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Year : 2005  |  Volume : 15  |  Issue : 4  |  Page : 447-451
CT evaluation of mandibular osteomyelitis


Government Medical College; Nagpur, India

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   Abstract 

Mandibular osteomyelitis often is associated with involvement of the soft tissues. The purpose of this study was to clarify the relationship between CT patterns and the presence of inflammation in soft tissues. 30 cases diagnosed with osteomyelitis of the mandible were evaluated with CT scans. CT patterns of osteomyelitis were classified into four types: lytic, sclerotic, mixed & sequestrum patterns. Location extent of the lesion and change of the cortical plate were evaluated. The data demonstrate a close interaction between cortical plate disruption and muscle inflammation. The extent of inflammation including soft tissue involvement was better appreciated with CT in osteomyelitis

Keywords: Computed tomography, Osteomyelitis, Mandible

How to cite this article:
Taori K B, Solanke R, Mahajan S M, Rangankar V, Saini T. CT evaluation of mandibular osteomyelitis. Indian J Radiol Imaging 2005;15:447-51

How to cite this URL:
Taori K B, Solanke R, Mahajan S M, Rangankar V, Saini T. CT evaluation of mandibular osteomyelitis. Indian J Radiol Imaging [serial online] 2005 [cited 2019 Dec 10];15:447-51. Available from: http://www.ijri.org/text.asp?2005/15/4/447/28770

   Introduction Top


Osteomyelitis is an inflammatory condition of bone that the medullary cavity and the adjacent cortex. It occurs more frequently in mandible than in the maxilla [1], although most cases of osteomyelitis of the jaws result from dental origins, other sources of infection are possible [2]. The significance of radiological evaluation is twofold: to differentiate osteomyelitis from other conditions that show similar signs & symptoms and to check the progress of the disease and its response to treatment. [3]

Ariji et al [4] reported the role of CT in the mandibular osteomyelitis. CT revealed the exact location and extent of infection ads well as the relationship between soft tissue and bony lesions. They concluded that CT provides useful additional information about mandibular osteomyelitis. The role of CT in the diagnosis of maxillofacial infection is to define the precise location and extent. The spread of infection can be defined on CT scan according to the appearance of fascial spaces.

In the evaluation of osteomyelitis, both bone trabecular patterns and the extent of the soft tissue inflammation should be assessed. The purpose of this study is to clarify the relationship between CT patterns and the presence of inflammation in the soft tissues.


   MATERIAL & METHODS Top


Total of 30 cases of mandibular osteomyelitis were evaluated with CT scan over period of 24 months from August 2002 to November 2004 in the department of Radiodiagnosis Government Medical College & Hospital, Nagpur (M.S.).

Diagnosis of osteomyelitis was on the presence of signs, symptoms and radiological findings, which was again confirmed by FNAC. The included 22 male (73.66%) and 8 female (26.33%) was ranged in age from 5 to70 yrs.

Contiguous axial scan 4mm thick were taken with the use of MDCT scanner (Siemens Somatom, volume Access Germany)

CT patterns of osteomyelitis were evaluated at the initial CT examinations and classified into four types: lytic, sclerotic, mixed & sequestrum patterns, according to the amount of bony sclerosis in osteomyelitis and the presence of sequestrum. Lesion location extent and cortical plate involvement were evaluated.

The spread of infection and soft tissue involvement of the lesion was evaluated by lateral asymmetry of the shape and density of the various fascial spaces and tissues using soft tissue window.

Evaluation of the lesion extent and cortical plate involvement was done with bone window CT sections. Evaluation of the extent of the lesion was based on the number of segments of the mandible involved. [Figure]


   Results Top


Total 30 cases ranged in age from 5 to 70 yrs including 22 male (73.66%) and 8 female (26.33%) were evaluated. The most common age group involved was 21 - 30 yrs (7 cases 23.33%) followed by 31 - 40 yrs (6 cases 20%).

[Table - 1] shows the distribution of patterns of osteomyelitis. The most common CT patterns in our study was lytic type (70%) followed by mixed type (16%) and sequestrum patterns. no case of purely sclerotic pattern was found in our study

[Table - 2] shows the distribution of extent of lesions. Most lesions with a lytic or sequestrum pattern were relatively localized, whereas the majority of the mixed pattern was diffuse.

[Table - 3] shows the block-wise laterality of lesions. The most common block involved in our study was molar followed by premolar.

