Treatment of periostitis

In recent years, cases of neglected, poorly treatable diseases, including periostitis, have increased. The timely treatment of periostitis, as a rule, leads to complete recovery.

Treatment of periostitis can be conservative and surgical. The method of treatment is chosen based on the severity and course of the disease.

Conservative treatment of periostitis consists, most often in the use of non-steroidal anti-inflammatory drugs, such as lornoxicam, which is prescribed at 8-16 milligrams per day. It is proved that the treatment with lornoxicam accelerates the regressive process in the lesion focus and recovery processes occur. This drug is very effective in the elderly.

With a simple periostitis at first appoint rest, applying cold. After the abatement of acute phenomena, thermal procedures are shown, as well as physiotherapy.

To treat purulent inflammatory processes in the periosteum, surgical intervention is often chosen. Initially, the treatment of periostitis with antibiotics. After the formation of the abscess, it is opened. In this case, a cut is made, the lesion is treated with antiseptics, the cavity is drained for a better outflow of pus. If the periostitis was caused by a sick tooth, then, more often than not, it is removed.

With periostitis of a specific nature, such as tuberculosis and syphilitic it is necessary to treat the symptoms of the underlying disease.

Ossifying periostitis is treated surgically.

What is a periostitis?

Under periostitis, it is customary to understand inflammatory phenomena in the periosteum. At first, the periosteum suffers from inside or outside, a little later other periosteum layers are involved. The periosteum and the bone themselves closely adjoin each other, so a rapid spread of the inflammatory process to the areas that are "next door" occurs. Periostitis can have acute as well as chronic course.

The pathological anatomy of periostitis is nonspecific (purulent, simple, serous, ossifying), and specific, among which a large percentage of syphilitic and tuberculous.

A simple periostitis is a non-microbial minor inflammatory process that proceeds with acute hyperemia and infiltration. The surface of the bone during palpation is tuberous.

To provoke the appearance of simple inflammation of the periosteum can be traumatic or inflammatory lesions, they also appear in nearby organs, bones and nearby tissues. In the lesion site, soreness and swelling may occur. Inflammation of the perioste is affected by those areas where their protection in the form of soft tissue is minimal: the ulna, the surface located in front of the tibia. Acute inflammatory phenomena can subside in fifteen to twenty days.

Occasionally, there are fibrous growths, salt calcium deposits, development of osteophytes or periostitis ossifying.

A prolonged inflammatory process in the periosteum leads to the fact that the disease often acquires a chronic character, while the formation of a new bone takes place on the internal layer of the periosteum. It develops as a result of prolonged irritation of the periosteum. A catagenesis of an inflammatory nature can occur in a re-infection limitedly or involve tissues and bones.

There is a periostitis of ossifying character near necrotic, as well as inflamed tissues, bones, with varicose veins in the skin affected by ulcers, bone tuberculosis. If the irritations that cause ossifying periostitis disappear, further bone formation stops. Abscess, resulting from the impact of the process, which lasts for many years, and is expressed in the thickened areas of fibrosis, as well as the nature of the corpus, fused with the bone tissue, called fibrous periostitis.

Often located on the tibia, if the shin is an ulcer, inflammation of the joints that occur chronically, the presence of necrosis of the bone. If the inflamed area is extensive, it can provoke a superficial destruction of bone tissue. A long-lasting process often leads to bone formation. If the irritating process is eliminated, the periostitis may stop or stop altogether. Then a purulent infiltrate appears in the periosteum. The inner surface of the periosteum becomes loose, because of this it becomes impregnated with purulent contents, which accumulate between the periosteum and bone, resulting in the occurrence of an abscess.

If the wounds next to the supratoon become infected or the infection comes from other organs located close to the period from the caries tooth - jawbone periostitis, infection through the blood, which leads to inflammatory catagenesis in a period of purulent nature. There are cases when the source of the infectious process can not be clarified. The disease begins with inflammation and redness in the periosteum, it can appear as fibrous and serous discharge. This leads to a disruption in the nutrition of the periosteum, the surface tissues die. This process can be suspended if the purulent contents are removed in time. If this is not done, then the inflammation will spread to the bone and the tissues located next.

