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    Journal Bilu

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    Bency Benjamin Machad
    This document presents a case study of a 19-year-old female patient who was initially diagnosed with multiple periodontal abscesses but was later found to have tuberculous osteomyelitis of the maxilla. The patient presented with pus discharge from the gums and loose teeth. Testing showed pulmonary tuberculosis lesions and bone loss in the maxilla. The patient was treated with anti-tuberculosis drugs and showed marked improvement after 4 weeks. This rare case demonstrates the importance of considering tuberculosis in differential diagnoses of oral bone infections.

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    Journal Bilu

    Uploaded by

    Bency Benjamin Machad
    59 views30 pages
    This document presents a case study of a 19-year-old female patient who was initially diagnosed with multiple periodontal abscesses but was later found to have tuberculous osteomyelitis of the maxilla. The patient presented with pus discharge from the gums and loose teeth. Testing showed pulmonary tuberculosis lesions and bone loss in the maxilla. The patient was treated with anti-tuberculosis drugs and showed marked improvement after 4 weeks. This rare case demonstrates the importance of considering tuberculosis in differential diagnoses of oral bone infections.

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    Tuberculous Ostemomyelitis of the Maxilla

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    This document presents a case study of a 19-year-old female patient who was initially diagnosed with multiple periodontal abscesses but was later found to have tuberculous osteomyelitis of the maxilla. The patient presented with pus discharge from the gums and loose teeth. Testing showed pulmonary tuberculosis lesions and bone loss in the maxilla. The patient was treated with anti-tuberculosis drugs and showed marked improvement after 4 weeks. This rare case demonstrates the importance of considering tuberculosis in differential diagnoses of oral bone infections.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    59 views30 pages

    Journal Bilu

    Uploaded by

    Bency Benjamin Machad
    This document presents a case study of a 19-year-old female patient who was initially diagnosed with multiple periodontal abscesses but was later found to have tuberculous osteomyelitis of the maxilla. The patient presented with pus discharge from the gums and loose teeth. Testing showed pulmonary tuberculosis lesions and bone loss in the maxilla. The patient was treated with anti-tuberculosis drugs and showed marked improvement after 4 weeks. This rare case demonstrates the importance of considering tuberculosis in differential diagnoses of oral bone infections.

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    © All Rights Reserved
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    of 30

    BY,

    BILU.B
    CRRI
     Tuberculosis osteomylitis is a chronic
    granulomatous systemic infectious disease
    caused by mycobacterium tuberculosis.
     The oral lesion found in the oral cavity is
    relatively rare and may present as
    ulcers,erythematous patches,indurated
    lesions,nodules or bony jaw lesions.
     This journal document a case of tuberculous
    osteomylitis of maxilla in 19 yr old female
    patient,who was initially treated for multiple
    periodontal abcesses,which later proved to be
    tubercular osteomylitis of maxilla.
     OSTEOMYLITIS:
    Osteomylitis is the inflammation of
    the bone marrow that produces clinically
    apparent pus and secondarily affects the
    calcified components.It infects all the three
    components of the bone like
    periosteum,cortex &marrow.
    Odontogenic infection
    Compound fracture of the jaws
    Traumatic injury
    Middle ear infection and respiratory
    infection
    Peritonsillar abscess
     ACCORDING TO ANATOMIC LOCATION:
    -Intramedullary
    -Subperiosteal
    -Periosteal
     ACCORDING TO DURATION AND SEVERITY:
    -Acute
    -Chronic
     DEPENDING ON PRESENCE OR ABSENCE OF
    SUPPURATION:
    *SUPPERATIVE:
    -Acute suppurative osteomylitis.
    -Chronic suppurative osteomylitis.
    -Infantile osteomylitis.
    *NON SUPPURATIVE :
    -Chronic nonsuppurative osteomylitis
    focal sclerosing
    diffuse sclerosing
    -Radiation osteomylitis.
    -Garre’s sclerosing osteomylitis
    -Osteomylitis due to specific infection:
    actinomycosis
    tuberculosis
    syphilis
     Staphylococcus aureus
     Staphyloccus albus
     Hemolytic streptococci
    GRAM NEGATIVE ORGANISM:
     Klebsiella
     Psudomonas
     Protease
     E.coli
    ANAROBIC BACTERIA
     Prepto streptococcus
     Bacteriods
     Fusobacterium
    OTHERS
     Mycobacterium tuberculosis
     Treponema palladum
     ACUTE LESIONS: Severe pain,parasthesia,intra
    medullary lesions.
    pus exudates from gingival sulcus,cellulitis
    and no swelling &sinus formation.
     CHRONIC LESIONS: Slight pain with swelling
    of jaw and sequestra formation & intraoral
    and extraoral formation of sinus,tender on
    palpation.
     INTIAL STAGE:Spontaneous(localised).
     ACUTE STAGE:Severe pain ,soreness &looseness
    of the involved tooth.
    -Early acute stage:pain adjacent tooth and
    side of jaw.
    -Late acute stage:Parasthesia of lip.
     OSTEONECROTIC STAGE:
    Diminished spontaneous pain
    abcess formation
    pus discharge
     SEQUESTRUM STAGE:Segments of necrotic bone
    become detached.
     Pagets disease
     Eosinophilic granuloma.
     Incision and drainage
     Irrigation & debridement of necrotic areas.
     Empiric therapy:
    Regimen I:Aqueous penicillin 2 million
    units IV ,4 hourly +oxacillin 1g IV 4hourly .
    Regimen II:If pt is asympyomatic after 48 -
    72 hrs,then penicillin IV 500 mg ,6hourly &
    dicloxacillin 250 mg 4 hourly for 2-4 weeks.
     Extraction of infected tooth.
     Sequestromy
     Saucerization
     Closed wound irrigation and suction.
     Decortication.
     Resection and immediate reconstruction.
     Hyperbaric oxygen therapy.
     Supportive therapy.
    adequate rehydration
    rich nutritional diet
    vitamin therapy
     Tuberculosis is a chronic granulomatous
    systemic infectious disease.
     Caused by MYCOBACTERIUM TUBERCULOSIS.
     Oral tuberculosis is rare.
     Oral lesion may present as
    ulcer, erythematous patches,indurated
    lesion,nodules ,bony jaw lesion.
     Oral lesion is due to inoculation of
    tuberculosis bacilli in to oral tissue.
     Tuberculosis in jaw is more common in
    children below age of 18yrs.
     TUBERCULOSIS INFECTIONS

