Bone destruction causes. Destruction of dental bone tissue

The word "destruction" has Latin roots. Literally this concept means "destruction". Actually, in a broad sense, destruction is a violation of integrity, normal structure, or destruction. This definition can be understood narrowly. For example, we can say that destruction is the direction or component(s) of human behavior and psyche that are destructive in nature and related to subjects or objects. Where and how is this concept used? More on this later in the article.

general information

The initial ideas about the presence of forces and elements in a person that have a destructive focus on external objects or oneself were formed in ancient mythology, philosophy, and religion. These concepts subsequently received some development in different areas. The 20th century saw some updating of understanding. Many researchers associate this surge with various phenomena in society, psychoanalytic problems, and various disasters social nature. These issues were dealt with quite closely by various thinkers of that time. Among them are Jung, Freud, Fromm, Gross, Reich and other theorists and practitioners.

Human work activity

What is personality destruction in the career field? In the process of work activity, a transformation of a person’s individual characteristics is observed. The profession, on the one hand, contributes to the development and formation of personality. On the other hand, the work process has a destructive effect on a person in a physical and psychological sense. In this way, it is possible to note what is happening in directions opposite to each other. In the field of career development management, the most effective tools are those that contribute to the conscious strengthening of the first tendency while minimizing the second. Professional destruction represents gradually accumulated negative changes in personality and methods of activity. This phenomenon occurs as a result of performing monotonous work of the same type over a long period. As a result, undesirable work qualities are formed. They contribute to the development and intensification of psychological crises and tension.

This is what destruction is in the career field.

Medicine

In some cases, destructive processes can help eliminate certain undesirable phenomena. In particular, this effect is observed in medicine. How can destruction be useful? This phenomenon, caused intentionally, is used, for example, in gynecology. When treating certain pathologies, doctors use different methods. One of them is radiofrequency destruction. It is used for diseases such as cysts on the walls of the vagina, condylomas, erosion, and dysplasia. Radio wave destruction of the cervix is ​​a painless and quick way effects on the affected areas. This method treatment of pathologies can be recommended even to nulliparous women.

Oncology

Many pathologies are accompanied by tissue destruction. These diseases include cancer. One of the special cases is a tumor. This round cell bone tumor is sensitive to radiation. Compared to others malignant neoplasms this pathology occurs at a fairly young age: between 10 and 20 years. The tumor is accompanied by damage to the bones of the extremities, but can also develop in other areas. The neoplasm includes densely arranged round cells. To the most characteristic symptoms include swelling and pain. Sarcoma tends to spread significantly and in some cases covers the entire central part of long bones. On an x-ray, the affected area does not appear as extensive as it actually is.

Using MRI and CT, the boundaries of the pathology are determined. The disease accompanies lytic destruction bones. This change is considered the most characteristic of this pathology. However, in a number of cases, “onion-like” multiple layers formed under the periosteum are also noted. It should be noted that previously these changes were classified as classical clinical signs. Diagnosis must be made on the basis of a biopsy. This is due to the fact that a similar X-ray picture can be observed against the background of other malignant bone tumors. Treatment involves the use of various combinations of radiation, chemotherapy and surgery. The use of this complex of therapeutic measures allows eliminating pathology in more than 60% of patients with a primary local form of Ewing's sarcoma.

Chemical destruction

This phenomenon can be observed under the influence of various agents. In particular, these include water, oxygen, alcohols, acids and others. Physical influences can also act as destructive agents. For example, among the most popular are light, heat, and mechanical energy. Chemical destruction is a process that does not occur selectively under the condition of physical influence. This is due to the comparative similarity of the energy characteristics of all bonds.

Destruction of polymers

This process is considered the most studied to date. In this case, the selectivity of the phenomenon is noted. The process is accompanied by the rupture of the carbon-heteroatomic bond. The result of destruction in this case is the monomer. Significantly greater resistance to chemical agents is observed in carbon-carbon bonds. And in this case, destruction is a process that is possible only under harsh conditions or in the presence of side groups that help reduce the strength of the bonds in the main chain of the compound.