Periostitis with metastatic course is characterized by a lesion of the periosteum of long bones tubular in shape: femur, tibial, humeral, sometimes - several bones at once. The result of purulent periostitis often is purulent osteomyelitis. The periostitis is often localized in the distal sections of long tubular bones, more often of the femur, less often the shin bone, humerus and ribs are affected. Most often the boys are ill. Periostitis occurs mainly after trauma. First, there is swelling, soreness in the lesion, hyperthermia. If the infection does not join, the process is suspended. If the inflammation is localized in the joint region, its function may be impaired. Edema in the inflamed area - at first dense, then it softens, there is a fluctuation.

When localizing periostitis in the jaw region, it is called a flux. Periostitis of the jaw occurs, most often, as a result of periodontitis or after removal of the tooth, hypothermia, sore throat or flu. Appears next to the aching tooth immediately after the appearance of swelling in the gums.

The course of periostitis begins with a slight swelling in the gum, which gradually increases, pain increases. A few days later, an abscess is formed. Puffiness, which is located under the eye, indicates maxillary periostitis. The mandibular periostitis gives edema of the lower jaw. Body temperature reaches 38 ° C. The patient notes the spread of pain on the ear, the temple, the eyes. The disease can be complicated by the appearance of a fistula, from which a purulent discharge is observed. This process is dangerous because with an apparent improvement in the condition (acute events subside), the disease can go on into a chronic form. If periostitis is not treated, the process extends to nearby tissues and is complicated by osteomyelitis and suppuration.

It is also possible the development of tuberculous periostitis, which develops if the tuberculosis focuses on the periosteum.

Syphilitic periostitis may develop with tertiary syphilis, in which the inflammatory process involved in diafizalnye area of the tibia bone is much more often symmetrical, thickens, it can be confirmed by radiographs. The patient is disturbed by intense soreness in the affected areas, which is intensified at night, a swelling that has the form of a spindle or a round shape, unchanged on the skin. Sometimes gamme can disintegrate, a breakthrough occurs, an ulcer is formed.

Periostitis can complicate such diseases as rheumatism, leukemia, gonorrhea, actinomycosis, leprosy, smallpox and typhoid fever. Occasionally, the depositions of a periostatic nature can be observed on the bones of the lower leg with varicose veins, mainly deep veins.

The diagnosis is confirmed by examination of the patient, X-ray examination, clinic, laboratory tests (they help determine the stage of the disease).

Treatment of periostitis with antibiotics

Periostitis is purulent and inflammatory and its complications of a purulent and septic nature are treated with antibacterial drugs. The discovery of antibiotics has moved medicine a few steps forward.

Diseases that were previously considered incurable, due to this discovery, already ceased to look so menacing, and many "hopeless" patients received a chance to recover. But treatment with antibiotics, as it turned out, has its drawbacks. And they are associated, most often, with the emergence of resistance of some pathogens to drugs with antibacterial action. For example, in the last years of the fifties, he was leading among microorganisms that lead to an inflammatory-purulent pathology, as well as to its complications of streptococcus, then at the beginning of the sixties, staphylococcus took the first place, which became the number one enemy for curing periostitis and other complex diseases, since he proved that he does not fear antimicrobial drugs. Streptococcus, like many years ago, perishes from penicillin, but staphylococcus survives this antibiotic, and many others. In recent years, it has become so resistant to medicinal products that it forms microbial associations with other microorganisms: Staphylococcus a streptococcus, Staphylococcus coli, Staphylococcus a Pseudomonas aeruginosa and Proteus, as well as other difficult to treat forms.

Disadvantages of antibiotic therapy are also various reactions of an allergic nature, intoxication, dysbacteriosis, etc. Therefore, the treatment of periostitis with antibiotics should be done after special tests, plantings for sensitivity, taking into account the individual characteristics of the organism, such as age, kidney and liver, their excretory function, the severity of the inflammatory process .

In past years, in the treatment of periostitis with antibiotics, shock doses were widely used.

