are spread hematogenously (“by the bloodstream”) from an existing focus of inflammation, thus causing endogenous (“internal cause”) osteomyelitis. Pathogens are staphylococci in 70 to 80 % of cases. However, other bacteria, viruses and fungi are also possible pathogens. The pathogen enters the body, for example, through open fractures (bone fractures) or, in a small percentage, through operations on the jaw bone. Jaw fractures often progress through germ-infected dental alveoli. Sex ratio: male predominance
Frequency peak: acute and chronic osteomyelitis can occur in all age groups. Exogenous forms of osteomyelitis occur predominantly in adults, whereas endogenous forms preferentially affect children and adolescents. Primary chronic osteomyelitis
In about 10% of cases, osteomyelitis is a bone infection without an exogenous genesis of unclear etiology that has not passed through an apparent (“clinically visible”) acute stage. A distinction can be made between an “early onset” (< 20 years) and an “adult onset” form (> 20 years). There are forms of the disease with only jaw involvement as well as with dermatoskeletal involvement (skin and skeletal system). Juvenile chronic osteomyelitis (synonyms: osteomyelitis sclerosans Garré, Garré’s osteomyelitis, Garré’s osteomyelitis; primary chronic aggressive osteomyelitis), may involve the mandible in addition to the long tubular bones. It is considered by some authors to be the early-onset form of primary chronic osteomyelitis. Multifocal special forms
Chronic (recurrent, recurrent) multifocal osteomyelitis (CRMO) is a sterile osteomyelitis of the skeletal system and preferentially affects the long tubular bones but may be associated with focalization of the mandible. SAPHO syndrome – The clinical picture includes joint and skin afflictions in addition to primary chronic multifocal (“in multiple locations of the body”) osteomyelitis, which may involve the mandible. Sex ratio: Women are more frequently affected by primary chronic osteomyelitis than men (2:1). Frequency peak: Primary chronic osteomyelitis occurs more frequently in adulthood (“adult onset”). The less frequent juvenile chronic osteomyelitis exclusively affects adolescents and young adults (“early onset”). Special forms
Radiation (“radioosteomyelitis”: infected osteoradionecrosis; IORN) and drug therapy – for example with bisphosphonates (bisphosphonate-associated osteomyelitis of the jaw; BP-ONJ) – cause physiological changes in the jawbone, making it more sensitive to bacterial colonization. The bone infection is therefore secondary.These forms of disease are therefore not considered further in the following. The prevalence (disease frequency): Osteomyelitis of the jaw bones is a frequently occurring disease. The number of refractory (“unresponsive to therapy“) chronic cases is increasing. Course and prognosis of osteomyelitis of the jaw bones: The prognosis depends on the type of pathogen as well as the patient’s age and immune status. Acute osteomyelitis of the jaw bones can often be cured in the early stages. However, the disease has a chronic character. A chronic course is difficult to treat, may persist for years, and may recur (recur). Therapy for primary chronic osteomyelitis of the jaw also often has little or no long-term effect.