Classification

In accordance with the characteristics of decomposition products, depolymerization and destruction are divided according to random law. In the latter case, we mean a process that is the reverse of the polycondensation reaction. During this process, fragments are formed whose sizes are larger than the size of the monomer unit. During the depolymerization process, monomers are presumably detached sequentially from the edge of the chain. In other words, a reaction occurs that is opposite to the addition of units during polymerization. These types of destruction can occur either simultaneously or separately. In addition to these two, there is probably a third phenomenon. In this case, we mean destruction by a weak bond present in the center of the macromolecule. During the process of destruction through a random bond, a fairly rapid drop in the molecular weight of the polymer occurs. With depolarization, this effect occurs much more slowly. For example, for polymethyl methacrylate, which has a molecular weight of 44,000, the degree of polymerization of the residual substance remains almost unchanged until depolymerization is 80%.

Thermal destruction

In principle, the splitting of compounds under the influence of heat should not differ from hydrocarbon cracking, the chain mechanism of which has been established with absolute certainty. In accordance with the chemical, their resistance to heat, the rate of decomposition, as well as the characteristics of the products formed in the process are determined. The first stage, however, will always be the formation of free radicals. An increase in the reaction chain accompanies the breaking of bonds and a decrease in molecular weight. Termination can occur through disproportionation or recombination of free radicals. In this case, a change in the fractional composition, the formation of spatial and branched structures may occur, and double bonds may also appear at the ends of macromolecules.

Substances affecting the speed of the process

During thermal destruction, as with any chain reaction, acceleration occurs due to components that can easily disintegrate into components. Deceleration is noted in the presence of compounds that are acceptors. So, for example, an increase in the rate of conversion of rubbers is noted under the influence of azo and diazo components. In the process of heating polymers at temperatures from 80 to 100 degrees in the presence of these initiators, only destruction is observed. With increasing concentration of the compound in solution, a predominance of intermolecular reactions is observed, leading to gelation and the formation of a spatial structure. During the thermal decomposition of polymers, along with a decrease in the average molecular weight and a structural change, depolymerization (monomer separation) is observed. At temperatures above 60 degrees, during the block decomposition of methyl methacrylate, if present, the chain breaks off mainly through disproportionation. As a result, half of the molecules must have a terminal double bond. In this case, it becomes obvious that a macromolecular rupture will require less activation energy than a saturated molecule.

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Spinal tumors

The same tumors as in other bones occur in the spine; they can be benign or malignant. At the age of up to 30 years, tumors are more often benign in nature, and at older ages they are malignant.

Benign tumors and tumor-like diseases of the spine (Fig. 301). Osteochondroma (Fig. 301, L) is a cartilaginous tumor of a growing organism. Clinically it is asymptomatic. Radiographs reveal a pedunculated mass arising from the cancellous bone (1). Pa MRI (Fig. 301, B) - osteochondroma of the posterior vertebral arch.

Rice. 301. Scheme of localization of tumors in the spine

Ostoid osteoma (Fig. 301,2,3). It occurs in childhood and adolescence, more often in men aged 15-25 years. Clinic: night pain radiating to the shoulder, arm, local pain. An X-ray examination reveals a focus of dense compact substance in the vertebra. A tomography reveals a cavity (2) containing a dense fragment of bone (3), a symptom of a “nest”.

Aneurysmal bone cyst (Fig. 301, 4). A formation emanating from the bone marrow (usually venous) spaces, surrounded by newly formed bone tissue and growing outward. The vertebral bodies and their posterior sections, the arches, are affected. Occurs in children and lindens young. Clinic: symptoms of compression of surrounding structures, radicular pain. Radiographs show a large focus of destruction with clear contours.

Eosinophilic granuloma (Fig. 301, 5). A type of histiocytosis, abnormal proliferation of histiocytes that replace bone. It occurs at any age, but most often in children 5-10 years old. X-ray examination reveals round-shaped foci of destruction in the vertebral body with clear contours and compression fractures.

Hemangioma

An asymptomatic tumor of a vascular nature, occurs at any age. An X-ray examination (Fig. 302) reveals the vertical striation of the vertebral bodies. Often the vertebra is swollen, a defect with finely festooned contours and a fine-mesh pattern (thickened trabscules) is determined, sometimes a vessel approaches the defect.

The transition of the process to the arches and the intact state of the disc are characteristic. Involvement of the arch is a poor prognostic sign, just as the symptom of swelling and the soft tissue component are signs of active tumor growth.