In modern medicine, such techniques are not relevant, since it is believed that impact doses can exacerbate the process. Other disadvantages of shock doses include allergic reactions, occurrence of toxic complications, development of candidiasis and dysbacteriosis.

For the treatment of periostitis, antibiotics are most suitable drugs that have tropism for bone tissue. Lincomycin hydrochloride - 0.6 grams twice a day, if the process is difficult - three times a day. Clindamycin or dalacin-C - 0.15 grams four times a day, in severe cases - the dose is increased to 0.3-0.45 grams. Rifampicin 0.45-0.9 grams (dose divided into 2-3 doses). It should be noted that the use of antibiotics in the treatment of periostitis is no less than seven days. If you need to use an antibiotic for a long period, they must be changed every seven to ten days to avoid the emergence of resistance of microorganisms to this antibiotic and side effects on the patient's body. When there are signs of any complications, it is also advisable to change the antibiotic. Also, with prolonged antibacterial treatment of periostitis, a detailed clinical analysis of the blood should be done weekly, with particular importance for white blood cells and white blood. It is recommended to combine antibiotic therapy with antifungal agents: nystatin - 500 thousand units every six hours, levorin - 400-500 thousand units four times a day, griseofulvin 4 times a day for 0.125 grams with one teaspoon of vegetable oil.

If suspected of an infection caused by anaerobic microorganisms, prescribe benzypenicillin sodium salt for 25-30 million units per day. You can replace ampicillin up to 14 grams per day, carbenicillin maximum dose - up to 40 grams per day in / m or / in drip, celaforidine - up to 6 grams per day, mostly in / m.

To treat anaerobic infections, cephalosporins are effective: ceftriaxone - up to 4 grams per day, cefepime - up to 2 grams every 8 hours. Very effective against anaerobes metronidazole or trichopolum - 250-750 mg after eight hours. The disadvantage of metronidazole is that it can penetrate the barrier of the placenta, which makes its application impossible with regard to pregnant women. In case of anaerobic infection, antibiotic use is combined with sulfonamides of the nitrofuran series: biseptol (combined drug - sulfamethoxazole with trimethoprim - up to 2880 mg per day, divided into 4 doses, sulfapiridazine - on the first day of 2 g / day in one or two doses; g once, a good result of the use of Dioxydin is noted due to its active effect on the intestinal, Pseudomonas aeruginosa, Proteus, Streptococcus, Staphylococcus, Anaerobic .. The drug is administered intravenously 600-800 mg per day 2-3 times. There is also a local use of dioxidine.

Treatment of periostitis in the home

Everyone has long known the unwritten truth: the treatment of any illness begins with a visit to the doctor's office, so at home, to treat periostitis better after consulting a specialist. Only those procedures that will reduce pain and, if possible, stop the development of the disease are possible before the patient can get to the hospital. In any case, the visit to the doctor should not be postponed. In no case can you do warming procedures and apply compresses to the site of the lesion.

Treatment of periostitis outside the hospital can only be under the supervision of a physician, the reception to which you need to appear regularly and perform exactly all the recommendations and appointments. Treatment of simple periostitis, after medical consultation, is quite possible at home. After all, all their treatment is to provide peace to the affected area, apply cold and pain, sometimes prescribed non-steroidal anti-inflammatory drugs, which can be taken at home, provided that the scheme prescribed by the doctor is followed.

Periostitis of the jaw or, in other words, the flux to be treated at home is extremely undesirable - this can lead to disastrous results. All alternative methods and rinses can only slow down the process and slightly reduce pain. All rinses are made only for the purpose of disinfection of the oral cavity. With a purulent periostitis of the jaw, surgical treatment is shown, at which the abscess will be opened, and only after this, if the doctor finds the patient's stay in the hospital impractical, it is possible to continue the treatment of periostitis at home.

Treatment of periostitis with alternative means

• To reduce pain, before the visit to the doctor, cold is applied to the affected area. Heating compresses do not apply - they provoke the further spread of inflammatory phenomena.
• Leaves of the scammia plant in a dosage of 20 g pour two hundred grams of boiled water. Insist 20 minutes, drain. With a flux, rinse the mouth three times a day.
• 4 tablespoons of lemon balm leaves are poured with steep boiling water in the volume of four hundred milliliters. Insist 4 hours, preferably in a thermos. Infusion filter, rinse the mouth.
• 2 teaspoons of sodium bicarbonate dissolve in a glass of water 25-28 degrees. Rinse the mouth three times a day.

