Ostéites des os de la face

Abstract

Various aetiologies have been identified for the inflammatory diseases of facial bones. They are often infectious (mainly dental, traumatic, tumoural, post-radiotherapy, …), but sometimes they may seem primitive (primary chronic osteomyelitis). In such cases, they occur either individually or in a context of plurifocal diseases. Recently, cases of osteomyelitis have been observed, occurring during diphosphonate-based therapies by an unknown process. The main clinical sign is pain, with frequently local swelling, trismus, halitosis and Vincent's sign in mandibular chronic features. Rigorous assessment is necessary to the diagnosis and to avoid errors of treatment. Imaging characteristic aspects (on conventional radiography, CT scanning, MRI) are osteolysis, periostal osteogenesis, sequestra, and sclerosis in primary chronic conditions. Scintigraphy may reveal the disease very early, but lacks specificity to accurately determine lesions localization. Haemogram, sedimentation rate and CRP are variable, but quite useful to assess evolution. Results of bacterial analysis are highly variable, and have to be analysed with some cautious. Diagnostic biopsy is often mandatory. Infectious spontaneous evolution may early result in local, regional, or general extension. Secondary, spontaneous fracture, delayed consolidation, or chronic evolution may occur. Finally, late in the disease, pseudarthrosis can occur, as well as neoplastic transformation, recurrence or sequelae (loss of substance, functional troubles by retraction of masticator muscles or temporo-mandibular ankylosis, aesthetic deformation with facial atrophy or hypertrophy). In infectious conditions, treatment associates antibiotherapy, which has to be used cautiously, sometimes hyperbaric oxygen therapy, and, if necessary, surgical treatment of the cause and of the infection (decortication, interruptive resection). In chronic conditions, this protocol is frequently followed by recurrences, so the use of diphosphonates as well as 14 or 15 carbon atoms macrolids is suggested. No recommendation exists yet for those osteomyelites occurring during diphosphonate therapy. Oral hygiene is the best prevention.