Rice. 302. Hemaigioma of the vertebral body with transition to the arch (diagram)

Primary malignant tumors

An early clinical sign of a malignant tumor of the spine is pain that worsens at rest, at night, and does not subside with massage and thermal procedures.

X-ray examination in standard projections allows to detect a tumor, but not early stage. The method of choice is CT, MRI, radioactive scanning. In case of mislom, X-ray examination provides comprehensive information.

Malignant tumors affect the arches, processes, and vertebral bodies. Compression without destruction of the endplate is characteristic (symptom of a “crumpled loaf of bread”), compression with compaction of the structure is the osteoblastic form, compression without compaction is the osteoclastic form.

X-ray signs of a malignant tumor.

1. Destruction in the spongy substance of the vertebra is often not visible until compression occurs. With a negative X-ray picture, up to 1/3 of the vertebral body may be destroyed. Diagnosis of early destruction is possible with CT and MRI (Fig. 303).

Rice. 303. Vertebral tumor: a — focus of destruction in the vertebral body; b — compression fracture, tumor invasion into soft fabrics

2. Osteosclerosis - often detected with osteoblastic metastases. Differential diagnosis with compact islands. Diagnosed by X-ray and radioisotope examination.

3. Periostitis - often occurs with a primary tumor. Metastases are characterized by “spicules.”

4. Enlargement of soft tissues - observed more often with a primary tumor, less often with metastatic ones. Soft tissues are usually more enlarged than seen on x-ray, especially in lumbar region, where the shadow of the muscles is layered. The diagnosis is established radiologically and using CT, MRI.

5. Calcification and ossification of soft tissues. The x-ray shows flaky, chaotic, rounded shadows at the level of the affected vertebra - a sign of exophytic tumor growth.

Myeloma

Complaints about constant pain weakness that does not disappear with rest, sometimes the diagnosis is made with the development of a spontaneous fracture. Radiographs show pronounced osteoporosis; in the diffuse-porotic form, the foci of destruction are round in shape with clear contours, 1-3 cm in diameter - “puncture symptom”, compression of the vertebra. In the osteosclerotic form, foci of osteosclerosis are identified - a “marble” spine. Multiple myeloma is often complicated by a fracture that occurs suddenly when coughing or sneezing.

Chondroma. Tumor from the rudiments of the notochord. In 33% of cases it is localized at the base of the brain and in 15% in the spine, mainly in the cervical region. The main clinical manifestations are symptoms of compression of surrounding structures - cranial nerves.

Ewing's sarcoma. A highly malignant tumor rarely originates from the tissues of the spine itself, but can metastasize to the vertebral bodies from another source. Occurs in children and young patients. Clinic: pain, low-grade fever, leukocytosis, increased ESR. Quickly gives symptoms of compression spinal cord and metastases to the lungs, liver, bones, lymph nodes, and brain. X-ray examination determines the focus of destruction.

Secondary metastatic tumors

Metastases most often affect the spine. The age of patients varies, but most often after 40 years. Clinic: the pain is constant, does not disappear with rest. In 5-10% of cancer patients, symptoms of spinal cord compression develop, and the level of damage is determined by myelography, CT, and MRI. X-ray examination (Fig. 304) reveals areas of compaction bone tissue for metastases of breast and prostate cancer (osteoblastic metastases). But more often, foci of destruction are identified (osteoclastic, lytic metastases). Pathological compression fractures are characteristic when the intervertebral discs are intact.

Rice. 304. Scheme of changes in the vertebrae with tumor metastases: 1 - osteoblastic metastasis (compaction of the structure) of the vertebral body; 2 - osteoclastic metastasis: a focus of destruction in the vertebral body; 3.4 - compression fractures of the vertebral bodies as a result of metastatic lesions. Compression with the osteoclastic type of metastases (see 4) is more pronounced

I.A. Reutsky, V.F. Marinin, A.V. Glotov

Osteoporosis (bone dystrophy) is a progressive disease in which the structure of bone tissue is destroyed, its density decreases and the human skeleton is affected.

With osteoporosis of the arms, legs and other bones, the complex architecture of bone tissue is disrupted; it becomes porous and susceptible to fractures even with minimal loads (see photo).

