Classification of periostitis
Classification of periostitis can be of several types.
There are several types of periostitis, which depend on the nature of the inflammatory processes and the causes of their occurrence. The first group of periostitis is exudative, including serous, serous-fibrinous, fibrinous and purulent periostitis. The second group of periostitis is proliferative, including fibrotic and ossifying periostitis. Exudative periostitis, usually, has an acute and rapid course, and proliferative always have a chronic nature.
- Serous albuminous.
- Tuberculous periostitis - is characterized by the appearance in the inner layer of periostitis of granulated damaged tissue. Then this tissue is modified into curdled necrotic manifestations or is susceptible to suppurative melting, as a result of which the periosteum is destroyed. Usually this kind of periostitis appears on the ribs and bones of the face.
- Syphilitic - a lesion of the periosteum, which occurs due to syphilis, which can be congenital or acquired. Syphilitic periostitis happens in two forms - ossifying and gummy. Ossifying form is characterized by the appearance of hyperiostoses (syphilitic nodes on the periosteum). Hummus periostitis provokes the appearance on the bones of gumm - elastic flat thickenings.
According to the duration of the course, two forms of periostitis are distinguished:
- Acute (subacute).
Due to involvement in the inflammatory processes of microorganisms that have arisen, there are periostitis:
- Aseptic - appear as a result of closed injuries of bones in those places that are not protected by soft tissues.
- Purulent - are the result of getting into the periosteum of various infections.
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Acute periostitis is a kind of periostitis, in which the course of the disease manifests itself in an acute form with purulent inflammatory processes. The occurrence of acute periostitis is due to the penetration of pathogenic microflora into the periosteum.
The first signs of acute periostitis - the appearance of swelling on the periosteum and edema of soft tissues. The appearance of these symptoms is accompanied by painful sensations in the swelling, which rapidly increases in size. Subsequently, the swelling is transformed into a purulent inflammation, the course of which is characterized by an increase in body temperature to 38 - 39 degrees.
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This is a long and slow inflammatory process of the periosteum of the bone. Chronic periostitis is characterized by the appearance of thickening on the bone, which does not deliver painful sensations.
In the X-ray study, it was found that chronic periostitis manifests itself in lesions that have clear limitations. In this case, pathological changes in bone tissue of moderate severity and the appearance of severe hyperplasia in the periosteum are observed.
The development of chronic forms of periostitis is due to untreated acute periostitis, which has been transformed into a chronic disease. There are cases when chronic periostitis does not go through an acute stage, but immediately turns into a slow, long-lasting illness.
Also, specific diseases of the inflammatory infectious nature (tuberculosis, syphilis, osteomyelitis, and so on) can cause chronic periostitis, which lead to complications, for example, the appearance of a chronic form of periostitis.
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Acute inflammatory process of aseptic nature, in which there is increased blood flow to the affected part of the periosteum (hyperemia), as well as a slight thickening of the periosteum and the accumulation in its tissues of a fluid that is not characteristic of it (infiltration).
The most common form of periostitis. It occurs as a result of injury of the periosteum and the appearance of infection in it, most often from neighboring organs. For example, a purulent periostitis of the jaw arises from caries of the teeth, when the inflammation is transferred from the bones to the periosteum. Sometimes this kind of periostitis arises from the hematogenous way, for example, with piety. Purulent periostitis always accompanies the manifestation of acute purulent osteomyelitis. Sometimes, it happens that the source of the infection can not be detected.
The purulent periostitis begins with an acute condition. Hyperaemia of the periosteum develops, in which exudate is formed - a fluid saturated with proteins and blood elements. There is a high body temperature, about 38 - 39 degrees, chills. In the affected area, a thickening is felt, which is painful when pressed. After this there is a purulent infiltration of the periosteum, as a result of which it is easily torn away from the bone. The inner layer of the periosteum becomes loose and filled with pus, which then accumulates between the periosteum and the bone, forming an abscess.
With purulent periostitis, inflammation of the soft tissues and skin of the patient associated with the periosteum can occur.
Serous (albuminous, slimy) periostitis occurs after various injuries. On the injured area of the periosteum, there is a swelling along with painful sensations in it. At the onset of the disease, the body temperature rises, and then normalizes. If the inflammatory process is observed in the articular region, this can lead to a decrease in its mobility. In the first stage of serous periostitis, the swelling has a dense consistency, but then softens and can become liquid.
There are subacute and chronic forms of serous periostitis. In each of these cases, the inflammation of the periosteum leads to the formation of exudate, which is localized under the periosteum in a bag similar to a cyst or in the periosteum itself. It has the appearance of serous-mucous viscous fluid. It contains albumins, as well as inclusions of fibrin flakes, purulent bodies and cells in the state of obesity, erythrocytes. Sometimes the liquid contains pigments and fatty drops. The exudate is in a shell of granulated fabric of brownish-red color, and on top is covered with a dense shell. The amount of exudate can reach two liters.
If the exudate accumulates on the outer surface of the periosteum, it can cause swelling of the soft tissues that show up in their swelling. Exudate, which is located under the periosteum, provokes its detachment from the bone. This leads to the fact that the bone is bare and necrosis occurs, when cavities appear in the bone, filled with granulated tissue and microorganisms with weakened virulence.
