Osteomijelitis čeljusti

master's thesis

• Title (english): Osteomyelitis of the jaw
• Author: Tena Krmpotić
• Mentor: Marko Granić (mentor)
• Committee member: Marko Granić (predsjednik povjerenstva)
• Committee member: Tomislav Škrinjarić (član povjerenstva)
• Committee member: Samir Čimić (član povjerenstva)
• Granter: University of Zagreb; School of Dental Medicine; (Department of Oral Surgery); Zagreb
• Defense date and country: 2020-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Dental Medicine; Oral Surgery

Abstract

Osteomijelitis je infekcija kosti koja zahvaća periost, spongioznu i kortikalnu kost.
Osteomijelitis čeljusti najčešće se javlja u donjoj čeljusti zbog slabije prokrvljenosti i veće
gustoće kortikalne kosti. Osteomijelitis dijelimo na gnojni (supurativni) i bez gnoja
(nesupurativni). U gnojne se osteomijelitise ubraja akutni, kronični i infantilni, dok se
kronični još dijeli na primarni i sekundarni. U nesupurativne osteomijelitise ubrajaju se
kronični sklerozirajući, osteomijelitis Garré, aktinomikotički osteomijelitis i
osteoradionekroza. Kronični sklerozirajući osteomijelitis još se dijeli na fokalni i difuzni.
Uzročnici osteomijelitisa mogu biti razni poput bakterija, gljivica ili mikobakterija, međutim
najčešći su uzročnici bakterije i to aerobni streptokoki te Staphylococcus aureus i epidermidis.
Drugi najčešći uzrok pojave te bolesti su traume.
Dijagnoza se u početku bolesti temelji na anamnezi i kliničkoj slici jer se radiološki promjene
na kosti vide tek nakon 4 – 8 dana, odnosno 3 tjedna od pojave simptoma. Akutni oblici
bolesti počinju općim simptomima, bolovima i pojavom gnoja, dok su u kroničnim oblicima ti
simptomi izrazito smanjeni ili ih nema. U ranoj dijagnostici osteomijelitisa može se koristiti
magnetska rezonancija i scintigrafija pomoću koje promjene postaju vidljive već 3 dana
nakon pojave prvih simptoma.
Terapija osteomijelitisa sastoji se primarno od dugotrajne primjene antibiotika, a često je to
intravenska primjena antibiotika prema antibiogramu i kirurškoj fazi. U većini slučajeva
penicilin je antibiotik izbora, odnosno klindamicin ako pacijent ima alergiju na penicilin.
Kirurško liječenje uključuje sekvestrektomiju. U težim slučajevima potrebna je dekortikacija
donje čeljusti te resekcija i rekonstrukcija zahvaćene kosti. Liječenje osteomijelitisa uključuje
i liječenje primarne bolesti s obzirom na to da je većina pacijenata koja razvije osteomijelitis
imunokompromitirana uslijed neke druge bolesti ili stanja.

Abstract (english)

Osteomyelitis is an infection in the bone including the periosteum, medullary portion of the
bone and cortical bone. Osteomyelitis of the jaw much more commonly involves the mandible
than the maxilla due to less profuse nature of blood supply and the density of the cortical
bone. Osteomyelitis can be classified as suppurative and nonsuppurative. The acute, chronic
and infantile osteomyelitis are all considered suppurative. Also, chronic suppurative
osteomyelitis can be classified as primary or secondary. Nonsuppurative osteomyelitis can be
divided into chronic sclerosing osteomyelitis, Garré’s sclerosing osteomyelitis, actinomycotic
osteomyelitis, and radiation osteomyelitis and necrosis. The classification recognizes focal
sclerosing and diffuse sclerosing osteomyelitis as well, which are considered to be the types
of chronic sclerosing osteomyelitis.
Osteomyelitis can be caused by bacteria, fungi or mycobacteria. Aerobic streptococci and
Staphylococcus aureus and epidermidis are responsible for the majority of the cases of
osteomyelitis of the jaw. Trauma is the second most common cause of osteomyelitis.
Radiographic changes of the bone can be seen 4-8 days or 3 weeks after the onset of the
infection. That is why the early diagnosis of osteomyelitis is difficult and in the beginning of
the disease diagnosis based on anamnesis and clinical findings. The onset of acute
osteomyelitis includes prodromal symptoms, pain i pus accumulation. Those symptoms are
weak or nonexistent in chronic forms of the disease. Magnetic resonance imaging and bone
scintigraphy have been proven useful in early diagnosis of osteomyelitis because changes are
seen as early as 3 days after the onset of the osteomyelitis symptoms.
The treatment of osteomyelitis consists primarily of long-term antibiotic therapy, most
commonly high-dose intravenous antibiotic therapy. Antibiotic therapy depends on antibiotic
sensitivity, testing and surgical phase of the treatment. The most valuable antibiotic in
treatment of osteomyelitis is penicillin or clindamycin in case a patient is allergic to penicillin.
The surgical treatment includes sequestrectomy. In some severe cases, extensive surgical
treatment is necessary, such as decortication of the mandible or resection and reconstruction.
Sometimes patients have underlying disease which can alternate their immune system and
make them susceptible to infections such as osteomyelitis. In those cases, it is necessary to
treat both osteomyelitis and the underlying disease.

• Keywords: osteomijelitis; čeljust; streptokok; antibiotici
• Keywords (english): osteomyelitis; Jaw; Streptococcus; Anti-Bacterial Agents
• Language: croatian
• URN:NBN: urn:nbn:hr:127:876412
• Study programme: Title: dental medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-01-20 11:23:52