Osteomyelitis Therapy – General Considerations and Surgical Therapy

Abstract

The final common pathway in all treatment of acute and secondary chronic osteomyelitis of the jaws is to achieve a shift in the disturbed balance between the responsible pathogen(s) and host defenses to the latter, allowing the body to overcome the infection. Reduction of pathogens is achieved by surgical removal of infected and necrotic tissue as well as by antibiotic therapy. Improvement of local vascularization is further accomplished by surgical decortication, exceeding conventional surgical debridement, which not only removes the poorly vascularized (infected) bone but also brings well-vascularized tissue to the affected bone, thus facilitating the healing process and allowing antibiotics to reach the target area; therefore, surgery and antibiotics are to be considered the major columns in treating osteomyelitis of the jaws. Hyperbaric oxygen (HBO), which can be recognized as an adjunctive therapeutic modality in treatment of acute and secondary chronic osteomyelitis, supports host-defensive mechanisms and promotes tissue vascularization as well as has direct toxic effects on microorganisms causing the infection. Although never as dominating as surgery and antibiotic therapy, HBO is to be considered the third column in the armentarium for acute and secondary chronic osteomyelitis treatment. A sufficient surgical debridement is as the most important factor in successful treatment of advanced acute and secondary chronic osteomyelitis of the jaws. The extent of the surgical debridement is dictated mainly by the extent of the infected bone. The most important surgical procedure to achieve a sufficient debridement and in addition bring well-perfused tissue in contact with the surgical site is the decortication procedure, which is considered the workhorse in surgical treatment of acute and secondary chronic osteomyelitis of the jaws. The main goal in treatment of primary chronic osteomyelitis of the jawbone is cessation or amelioration of symptoms. In addition, bone deformity may or must be surgically addressed. Dealing with symptoms, aside from surgery, several conservative treatment options are available. Even though the disease may not been cured, change of course and severity should be considered a sign of success.