Treatment of purulent periostitis

Treatment of purulent periostitis - a complex, which consists in combining the operative (opening the purulent focus and creating an outflow of purulent contents) and conservative treatment. After opening the purulent focus, the cavity is washed with antiseptics: hydrogen peroxide of 3% solution, if it is a mouth cavity - rinse is made with 2% sodium hydrogen carbonate solution, 0.02% furacillin solution, 0.5% chlorhexidine solution. This procedure is carried out on an outpatient basis, the inpatient treatment is infrequent.

Treatment of peristritis complicated by suppuration is carried out with the help of sulfonamides: sulfadimethoxin on the first day - 1-2 grams per day, then - 0.5-1 grams per day or sulfadimezin, the highest single dose of which is two grams, daily - should not exceed seven grams . Nitrofurans: furadonin 100-150 mg per day apply from five to eight days. Antibiotics that can be deposited in bone tissue: lincomycin hydrochloride - 0.6 grams twice a day. Antihistamine: dimedrol 1% - 1.0 ml, suprastin - from 75 to 100 mg in 3-4 divided doses daily. Calcium preparations - calcium gluconate 1-3 g per day. Analgesics: analgin 50% solution - 2.0 ml 3 times a day. When the source of pus is opened, physiotherapy procedures are shown: solux, microwave, laser therapy, infrared rays, magnetotherapy, UHF.

Locally also prescribe ointment dressings: ointments "Levosin", "Levomekol", with the flux of a well-proven ointment "Metrogil denta".

A good effect has lotions with dimexid and soda.

Treatment of chronic periostitis

Chronic periostitis is characterized by a slow inflammation in the periosteum. On the roentgenogram, there are clearly limited changes in the destructive nature in bone tissue and in the periosteum, active hyperplastic changes are observed. The process can acquire a chronic course, as a result of irrational treatment (the preservation of a diseased tooth that can not be treated) or in the primary chronic course, that is, the acute stage is erased. First, a dense and elastic thickening appears in the periosteum, which subsequently becomes painful. Characteristic of a prolonged course without visible changes. Radiographically, moderate changes in the destructive character in the bone are revealed, and the hyperplastic altered tissue is clearly visible in the periosteum.

Treatment of periostitis with a chronic course consists in combating the source of infection, for example, removing a sick tooth. Further, a course of antibacterial therapy is carried out: lincomycin hydrochloride 0.6 g twice daily, ceftriaxone 2-4 g per day. General strengthening therapy: vitamins B6, B1, B12, 1.0 ml every other day, ascorbic acid 250 mg twice a day. Physiotherapy with resorption effect: paraffin treatment, laser therapy, iontophoresis with KI 5%. When the process of complete resolution of the peritostite is too slow, it is not always possible.

Treatment of traumatic periostitis

A traumatic periostitis means inflammation of the perioste due to trauma or injury. More often with this disease, athletes often face injuries and injuries.

Patprotsess can develop after the impact, which fell on the bony areas, covered with a slight muscle layer: the lower part of the bones of the forearm, metacarpals, skull bones. Moreover, periostitis, caused by trauma, can only be a symptom of a chronic disease, such as osteomyelitis, syphilis, tuberculosis, and tumors.

Treatment of periostitis, arising from injuries, in the first stages is to provide rest for the affected limb. She is given an elevated position.

Compresses with ice are shown in the first few days, later - physiotherapeutic treatment: UV, electrophoresis, UHF, ozocerite applications. If a suspected secondary infection is prescribed antibiotics (the same lincomycin). With the development of purulent periostitis - dissection of the abscess (dissection of the periosteum).

