Treatment of Osteomyelitis: A Less Radical Approach To This Surgical Disease

Introduction:  Osteomyelitis has long been a nemesis of OMFS surgeons.  Interest continues to be high as evidenced by the large number of search hits for presentations on osteomyelitis treatment reviewing the surgical alternatives of osteomyelitis on the AAOMS website.  Treatment does not have to always be radical.  A review of five cases has demonstrated resolution in the mandibular osteomyelitis treated with decortication and most importantly, disrupting the inflammed hypertrophic periosteal abscess encapsulation rather than resection creating a continuity defect .

Purpose:  To evaluate the response of osteomyelitis treated by surgical decortication, removing the buccal cortical bone and leaving the lingual and inferior borders intact.  The hypothesis is that removing the buccal cortical plate, disrupting the hypertrophically inflammed periosteum, brings the medullary bone in contact with bleeding muscle and improves antibiotic delivery and penetrence to the diseased area with resolution.

Methods:  A retrospective review was performed of 5 patients charts and radiographs treated by Dr. JW Hudson at UTMC in Knoxville, TN for chronic suppurative or nonsuppurative osteomyelitis with decortication and periosteal disruption from November 2010 to September 2012.

Results:  A total of 5 patients were treated for osteomyelitis.  The group consisted of 4 females and 1 male with a mean age of 54 years.  All cases were classified as chronic suppurative or nonsuppurative osteomyelitis located only in the mandible.  Each patient underwent decortication and periosteal disruption of the affected area and received a total of six weeks of antibiotics.  A CT scan was performed preoperatively and after completion of the surgical procedure and antibiotics.  Post-operative 3D CT revealed remarkable images demonstrating resolution in the bone infection without creating a discontinuity defect in the mandible requiring a second major reconstruction surgery that itself may or may not be successful. 

Conclusion:  Decortication and periosteal discruption should be considered a integral alternative for the surgical treatment of osteomyelitis as opposed to the radical and potentially debilitating resection surgery that is frequently performed. 

References:

1. HudsonJW. Osteomyelitis of the jaws: a 50-year perspective. J Oral Maxillofac Surg1993; 51(12): 1294–1301.
2. Hudson JW. Osteomyelitis Presented at American Association of Oral and Maxillofacial Surgeons 93rd Annual Meeting; 2011 Sep 12-17; Philadelphia, PA.