X-ray signs of inflammatory diseases of the jaws

Inflammatory diseases of the jaws are more often observed in children 5-10 years old and patients aged 20-40 years. The most common odontogenic osteomyelitis occurs mainly in the lower jaw (up to 93% of all cases); 35-55% of all patients with osteomyelitis are affected by jaws.

Infection of the bone occurs from near-periuretic foci with acute and exacerbation of chronic periodontitis, less often from the marginal parts of periodontitis and suppuration of radicular cysts. Osteomyelitis can also develop when the well is infected after tooth extraction.

Depending on the state of the organism's reactivity and the pathogenicity of the microflora, a small portion of the bone tissue within 3-4 teeth or large parts of the bone-half the jaw or the entire jaw (diffuse osteomyelitis) is involved in the inflammatory process.

Despite the fact that purulent melting begins already on the 3rd-4th day from the onset of the disease, the first radiologic signs in acute osteomyelitis occur only after 10-14 days. At the top of the "guilty" tooth is determined the picture of chronic periodontitis. The earliest (on the 2nd-3rd day) indirect radiographic signs may be a thickening and deformation of the peri-jawed soft tissues, clearly visible on electro-X-ray patterns. On the roentgenogram, foci of rarefaction of bone tissue of round or oval shape with uneven contours are determined, in some areas merging with each other, and non-assimilated linear periostitis.

After the spontaneous separation of pus, a subacute period of osteomyelitis begins, characterized by an increase in the destructive process. The duration of this period is 10-12 days, with diffuse osteomyelitis - up to 3 weeks. Necrosis of the bone causes a violation of its blood supply due to vascular thrombosis and exposure to toxic substances. Formed from the neosteogenic stroma of the bone marrow, granulation tissue participates in the rejection of necrotic bone sites - the formation of sequesters. After rejection, the sequestrum turns out to be lying in the cavity of the abscess. On the roentgenogram, the sequestration has the form of a denser shadow, sometimes with uneven, "edied" contours, against the background of the rarefaction focus. Timely detection of sequestrants is an important diagnostic task, on the basis of which the indications for surgery and the success of osteomyelitis treatment depend, as the presence of sequesters impedes healing. Surgery - sequestrectomy - is carried out with complete rejection of the sequester.

Duration of chronic osteomyelitis from 1 month to several years, during which the demarcation (separation) of bone necrosis continues, separation of sequestrants, fistula formation. In young patients, rejection of spongy sequesters located in the region of the alveolar part occurs after 3 to 4 weeks, cortical - after 6-7 weeks. Jaw deformity increases as a result of assimilation of periosteal layers.

The detection of sequestrants on an X-ray diffraction pattern is sometimes a rather difficult task. Recognition is simplified when a demarcation shaft is formed from the granulation tissue around the sequestration, defined as a band of enlightenment around the more intense shadow of the sequester. Detection of an additional shadow that extends beyond the jawbone into soft tissues, a change in the location of the suspicious site on repeated identical radiographs undoubtedly indicates the presence of a sequester.

In osteomyelitis of the socket of the removed tooth, the process begins with fragmentation of the cortical closure plate, then the destruction of the inter-root septum occurs, the size of the socket increases, cortical sequesters are visible.

If untimely opening of maxillary abscesses and phlegmon occurs contact osteomyelitis with the formation of cortical sequesters. After sequestration, significant bone defects remain.

Pronounced destructive changes and the formation of large sequesters can lead to a pathological fracture. With incorrect and untimely treatment, especially in elderly patients, who have reduced reparative processes, a false joint with pathological mobility can form. Old people often have atypical chronic osteomyelitis with a predominantly productive reaction (hyperplastic, hyperostic), mainly affecting the lower jaw. On the roentgenogram, assimilated periosteal stratifications with thickening of the cortical layer, foci of expressed osteosclerosis, obliteration of bone marrow spaces are determined. Formation of sequestration does not occur, there are swish strokes.

Traumatic osteomyelitis as a complication of jaw fractures develops in 3 - 25% of cases. The frequency of its occurrence is affected by the severity of the lesion, the presence of an open fracture, the timing of seeking medical help and insufficient immobilization of jaw fragments. The long-lasting edema of soft tissues in the fracture region makes it difficult to detect the incipient suppuration of the bone wound in a timely manner.

The first radiographic signs of traumatic osteomyelitis: the growth of spotted osteoporosis, the fuzziness and roughness of the marginal parts of the fragments, the increase in the width of the fracture line, the displacement of fragments due to disruption of the formation of connective tissue callus, are noted 8-10 days after the onset of clinical symptoms of the disease.