Treatment of periostitis of the jaw

Inflammation of the jawbone often appears as a complication of untreated caries. This kind of periosteum is dangerous because it develops without precursors, covers both internal and external layers of the periosteum. The source of the purulent process, initially located in the area of the tooth root, then grabs the pulp, collects under the perioth, causing its inflammation. If the patprocess is located between the tooth and the gum, affected by tooth decay, then soft tissue can become inflamed. The pathological process gradually builds up, which in turn leads to a swelling of the gums, which causes strong pain and the appearance of a flux. The flux is treated promptly, with what, urgently, otherwise serious, life-threatening conditions, such an abscess or sepsis may occur. Periosteum jaws can develop as a result of trauma. The disease begins with swelling in the gum area, aching pain, varying intensity. If the cheek and the infraorbital region swells, this indicates the onset of a purulent process. The body temperature rises, local lymph nodes increase. Diagnosis of the disease can be on examination with a dentist. Clarifies the diagnosis of an X-ray examination of the jaw.

Treatment of periostitis of the jaw consists in surgical intervention, which consists in opening the abscess and, sometimes, removing the unhealthy tooth, washing the cavity with solutions of antiseptics, such as hydrogen peroxide 3%, furacillin, the cavity is drained. The procedure is performed under anesthesia. Assign antibiotics: clindamycin at 0.15 mg four times a day, rifampicin at 0.45 mg twice daily.

Lornoxicam at eight grams per day, divided into two doses. Rinse with a soda solution: two tablespoons of sodium bicarbonate for two hundred grams of boiled warm water. It is necessary to take a large amount of liquid.

Treatment of odontogenic periostitis

Under odontogenic periostitis is the inflammation of the periosteum, which is the result of neglected caries, when the inflammation of the tooth tissues is thrown on the inside of the tooth - the pulp. It is accompanied by acute pain, swelling in the site of inflammation and nearby tissue, the body temperature rises.

Treatment of odontogenic periostitis consists in the appointment of such drugs: lincomycin 0.6 g after 12 hours, metronidazole 0.5 mg 3 times a day. Analgesics: analgin 50-2,0 ml with dimedrol 1% - 1,0 ml. Lornoxicam according to the above scheme. Abundant drink, diet, consisting in the exclusion of solid and spicy food. Rinses with a soda solution. Physiotherapy: UHF, electrophoresis. In the absence of a therapeutic effect, operative treatment of periostitis is shown, which consists in removing the diseased tooth, opening the abscess.

Treatment of periostitis of the upper jaw

Periostitis of the upper jaw can occur due to sick teeth and belated treatment of inflammatory phenomena that can lead to infectious processes in the upper jaw. Also cause maxillary periostitis can be infected wounds of soft tissues in the face, as well as fractures of the upper jaw, inflammatory infected processes in the oral cavity, when pathogens from the foci of inflammation enter the upper jaw. But the main cause of periostitis of the upper jaw is most often complicated periodontitis and complications that have arisen after tooth extraction, hypothermia, viral infections, sore throat. The disease begins with swelling in the area next to the affected tooth, intense pain in the gum area. Further under the period, an abscess is formed, the cheek under the eye swells. The body temperature is 38 ° C, the pain sensations expand to the eye and the temple.

Treatment of periostitis of the upper jaw consists in the use of medicines (antibiotics - lidocaine 0.6 g in 12 hours, nonsteroidal anti-inflammatory - lornoxicam to 8 g per day, pain relievers - analgin 50% -2.0 ml, diphenhydramine 1% - 1.0 ml ), physiotherapy - UHF, electrophoresis, surgical intervention, consisting of a cut of the periosteum and oral mucosa to the bone itself, remove the diseased tooth, the abscess cavity is washed with antiseptic solutions and drained. After surgery, rinse the mouth with a solution of sodium bicarbonate.

Treatment of periostitis of the lower jaw

Periostitis of the lower jaw occurs 61% more often than a similar pathology in the upper jaw. The strongest part of mankind is subject to the disease most often up to forty years.

Call the disease can inflammation in the first and third molars of the lower jaw. Acute and chronic periostitis in the stage of exacerbation can be complicated by purulent patprocess in periosteum. To cause inflammation in the periosteum can be hard to erupt teeth, suppuration of the radicular cyst, pathology of the periodontal disease, incorrect dentistry.