Fibrous periostitis has a chronic form of percolation and a long process of injury. It develops over many years and is characterized by the appearance of a corpuscle fibrous thickening of the periosteum, which is strongly associated with bone. If the fibrous deposits are significant, this can lead to the destruction of the surface of the bones or the appearance of new formations on it.
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This is the configuration of the periostitis, which is revealed on an x-ray study. Linear periostitis on the X-ray image looks like a single line, located along the bone. There is a linear blackout in the form of a strip (ossification) along the edge of the bone. This form of periostitis is observed in the inflammatory process, which develops slowly and gradually. For example, linear periostitis is observed in syphilis, which occurred at an early age, in childhood or in the initial phase of bone inflammation (osteomelitis).
In acute periostitis, the dark linear blackout is separated from it by a light patch. It can be exudate, osteoid or tumor tissue. Such manifestations in the X-ray image are typical for acute inflammatory periostitis - acute periostitis, exacerbation of chronic osteomyelitis, the primary stage of appearance in the period of bone callus or for a malignant tumor.
With further observations, a bright band may become wider, and a darker one may disappear altogether. Such manifestations are characteristic for hyperostosis, when the formations in the perioste merge with the cortical layer of bone.
It is due to a simple periosteum due to the constant irritation of the periosteum and is a chronic form of this disease. Characterized by the deposition of calcium salts in the periosteum and bone formation from the inner layer of the periosteum. This kind of periostitis can proceed independently or be accompanied by inflammation of surrounding tissues.
A disease that is caused by acute pericoronitis. With the progression of this disease inflammation of the periosteum occurs in the retro-molar area.
In the future, under the periosteum, an abscess occurs, along the edges of which there is inflammation of the soft tissues. The area of the wing-jaw folds, the front palatal arch, the soft palate, the anterior edge of the jaw branch, the mucosa of the fold over the external oblique line in the region of the sixth to the eighth tooth suffers. There may be pain in the throat.
A few days after the appearance of the abscess from the inflamed shell around the eighth tooth begins to appear pus. Sometimes the abscess does not open in this area, but spreads along the external oblique line to the level of premolars and forms a fistula in this area. Sometimes the abscess can be opened and in the maxillofacial groove also in the form of fistula formation.
The acute phase of retro-molar periostitis is accompanied by an increase in body temperature to 38 - 38.5 degrees, trismus of the jaws, difficulty in eating food due to this, the appearance of weakness. The acute form of periostitis, if not treated, changes into a chronic phase, which is accompanied by the development of acute cortical osteomyelitis of the jaw.
Odontogenic periostitis is an inflammatory process in the jawbones, which is manifested in the inflammation of the periosteum of the jaws. There is odontogenic periostitis due to the penetration of infection from the inflamed tissues of the tooth into the periosteum of the jaw. Such lesions arise due to some diseases of the teeth - caries, pulpitis and periodontitis. The inflammatory process penetrates from the diseased tooth first into the bone that surrounds it, and then onto the periosteum that covers the bone tissue.
Sometimes odontogenic periostitis occurs due to increased blood supply and supply of pulpal lymph, jaw bones and soft tissues during the formation of teeth, their eruption and change, as well as the growth of jawbones during this period.
This is the inflammatory process of the periosteum of bones, which are regularly increased. For example, the loading periostitis appears on the bones of the foot and legs of the legs, when the patient has to stand on his feet for a long time - to stand, walk or run. This kind of periostitis occurs in athletes engaged in athletics; weightlifters; people who, by their nature, are associated with the constant carrying of heavy loads.
Load periostitis may occur due to injuries, for example, with dislocations.
Symptoms of stressful periostitis are the occurrence of painful sensations with the load on the legs, the appearance of edema of the legs and the appearance of seals on the bones during palpation.
Damage to the periosteum (traumatic periostitis) is an inflammatory disease of the periosteum, which occurred as a result of any injury. This kind of periostitis is most common in athletes and in people who are constantly training.
It arises from a bruise of soft tissues covering the bone (i.e., the periosteum), when a blow falls on that part of the bone that is poorly protected by the surrounding muscles.
Traumatic periostitis may be a consequence of other diseases, for example, tuberculosis, osteomyelitis, syphilis, malignant tumors and so on. Since these diseases lead to mechanical damage to the periosteum, an aseptic inflammatory process occurs.
Traumatic periostitis has two forms of perforation - acute and chronic.
The clinical picture in the acute form of the disease is very similar to manifestations with bruises. At the site of the injury, a bruise and swelling is formed, which is painful when pressed. Perhaps the appearance of swelling of the nearby tissue, as well as the continued preservation of pain. When examining the patient on the bone, a dense thickening is felt. This kind of periostitis is most common for injuries of the tibia.
The chronic form of traumatic periostitis is manifested in the thickening of the cortical layer of the bone. It is also possible the formation of osteophytes (outgrowths on the marginal bone tissue) and synostosis (fusion of the nearest bones).
This is a form of periostitis that occurs as a consequence of trauma after a bone injury. Also, after fractures, sprains and other injuries, symptoms of post-traumatic periostitis may appear.
In this case, an aseptic inflammatory process occurs in the periosteum, which can lead to acute manifestations of periostitis or to develop into a chronic form. The manifestations of post-traumatic periostitis are similar to the previously described symptoms of traumatic periostitis.