Types of osteoporosis

The types of osteoporosis are:

1. Postmenopausal osteoporosis of the legs develops due to a lack of production of female sex hormones during menopause.
2. Senile osteoporosis is associated with wear and tear and aging of the body as a whole. A decrease in the strength of the skeleton and its mass occurs after 65 years.
3. Corticosteroid bone dystrophy occurs as a result of long-term use of hormones (glucocorticoids).
4. Local osteoporosis is characterized by the presence of the disease only in a certain area.
5. Secondary osteoporosis develops as a complication diabetes mellitus, with oncological pathologies, chronic kidney diseases, lung diseases, hypothyroidism, hyperthyroidism, hyperparathyroidism, with ankylosing spondylitis, with calcium deficiency, Crohn's disease, chronic hepatitis, rheumatoid arthritis, long-term use aluminum preparations.

Osteoporosis can be grade 1, 2, 3 and 4. The first two degrees are considered milder and often go unnoticed. Symptoms of osteoporosis in these cases are difficult even with radiography. The next two degrees are considered severe. If there is a degree of 4, the patient is assigned disability.

Causes of bone dystrophy of the legs

The reasons for the development of the disease lie in an imbalance in the reconstruction of bone tissue, which is constantly renewed. Osteoblast and osteoclast cells take part in this process.

One such osteoclast is capable of destroying the same amount of bone mass as 100 osteoblasts will form. Bone gaps caused by the activity of osteoclasts in 10 days will be filled by osteoblasts within 80 days.

For various reasons, when osteoclast activity increases, bone tissue destruction occurs much faster than its formation. The trabecular plates become perforated, become thinner, the fragility and fragility of the bone increases, and the horizontal connections are destroyed. This is fraught with frequent fractures.

Note! The peak of bone mass gain normally occurs at 16 years of age, bone construction prevails over resorption. At the age of 30 – 50 years, both of these processes last approximately the same. The older a person gets, the faster the processes of bone tissue resorption occur.

For each person, the annual loss of bone tissue under the age of 50 is 0.5 - 1%; for a woman in the first year of menopause, this figure is 10%, then 2 - 5%.

Causes of bone osteoporosis:

• low weight;
• thin bones;
• short stature;
• physical inactivity;
• female;
• menstrual irregularities;
• elderly age;
• familial cases of osteoporosis;
• application steroid drugs, antacids containing aluminum, thyroxine, heparin, anticonvulsants.

Causes of bone osteoporosis that can be affected:

1. caffeine and alcohol abuse;
2. smoking (you need to get rid of this bad habit as quickly as possible);
3. insufficient intake of vitamin D;
4. physical inactivity - a sedentary lifestyle;
5. calcium deficiency in the body;
6. lack of dairy products in the diet;
7. excessive consumption of meat.

Symptoms of bone osteoporosis

Danger clinical picture explained by the low-symptomatic or asymptomatic occurrence of osteoporosis. The disease can be disguised as arthrosis of the joints or osteochondrosis of the spine.

Often the disease is diagnosed at the moment when the first fractures appear.

Moreover, these fractures occur due to minor trauma or simple lifting of weight.

It is quite difficult to recognize the disease at its early stage, although the main signs of osteoporosis of the legs and arms still exist. These include:

• bone pain when the weather changes;
• fragile hair and nails;
• changes in the patient's posture;
• destruction of tooth enamel.

The areas most affected by osteoporosis are the femoral neck, arm and leg bones, wrist, and spine. How does osteoporosis manifest at the initial stage? And this happens approximately like this: in the lumbar and thoracic region In the trunk of the spine, with prolonged stress, pain appears, night cramps in the legs, senile stoop (see photo), brittle nails, and a decrease in the growth of periodontal disease are observed.

Symptoms of osteoporosis may include regular pain in the back, interscapular region, and lower back.

If your posture changes, there is pain, or your height decreases, you should consult a doctor to check for osteoporosis.

Diagnosis of bone osteoporosis

X-ray of the spine is not suitable for accurate diagnosis. Can't be found in the photo initial forms and osteopenia. Minor bone loss is also not visible on x-rays.

DEXA – dual-energy X-ray densitometry – osteodensitometry, ultrasound densitometry, quantitative computed tomography.