Treatment of periostitis of the lower jaw is conservative, which is similar to the treatment of periostitis of the upper jaw, it is desirable to try to keep the tooth. The cavity of the tooth is opened and creates a sufficient outflow of purulent contents through the cavity of the tooth. In the future, if the treatment is not effective, the unhealthy tooth is removed, since it is the source of the infection. Treatment is carried out under X-ray control. All surgical procedures are performed under local anesthesia.

Treatment of periostitis of foot

The periostitis of the feet or the march stop is characterized by a rearrangement of the middle third of the diaphysis of the second or third, sometimes the fourth to the fifth metatarsal bones located on the foot, due to the fact that the anterior section is overloaded, neurophysical changes are observed in the foot, blood and lymph circulation are disturbed. This pathology occurs, most often, in soldiers in the first year of service, due to prolonged marching and drill training.

Treatment of periostitis of the foot, as a rule, is outpatient. Recommend rest, immobilization of the affected foot with a plaster bandage for three to four weeks. In the future, massage, physical therapy, and exercise therapy are shown.

Treatment of periostitis in children

Periostitis in children occurs due to inflammatory phenomena in peridonitis. Can be both endogenous and post-traumatic. In children, because of the anatomical features of their body, the disease develops very quickly. The disease begins with local signs of inflammation, subfebrile temperature. The manifestation of the inflammatory process is expressed by an asymmetric edema from the affected area, soft tissue edema, and regional lymph node enlargement. The disease, if untimely treatment or ill treatment, can be complicated by suppuration or become chronic.

Treatment of periostitis in children is to remove the focus of infection, for example, a sick tooth. Assign antibiotics amoxiclav 25 m / kg body weight, metronidazole children of two to five years - up to 250 mg per day, five to ten years - up to 375 mg per day, over ten years - 500 mg per day. Nurofen - five to ten milligrams per kilogram of body weight, analgin 50% 0.1-0.2 ml per ten kilograms of body weight. Diphenhydramine 1% 0.5-1.5 ml. Vitamins:

"Multitabs" one tablet a day during or after a meal. Physiotherapy: Electrophoresis, UHF. With purulent periostitis, surgical treatment is indicated, washing the cavity with antiseptics, draining.

Ointments with periostitis

Vishnevsky ointment

Ointment Vishnevsky helps to stop the purulent process, to remove swelling and toothache. Xeroform, which is part of the drug, acts antibacterially, tar from birch stimulates blood circulation in the damaged area, while due to castor oil, the medicinal components penetrate deeper. Liniment in Vishnevsky can be used at the beginning of the disease and after the opening of a purulent focus.

Ointment is applied to the skin or mucous membranes directly above the area of the periosteal lesion. Ointment is used for more rapid extinction of inflammatory phenomena, early healing of diseased tissues, significantly reduces pain.

Apply balsamic liniment to the aseptic napkin, then apply to the lesion site for 2-3 hours. When applying the ointment, remember that you can not use it with the slightest suspicion of having an abscess in the lesion, as this can worsen the condition and lead to complications.

Metrogyl denta

The drug, which has a gel-like consistency, kills pathogenic bacteria, due to the fact that its composition includes metronidazole and chlorhexidine, easily fall into the center of the pathprocess, it anesthetizes, reduces swelling, prevents suppuration. Apply the gel on the skin or mucous over the site of inflammation of the periosteum. Applied three times throughout the day, until the inflammation subsides.

Levomexol

The ointment consists of components that have a wide range of action against bacteria and have good ability to regenerate tissues. The properties of Levomecol are not lost, even if suppuration occurs, since it has the ability to clean the wound surface and has a hydrophilic base that does not form a fatty film, but allows the tissues to "breathe". The ointment in this case is applied to a sterile napkin and applied to the affected area for two hours, the bandages with levomel is shown to be done three times a day until recovery. When the abscess is opened, the ointment is applied directly to the wound cavity.

I would like to remind you that there are no medications without side effects, that's why it is very harmful to engage in self-medication and is fraught with serious consequences. At the slightest suspicion of inflammation of the periosteum, you need to go to a medical institution where a competent doctor for periostitis will be prescribed.