When necrotic small fragments and marginal parts of bone fragments, X-ray shows sequestration in the form of denser shadows. On repeated radiographs, the fragments change little, a gentle shadow along the contour can appear due to endosteal bone formation. Shadow sequesters within 2-3 weeks become more intense. The necrosis of the fragment is also indicated by its displacement in the analysis of identical repeated X-ray diffraction patterns. Small sequesters and debris can dissolve for 2-3 months. In connection with the peculiarities of the blood supply, even small fragments in the middle zone of the face retain their viability.

Sclerotic changes in traumatic osteomyelitis are rare. Periodic reaction in the form of linear detached periostitis is visible only along the lower edge of the body and along the posterior edge of the branch of the lower jaw.

In osteomyelitis, not all the surface of the fragments may be affected, but only limited areas (the zone of the welded seam, the region of the alveolar margin). In the chronic course of the process in other departments, the fracture heals with the formation of bone callus. In these cases, sometimes only an X-ray study allows one to suspect the presence of a complication.

When involved in the process of the mucous membrane of the maxillary sinus, the course of osteomyelitis is complicated by odontogenic sinusitis. The inflammatory process is localized mainly in the tissues around the root of the "causal" tooth, with only the mucous membrane of the lower sinus parts being affected. In these cases, radiographic examination plays a major role in the recognition of the disease. Obstetric chin-nasal radiographs in most cases do not solve diagnostic difficulties. Sometimes when radiographing in a vertical position, the horizontal level of the liquid is visible, if the outflow from the sinus is not disturbed. More informative panoramic lateral radiographs and tomograms, as well as zonograms in the frontal-nasal projection. The pictures determine the uneven thickening of the entire mucosa or only in the area of the lower wall.

Introduction in the sinus of radiopaque substance (hymorography) does not provide obtaining the necessary information on the mucosal status.

Osteomyelitis of the jaws in children. In children, osteomyelitis occurs in the area of milk molars and the first permanent molars on the upper and lower jaws. Features of the anatomical structure of bones with their insufficient mineralization cause a diffuse course of the inflammatory process in children. On X-rays in the acute period in the first days of the disease, in spite of the pronounced clinical picture, only the foci of bone tissue destruction in the zone of bifurcation of milk molars (a picture of chronic granulating periodontitis) are revealed. Already at the end of the first week, foci of rarefaction of bone tissue, linear periosteal stratifications and soft tissue shade may appear.

In the chronic course of osteomyelitis, the rudiments of permanent teeth are subjected to sequestration, the image of the closing cortical plate of the follicle disappears, the tooth formation is disrupted; in the late stages, the fuzziness of the contours of the rudiment and its displacement are noted.

With the hyperplastic form of osteomyelitis, deformation of the jaw arises due to pronounced periosteal layers. To get an idea of the state of the spongy substance, it is necessary to perform a tomography, which allows to reveal the areas of rarefaction of bone tissue that do not contain sequestrants. There are difficulties in the differential diagnosis of disease with tumors, in particular with osteogenic sarcoma, which sometimes can be overcome only through histological examination. It should be noted that, in contrast to osteogenic sarcomas in osteomyelitis, periosteal stratifications have a linear character.

Hematogenous osteomyelitis occurs in newborns and in early childhood as a complication of pyoderma, pemphigus, umbilical sepsis, pneumonia, mastitis in the mother, meningitis, mediastinitis. With hematogenous osteomyelitis, the zones of active growth of bones are affected: on the lower jaw, the condylar process with a tendency to involve the joint in the pathological process, on the upper edge of the orbit, the alveolar process, the area of the dental rudiments. On the 6th-7th day from the onset of the disease on the roentgenogram, the fuzziness and blurredness of the bone pattern are determined. The centers of dilution of round and oval form on separate sites merge. For hematogenous osteomyelitis is characterized by the involvement of significant sections of the bone in the process. On the 3-4th week spongy and cortical sequesters become visible. Detection of periosteal layers along the outer surface, posterior margin and parallel to the base of the jaw indicate a chronic course of the disease.

Radiation damage to the jaws. The wide use of radiotherapy in the treatment of malignant tumors of the maxillofacial region and large radiation loads on the upper and lower jaws during the radical course of radiotherapy cause a relatively high frequency of their radiation injuries.

The first clinical symptom of developing osteomyelitis is pain. Later, there are osteoporosis, areas of destruction, spongy and cortical sequesters, pathological fractures can occur. Radial osteomyelitis is characterized by a long torpid current, sequestration occurs only after 3-4 months. A characteristic feature of the x-ray picture is the lack of reaction of the periosteum.

Irradiation of growth zones in childhood and adolescence causes a halt in the growth of the corresponding departments.