DEXA is a diagnostic standard. Quantitative assessment of bone mass – bone densitometry. Bone mineral density and bone mass are measured. The difference between the theoretical bone mass density of an absolutely healthy person and the bone tissue density of a patient of the same age is the Z score.

The difference between the average value healthy people at the age of forty years and the patient’s bone tissue density is the T indicator. Diagnosis according to WHO recommendations is carried out on the basis of the T indicator.

Reasons why densitometry is performed:

• anorexia, malnutrition;
• hereditary history;
• insufficient body mass index;
• prolonged repeated amenorrhea;
• early menopause;
• estrogen deficiency;
• primary hypogonadism;
• chronic renal failure;
• organ transplantation;
• hyperparathyroidism;
• hyperthyroidism;
• Itsenko-Cushing syndrome (photo);
• long-term immobilization;
• decreased testosterone levels in men;
• corticosteroid therapy;
• spondyloarthritis, rheumatoid arthritis arms and legs.

In order to diagnose osteoporosis, doctors use biochemical markers: vitamin D, calcium, magnesium, phosphorus, various hormones (parathyroid and thyroid hormones, estrogens), formation markers (osteocalcin, procollagen C-peptide and N-peptide, specific bone alkaline phosphatase ), resorption markers (deoxypyridinoline, hydroxyline glycosides, pyridinoline, tartrate-resistant acid phosphatase, calcium).

Treatment of bone dystrophy

Treatment of osteoporosis is a rather complex problem. It is dealt with by rheumatologists, immunologists, neurologists, and endocrinologists. It is necessary to achieve normalization of bone metabolism, prevent fractures, slow down bone loss, increase physical activity, reduce pain syndrome.

Etiological treatment – ​​it is necessary to treat the underlying disease that led to osteoporosis,

Symptomatic treatment – ​​pain relief.

Pathogenetic treatment – ​​pharmacotherapy of osteoporosis.

Drug treatment

Natural estrogens - drugs to suppress bone resorption: calcitonin, bisphosphonates (zoledronic acid, risedronate, ibandronate, pamidronate, alendronate). These medications are taken for a very long time, for years.

There are differences in taking medications:

1. once every 12 months (aklasta);
2. once every 30 days (bonviva);
3. once every 7 days (ribis).

Drugs that stimulate bone formation - vitamin D3, bioflavonoids, fluorine salts, strontium, calcium. Treatment for osteoporosis of the bones of the arms and legs is prescribed by a doctor!

Important! Osteoporosis may not be completely curable. You can only achieve improvement of the skeletal system with calcium preparations and those means that affect the assimilation and absorption of this element.

Treatment of bone dystrophy with diet

First of all, for proper nutrition, you need to eat foods high in calcium and vitamin D. These include:

• dairy products;
• nuts;
• broccoli;
• greenery;
• yolk;
• fish fat;
• fish.

In addition, exposure to the sun also promotes the production of vitamin D.

Exercise therapy for osteoporosis of the bones of the arms and legs

Physical activity for osteoporosis should consist of walking, which puts maximum stress on the bones of the legs. It is worth noting that swimming does not contribute to this. This is explained by the fact that in water the body becomes weightless, so there is no load on the bones of the arms and legs.

Here is an exercise to strengthen bones that must be performed systematically:

While kneeling (your hands rest on the floor, your back is straight), you need to pull your stomach in and raise your right hand up, looking at it. The chest should open at this moment and you should breathe evenly. The hand lowers to its original position. Then, the same is done with the other hand. And so on several times.

After finishing the exercise, you need to lower your pelvis onto your feet, straighten your arms, lower your head down, relax your body, while maintaining even breathing. This exercise is performed 2-3 times a week. It is recommended to combine it with proper nutrition and half an hour's walk.

Complications of bone dystrophy

Most often, fractures occur in the radius, vertebrae, and femoral neck. According to WHO, hip fractures (photo) place bone dystrophy in 4th place among the causes of disability and mortality.

The disease reduces life expectancy by an average of 12–20%.

A spinal fracture increases the risk of another fracture in the same place several times. A prolonged stay in bed due to injury causes pneumonia, thrombosis and bedsores.

