Prasad Kishore Chandra, Prasad Sampath Chandra, Mouli Neela, Agarwal Salil
Department of Otolaryngology - Head & Neck Surgery, Kasturba Medical College, Mangalore, India.
Acta Otolaryngol. 2007 Feb;127(2):194-205. doi: 10.1080/00016480600818054.
All bones of the facial skeleton and spine are susceptible to osteomyelitis due to various predisposing conditions. Current radiological tools are sufficient to provide adequate diagnosis. Treatment can be conservative resection of the diseased bone with adequate clearance in all cases except in cases of osteomyelitis due to osteoradionecrosis (ORN) where resection has to be more radical.
In today's antibiotic era, osteomyelitis in the head and neck is a rare occurrence. Dealing with osteomyelitis in head and neck bones is not the same as in other bones of the body due to the nature of the bones, complex anatomy of the region, and esthetics. Our purpose was to analyze the behavior of osteomyelitis in the head and neck bones and its management.
A total of 84 cases of osteomyelitis in head and neck were reviewed in a 10-year period. Pus for culture, antibiotic sensitivity, and radiology were the main investigations. A medical line of treatment was effective in acute cases. Surgery was opted for in chronic cases.
Mandible, frontal bone, cervical spine, maxilla, temporal bones, and nasal bones were involved, in descending order of frequency, i.e. the mandible was the most common bone affected. Nine patients were diagnosed as having acute osteomyelitis (11%); 75 were diagnosed as having chronic osteomyelitis (89%). Radiation-induced ORN leading to osteomyelitis was the most common cause of osteomyelitis of the mandible (13 of the 32 cases; 41%). Odontogenic infections and chronic sinusitis each gave rise to osteomyelitis in 3 of 10 cases (30%) of the patients with osteomyelitis of the maxilla. Chronic sinusitis was the main cause of frontal bone osteomyelitis in all 20 cases (100%). Tuberculosis (10 of 15 cases; 67%) and malignancy (5 of 15 cases; 33%) were the main predisposing factors in cervical spine osteomyelitis. Malignant external otitis (MEO) with diabetes mellitus was an underlying factor in all four cases of osteomyelitis of the temporal bone. Of the 18 patients with a diagnosis of ORN, the mandible was found to be the most susceptible bone (13 cases; 72%), followed by the maxilla (four cases; 22%) and cervical spine (1 case). Acute osteomyelitis responded to antibiotics. Sequestrectomy was carried out in all chronic cases but in cases of ORN more radical surgery was performed.
由于各种诱发因素，面部骨骼和脊柱的所有骨骼均易患骨髓炎。目前的放射学检查手段足以进行充分诊断。除放射性骨坏死（ORN）所致骨髓炎外，所有病例的治疗均可采用保守性切除病变骨并进行充分清创，而ORN所致骨髓炎的切除则需更彻底。
在当今抗生素时代，头颈部骨髓炎较为罕见。由于头颈部骨骼的性质、该区域复杂的解剖结构以及美学因素，对头颈部骨骼骨髓炎的处理与身体其他骨骼不同。我们的目的是分析头颈部骨骼骨髓炎的表现及其治疗方法。
回顾了10年间共84例头颈部骨髓炎病例。主要检查包括采集脓液进行培养、抗生素敏感性检测及影像学检查。急性病例采用内科治疗有效。慢性病例选择手术治疗。
受累骨骼依次为下颌骨、额骨、颈椎、上颌骨、颞骨和鼻骨，即下颌骨是最常受累的骨骼。9例被诊断为急性骨髓炎（11%）；75例被诊断为慢性骨髓炎（89%）。放射性ORN导致的骨髓炎是下颌骨骨髓炎最常见的原因（32例中的13例；41%）。牙源性感染和慢性鼻窦炎在10例上颌骨骨髓炎患者中各导致3例（30%）骨髓炎。慢性鼻窦炎是所有20例额骨骨髓炎的主要原因（100%）。结核（15例中的10例；67%）和恶性肿瘤（15例中的5例；33%）是颈椎骨髓炎的主要诱发因素。伴有糖尿病的恶性外耳道炎（MEO）是所有4例颞骨骨髓炎的潜在因素。在18例诊断为ORN的患者中，下颌骨是最易受累的骨骼（13例；72%），其次是上颌骨（4例；22%）和颈椎（1例）。急性骨髓炎对抗生素有反应。所有慢性病例均进行了死骨切除术，但ORN病例则进行了更彻底的手术。
