Inflammatory Diseases of the Maxillofacial Bones

These include osteomyelitis, which mainly involves the mandible. It may occur through extension of infection of the dental pulp or as a complication after tooth extraction. When seen after irradiation, e.g. for head and neck cancer, it is called osteoradionecrosis.

There are five types: acute suppurative osteomyelitis, chronic suppurative osteomyelitis, chronic focal sclerosing osteomyelitis, chronic diffuse sclerosing osteomyelitis, and proliferative periostitis. Acute suppurative osteomyelitis shows bone marrow cavities infiltrated with neutrophils. The bony trabeculae are necrotic. Usually, this form of osteomyelitis evolves into chronic suppurative osteomyelitis, which also may arise de novo. Besides bone sequesters surrounded by numerous neutrophilic

Fig. 4.2. The periodontal ligament connects the root surface (right side) with the bony socket (left side). An epithelial rest of Malassez is clearly visible

granulocytes granulation tissue is also present. Sinuses are formed partly lined by squamous epithelium from the oral mucosa. In less severe cases, fibrosis and development of a chronic inflammatory infiltrate may also be seen. Unless the sequestra are removed, the disease will not heal.

When the inflammation is mild, the jaw bone responds by bone formation. This form of osteomyelitis is known as chronic sclerosing, which may be focal as well as diffuse. Dense sclerotic bone masses are seen together with a bone marrow exhibiting oedema and small foci of lymphocytes and plasma cells. Both focal as well as diffuse chronic sclerosing osteomyelitis must be distinguished from other bone lesions, especially the fibro-os-seous ones (see Sect. 4.5).

Odontogenic cysts - inflammatory

Odontogenic cysts - developmental

Non-odontogenic cysts

Pseudocysts

Radicular cyst Residual cyst Paradental cyst Dentigerous cyst Lateral periodontal cyst Botryoid odontogenic cyst Glandular odontogenic cyst

Odontogenic keratocyst (keratocystic odontogenic tumour [181])

Gingival cyst

Nasopalatine duct cyst

Nasolabial cyst

Surgical ciliated cyst

Solitary bone cyst

Focal bone marrow defect

When the inflammation mainly involves the periosteum, the disease is called proliferative periostitis, or called periostitis ossificans. Histologically, bony trabec-ulae that lie in a linear parallel pattern are seen. The intervening stroma is composed of fibrous connective tissue sparsely infiltrated with lymphocytes and plasma cells.

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