Treatment or prevention

To prevent the disease, it is necessary to consume foods rich in calcium and vitamin D. Their list was given above. You should give up bad habits (smoking, alcohol) and limit caffeine and foods containing phosphorus (sweet carbonated drinks, red meat) in your diet. Physical activity, on the contrary, it is worth maximizing.

If conventional measures to prevent the disease are ineffective or impossible, doctors recommend turning to preventive medications. Choosing the right drug is actually not so easy.

The fact is that the presence of calcium alone in a medicine cannot solve the problem of its deficiency. Calcium is very poorly absorbed. Therefore, the best option is to have both calcium and vitamin D in the preparation.

Healthy lifestyle and regular moderate physical exercise– deposit strong bones. All women, without exception, after forty years of age need to check the correct functioning of their thyroid gland. If a pathology is detected, begin its treatment immediately.

The Russian Osteoporosis Association regularly conducts free medical examinations of patients at risk of bone dystrophy.

What is odontogenic osteomyelitis

Odontogenic osteomyelitis is a purulent-necrotic lesion of bones such as the upper and lower jaw. Occurs against the background of a significant decrease in the body’s immune defense in combination with increased virulence of odontogenic microflora oral cavity.

The term “osteomyelitis” was first introduced in medical practice at the beginning of the 19th century and it means inflammation bone marrow. In the modern understanding, this concept includes much more pathological processes, since with the development of osteomyelitis, not only the bone marrow tissue suffers, but also the bone itself, the periosteum, and surrounding soft tissues. But the term is firmly entrenched in clinical practice and is still used today.

Acute odontogenic osteomyelitis mainly affects people aged 20-45 years, men suffer more often than women. Inflammation of the lower jaw is diagnosed in 85% of all cases of odontogenic forms of osteomyelitis, the upper jaw is affected only in 15%. However, the frequency of treatment of patients with osteomyelitis upper jaw to the doctor is 3 times higher than with purulent inflammation of the lower, which is explained by the more severe course of this variant of the pathology.

Depending on the route of penetration of pathogenic microorganisms into the bone tissue, there are 2 main types of osteomyelitis:

• hematogenous (you can read about it in detail in this article) – the infection penetrates the bone with blood flow from the primary focus;
• exogenous – pathogens enter the bone directly from external environment, for example, due to injuries with bone fractures (traumatic osteomyelitis), surgical interventions and other medical procedures, odontogenic osteomyelitis, which is described in detail in this article, can also be included in this group.

Causes

With the development of odontogenic osteomyelitis, the source and entry point for infection are diseases of the hard and soft tissues of the tooth. It is the presence of teeth that gives clinical specificity this species purulent-necrotic lesions of the jaw bone tissue. Naturally, the occurrence of the disease is influenced by a number of other factors, for example, age, anatomical features of the structure of the jaw bones, physiological characteristics of the body, but the main role is played by the presence of chronic foci of odontogenic infection in the oral cavity (various dental diseases).

Most often, acute odontogenic osteomyelitis occurs due to infection of teeth such as temporary molars and first permanent molars (chewing teeth).

You should know that the term “odontogenic infections” means infections of the oral cavity. Depending on their location, they are divided into:

• truly odontogenic, which are directly related to damage to tooth tissue (caries, pulpitis, etc.);
• periodontal, which are associated with periodontal damage to the tooth and gums (gingivitis, periodontitis, pericoronitis), surrounding tissues (soft tissues of the face, neck, lymph nodes, periosteum, bone tissue, paranasal sinuses);
• non-odontogenic, which are associated with damage to the mucous membranes of the oral cavity and salivary glands (stomatitis, mumps).

Among the most common pathogens of odontogenic osteomyelitis are the following microorganisms:

• streptococci – S.mutans, S.milleri;
• anaerobic microflora – Peptostreptococcus spp., Fusobacterium spp., Actinomyces spp.;
• gram-negative microflora – Enterobacteriaceae spp. and S. aureus.

It is important to know that in Lately More and more microbial associations are being identified as the causative agent of odontogenic osteomyelitis, that is, the disease is caused not by one type of pathogen, but by their association, which sometimes includes 5 or 6 pathogenic pathogens. This significantly worsens the prognosis of the disease and complicates the selection of medications, in particular antibiotics.