[Table - 4] shows the incidence of periosteal reaction. The periosteal reaction was seen in 10 (%) of the 21 lytic pattern cases, the incidence of which was significantly higher than in mixed pattern (2 / 5; --%).

[Table - 5] shows the incidence of cortical plate disruption. Disruption of cortical plate was seen 17 patients out of 30 amongst which 5 cases showed bilateral cortical break. 12 out of 21 cases of lytic pattern showed cortical break with 4 cases showing bilateral cortical break, the disruption was seen in two cases each of the mixed type and sequestrum type, out of which one case of mixed pattern had bilateral break. The incidence of cortical plate disruption was seen more frequently in buccal cortex than the lingual

[Table - 6] shows the extent of soft tissue involvement. More number of cases showed involvement of more than one soft tissue space (19/30, 63.33%) involvement than involvement of only one space (11/30,36.66%).


   Discussion Top


Osteomyelitis results from either from the direct extension of pulpal infection without the formation of a granuloma or from the acute exacerbation of a periapical lesion .it may also occur following penetrating trauma or various surgical procedures. Extension of the infection into adjacent soft tissue and fascial spaces is common, and often the presenting the clinical symptom for which the

CT study may be ordered. Trans cortical extension of the inflammatory process can result in cortical destruction, fistulization and periosteal reaction, all these changes can be evaluated very well by CT [5] Appropriate evaluation of radiographic types of osteomyelitis is necessary for treatment planning. Kazunori Yoshiura [6] classified mandibular osteomyelitis into four basic patterns, as lytic, sclerotic, mixed and sequestrum pattern .our study also comprise of the same

classification of osteomyelitis patterns. Periosteal reaction and cortical plate disruption were also common findings in our study. Ariji et al [4] reported that all infection of the masticator spaces were accompanied by trismus and were associated with swelling of the masseter muscle.

Kazunori Yoshiura [6] speculated mixed pattern osteomyelitis with cortical plate abnormalities may initiate masticator space inflammation. In our study the involvement of more than one Space was more frequently seen than that of the one Space. A periosteal reaction and cortical plate disruption were observed in the buccal plate more often than ion the lingual plate. This finding is probably related to inflammation of the masseter muscle or submandibular space as hypothesized by the Kazunori Yoshiura.[6] The masseter and medial pterygoid muscles attached to the lateral and medial surfaces of the mandibular ramus respectively. The termination areas of the masseter muscle on the lateral surface by comparison is wider than that of medial pterygoid muscle on the medial surface, hence, mandibular inflammation could affect the masseter muscle

proportionately more than the medial pterygoid muscle. Adekeye and Cornah [7] have reported the incidence of blood supply in maxillary osteomyelitis. When the masseter muscle is involved in mandibular inflammation, disturbance of blood supply to the mandibular ramus and its periosteum may occur. This could leads to surface bone resorption and induced disruption of the cortical plate.

 
   References Top

1.Kruger GO, ed. Textbook of oral and maxillofacial surgery.St.Louis:CV Mosby, 1979:204-7.  Back to cited text no. 1    
2.Shafer WG, Hine MK, Levy BM, eds. A textbook of oral pathology. Philadelphia: WB Saunders, 1974:453-61.  Back to cited text no. 2    
3.Stafne EC, Gibilisco JA, eds. Oral roentgenographic diagnosis. Philadelphia: WB Saunders, 1975:79-85.  Back to cited text no. 3    
4.Ariji E, Yuasa K, Tabata O, Yonetsu K, Ono Y, Kanda S. CT imaging of chronic osteomyelitis of the mandible . Oral Radiol 1987; 3:177-82.  Back to cited text no. 4    
5.Angelo M. DelBalso, MD DDS. An Approach To The Diagnostic Imaging of Jaw Lesions, Dental Implants, and The Temporomandibular Joint. RCNA 1998; 36(5): 855-890.  Back to cited text no. 5    
6.Kazunori Yoshiura et al. Radiographic patterns of osteomyelitis in the mandible . Oral Surg Oral Med Oral Pathol.1994; 78:116-24  Back to cited text no. 6    
7.Adekeye EO, Cornath J. Osteomyelitis of the jaws: a review of 141 cases. Br J Oral Maxillofac Surg 1985; 23:24-35.  Back to cited text no. 7    

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Correspondence Address:
K B Taori
Dept. of Radio-diagnosis, Govt. Medical College, Nagpur - 440 003
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.28770

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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]

    Tables

[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]

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    Abstract
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