Osteomyelitis of the mandible and head

Frequency

Rare, most often related to tooth extraction. 3-4 cases per 100,000 inhabitants (1) . Currently increasing (about 1 case for 1,000-1,500 women (2) since introduction of osteoporosis biphosphonates in women. Biphosphonates are also used in the treatment of bone metastases. In this situation, the risk is considerably increased with 5.5 patients for only 100 patients (3) .

Characteristics

The patients still have pain, often a big cheek; or pus in the mouth, complains of a loss of sensitivity in the affected mandible and can no longer fully open the mouth.

Diagnostic

Confirmation by the maxillofacial surgeon, the blood count and scanners.

Spontaneous evolution

Without treatment, the infection progresses to the formation of abscess with fracture of the mandible or to chronic infection with formation of fistula and possibly the fracture.

Clinical studies

The treatment is above all surgical. Treatment against infection with antibiotics and mouthwashes is necessary. HBOT is useful because it helps accelerate healing and the reduction of swelling. In chronic cases, treatment improves tissue vitality so that the surgical results are better. the operation will be less extensive.

Results 18 months after treatment at the University of Zürich. ( 4 )

 

With HBO

Without HBO

Heal

28

31

Improved

10

8

Unchanged

5

4

Worse

0

0

Extended operation

28

36

Restricted Operation

12

5

No Operation

3

2

Practical use of HBO

In acute osteomyelitis, 20 sessions performed as quickly as possible after the operation seem to be sufficient for rapid healing. In chronic osteomyelitis, similar to other chronic infections, it is necessary to do 40 consecutive sessions ( 9 ).