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Osteomyelitis

Jaw osteomyelitis is an inflammation of bone and marrow, potentially infectious or of unknown origin. The Zurich classification divides it into primary chronic osteomyelitis (PCO) without bacterial cause, and secondary acute and chronic osteomyelitis, often linked to infection or trauma.

Author: Caroline Robertsson • Consultant Oral & Maxillofacial Surgery • Section of Craniofacial and Maxillofacial Surgery • Karolinska University Hospital
Reviewed by: Robert Heymann • Oral and Maxillofacial Surgeon • PhD • Department of Oral and Maxillofacial Surgery • Karolinska University Hospital • Stockholm
7 min read
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    This article is based on an original article in Swedish which can be found here

    BACKGROUND

    Osteomyelitis is an inflammation of the bone and bone marrow. It can occur in all parts of the skeleton and can be uni- or multifocal. It can be triggered by an infection or have an unknown cause. Theories include a combination of autoinflammatory disease with predisposing factors such as poor blood supply to, for example, the mandible. There are several different classification systems and many different terms for osteomyelitis in the jaw. This article is based on “The Zürich Classification System” presented by Baltensperger et al in 2010 (1) and is currently the most common way to classify the disease. According to Baltensperger et al, osteomyelitis of the jaw can be divided into three different groups: primary chronic osteomyelitis, secondary acute osteomyelitis, and secondary chronic osteomyelitis.

    Primary chronic osteomyelitis (PCO) in the jaw is when no external cause for the inflammation is found. It is a non-bacterial, chronic inflammatory condition and has several other names in the literature (Garrés osteomyelitis, “DSO” (diffuse sclerosing osteomyelitis), “CNO” (Chronic Nonbacterial Osteomyelitis), etc.). It can affect only the jaw or be present in multiple skeletal parts simultaneously. It can also be part of a syndrome. For example, the conditions “SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) syndrome,” “CRMO” (Chronic Recurrent Multifocal Osteomyelitis), Majeed syndrome, and cherubism can present with osteomyelitis in the jaw. The etiology of PCO is unknown, and due to its unusual nature, only case reports/case series have been published in the literature. It appears to be an overrepresentation of young individuals (younger than 20) who develop this, as well as a peak in the 50s. (2)

    Secondary osteomyelitis is induced by an external cause such as dental infection, jawbone necrosis, previous trauma/surgery, foreign body, pathological tooth germ, or another external cause. Secondary osteomyelitis can be divided into acute and chronic depending on time elapsed since first symtoms occured. The acute form eventually transitions into the chronic form when symptoms persist for more than four weeks. Secondary acute and chronic osteomyelitis appears to affect men more often than women (men: women 1:1–3:1). It has been reported in all age groups with a mean age of 43–44 years at onset. (2)

    SYMPTOMS

    Primary Chronic Osteomyelitis

    • Swelling and pain that occurs in episodes
    • Trismus
    • Unaffected general condition
    • Normal leukocytes, possibly a slight increase in C-Reactive Protein
    • Absence of fistulation, pus, sequestra or any sign of infection

    Secondary Acute Osteomyelitis

    • Fever/Feeling of illness with significantly elevated leukocytes and C-Reactive Protein
    • External swelling and trismus
    • Lymphadenopathy of the neck
    • Pain
    • Pus/Abscess formation
    • Fistulation
    • Bone sequestration
    • Paresthesia

    Secondary Chronic Osteomyelitis

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