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Die akute und sekundär-chronische Osteomyelitis des Kiefers

Acute and secondary chronic osteomyelitis of the jaws

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Zusammenfassung

Die akute und sekundär-chronische Osteomyelitis der Kiefer sind Formen einer pyogenen bakteriellen Infektion. In den meisten Fällen ist dabei der Unterkiefer betroffen. Als Ursache des Infekts liegt zumeist ein dentogener Fokus vor. Dadurch gelangen potenziell pathologische Keime der oralen Flora in den Knochen und können sich vermehren. Neben systemischen sind vor allem lokale Faktoren, wie die Blutversorgung, entscheidend für den natürlichen Verlauf und die Ausbreitung der Infektion. Die Diagnostik der akuten und sekundär-chronischen Osteomyelitis erfolgt in erster Linie klinisch und radiologisch. Als Anfangsuntersuchung dient die Orthopantomographie (OPG). Weitergehende bildgebende Verfahren, wie die Computertomographie (CT) und digitale Volumentomographie (DVT) sowie in frühen Stadien (akute Osteomyelitis) die Magnetresonanztomographie (MRT), ergänzen die Diagnostik. Die Therapie der akuten und sekundär-chronischen Osteomyelitis umfasst chirurgische Maßnahmen, begleitet von einer prolongierten Antibiotikagabe. Entscheidend sind die Entfernung der Infektursache sowie ein sauberes Débridement des infizierten und nekrotischen Gewebes, um eine Ausheilung des Infekts zu ermöglichen.

Abstract

Acute and secondary chronic osteomyelitis of the jaws are considered to be true infections caused by pyogenic bacteria, in most cases involving the mandible. The etiology and pathogenesis are mostly in the form of odontogenic infections allowing deep tissue penetration and proliferation of oral pathogens and hence establishment of a bone infection. Systemic and especially local host factors, such as bone vascularization are also considered to be important in determining the natural course of the disease. The diagnosis of acute and secondary chronic osteomyelitis of the jaws is made based on clinical findings and radiological imaging. While the panoramic radiograph is considered to be an appropriate first-line examination, computed tomography CT, digital volume tomography (DVT) and in early stages (acute osteomyelitis) magnetic resonance imaging (MRI) are considered to be the gold standard for imaging studies. Surgery and prolonged antibiotic therapy are considered to be the most important methods in the treatment of acute and secondary chronic osteomyelitis of the jaws. The surgical removal of infected and necrotic tissue is essential to promote healing.

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  1. Dentomaxillofaciale Radiologie und Virtuelle Planung, Zentrum für Kieferchirurgie und Plastische Gesichtschirurgie, Pionierpark Zürcherstr. 7, 8400, Winterthur, Schweiz

    M. Baltensperger

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Baltensperger, M. Die akute und sekundär-chronische Osteomyelitis des Kiefers. MKG-Chirurg 6, 80–87 (2013). https://doi.org/10.1007/s12285-012-0321-z

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