    PRIMARY SECONDARY

     PRIMARY LESIONS – Directly inoculated into the


    oral tissues who has not acquired immunity to
    the disease.
     SECONDARY LESIONS – Infections to oral tissue
    either by hematogenous or lymphatic spread.
     A 19yr old female patient report to the
    department with chief complaint of mobile
    teeth along with pus discharge.

     HISTORY OF PRESENTING ILLNESS:


    History reveals pt had painful swelling
    in the upper front region of face three
    months back which later formed multiple
    sinuses.
     PAST MEDICAL HISTORY:
    Patient had generalised
    weakness,weight loss & episodic fever for past
    one month.
     GENERAL EXAMINATION:
    The patient was poorly nourished & thin
    built.
     EXTRAORAL EXAMINATION:
    A diffuse swelling was present in the
    middle third of upper left and right side of
    face,which extended from the right to left mid
    pupillary line mediolaterally & from the ala
    tragus line,4 cm inferior to the infraorbital
    margin.ON PALPATION the swelling was
    tender.
     INTRA ORAL EXAMINATION:
    Multiple draining sinuses were present
    in relation to 14,15 & 23,26 extration socket
    with pus discharge.
    ON DIGITAL PALPATION-The tooth and
    maxillary arch was moveable like paper thin
    bone.
    No caries tooth associated with the
    sinuses.
     Based on the history and clinical presentation

    MULTIPLE PERIODONTAL ABCESSES


     Routine hematological
     Radiological
     Histopathological
     HEMATOLOGICAL REPORT:
    Erythrocyte sedimentation rate is high.

     RADIOGRAPHIC REPORT:
    -PANORAMIC EXAMINATION:
    Diffuse bone loss in the maxilla involving all
    maxillary teeth.
    -CHEST X-RAY:
    Pulmonary koch’s were found.
     HISTOPATHOLOGICAL REPORT:
    -CYTOLOGICAL SMEAR:
    Polymorphonuclear leucocytes &few
    lymphocytes.
    -FINE NEEDLE ASPIRATION (FNAC):
    Granulomatous lesion.
     Diagnosis pulmonary tuberculosis as a
    primary lesion with secondary lesion in the
    maxilla.
     ANTI TUBERCULOUS FOR BONE TUBERCULOSIS
    DRUGS:
    Rifampicin
    Isoniazid
    Ethambutol
    Streptomycin
    After four week follow up,marked
    improvement in over all health was
    noticed,with over all reduction in the mobility
    of maxillary bone.
     Tuberculosis still remains a dreaded disease.
     Primary Oral Tuberculosis is rare because of
    various barriers present in the oral cavity,
    intact oral mucosa
    salivary enzymes
    tissue antibodies
    oral saprophytes
     Any breach in these barries can lead to
    infection by the tubercle bacilli.
     Tuberculous osteomylitis is even rare and
    constitutes less than 2% of skeletal TB.
     Involvement of maxillary is extremely rare.
     Diagnosis:clinical findings,radiographs &
    sputum examination.
     Recent methods:DNA probe & polymerase
    chain reaction assays.
     Tuberculous Osteomylitis of the maxilla is an
    extremely rare condition of the oral cavity.It
    can present in an unusual form in the oral
    cavity and can be misdiagnosed.
     Tuberculosis must always be included in the
    differential diagnosis.
     Before diagnosing the oral tuberculosis must
    locate the primary site in the body.
    THANK YOU

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