Development mechanism

Unfortunately, to date, the exact mechanisms of the development of osteomyelitis remain not fully studied and understood. Several theories have been proposed for this pathological process, among which three were particularly popular:

• vascular (infectious-embolic);
• allergic;
• neurotrophic.

If we combine all these theories into one, then the development of osteomyelitis can be imagined in this way. Due to certain factors (peculiarities of blood flow in bone tissue, sensitization of the body to microbial antigens, violation nervous regulation vascular tone and their tendency to spasms, penetration of pathogens into the bone) multiple thrombosis of intraosseous vessels of the jaw bones develops, due to which areas of hemorrhage are formed.

Pathogenic microorganisms penetrate into them and foci of purulent inflammation form. This leads to necrosis varying degrees severity with further spread of the purulent-necrotic process to the spongy bone tissue, periosteum and surrounding soft tissues.

Classification

Depending on the clinical course odontogenic osteomyelitis, there are 4 stages of the disease:

1. Acute stage, which lasts up to 14 days.
2. Subacute – from 15 to 30 days of illness.
3. Chronic is observed if the disease continues after 30 days, but it can last for several years.
4. Exacerbation of chronic odontogenic osteomyelitis.

Depending on the prevalence of the pathological process, osteomyelitis is distinguished:

• limited – localized within the periodontal tissues of 2-3 adjacent teeth;
• focal - spreads within the alveolar process of the jaw, its body over 3-4 adjacent teeth, its branches over 2-3 cm;
• diffuse - when half or most of, sometimes the entire jaw (upper or lower) is affected.

You should know that recently they began to identify another form of odontogenic osteomyelitis, which does not have a typical course. That is, there is no acute phase of pathology, the destruction of bone tissue is insignificant, and the formation of fistula tracts is possible. This form of the disease is called primary chronic odontogenic osteomyelitis.

Symptoms

Signs of odontogenic osteomyelitis depend on the stage of the disease and its prevalence. Let's consider clinical features every form of illness.

Acute stage

As already said, acute stage The illness lasts for the first 14 days. Depending on the body’s reaction, there are three variants of its course:

• hyperergic,
• normergic,
• hypoergic.

The hyperergic variant is the most common, with multiple local and general signs of pathology present. A person experiences a very intense pain syndrome, the pain spreads from the area of ​​the affected area of ​​the jaw to the ear, temporal zone, back of the head, and neck on the corresponding side. In some patients, pain appears or intensifies during chewing, talking, swallowing, or opening the mouth.

In this case, significant swelling of the soft tissues of the face occurs, the skin color does not change, it may turn slightly red, and the skin gathers into a fold. When you try to palpate the swollen tissues, severe pain occurs. Some patients develop muscle contracture and the inability to open their mouth. You can also feel enlarged and painful regional The lymph nodes(cervical, submandibular).

When you tap on your teeth, pain occurs, and both the causal teeth and intact teeth hurt (a symptom of “multiple periodontitis”). As the pathology progresses, the tooth begins to loosen, become mobile and adjacent teeth(symptom of “keys”).

If a diseased tooth is removed, then purulent contents may be released from its socket. Appears putrid smell from the mouth, there is a white coating on the tongue. The mucous membrane in the area of ​​the affected area of ​​the jaw is hyperemic and swollen. After 2-3 days from the onset of the disease, it acquires a bluish tint.

At the same time, symptoms of severe intoxication syndrome develop:

• high temperature, which often reaches the level of hyperthermic fever (40-41ºС);
• severe general weakness, chills;
• impairment of consciousness from mild forms to deep coma;
• rapid heartbeat, increase, and then a significant decrease in blood pressure, cardiac arrhythmias;
• nausea, vomiting, bowel dysfunction;
• pallor skin, cold sticky sweat.

Sometimes because state of shock patient and the rapid course of the disease, it is very difficult to detect local signs of damage to the jaw, which make it possible to recognize osteomyelitis. Risk fatal outcome in such cases it is very high, as a rule, death occurs within the first 2-3 days from the onset of the disease, and most often it is not possible to recognize odontogenic osteomyelitis.

The normergic variant is not common in practice. As a rule, most often observed when started in a timely manner successful treatment hyperergic variant of the pathology and is a criterion for a favorable prognosis. Also, this course of osteomyelitis can be observed in cases where patients self-medicate before a medical examination and take antibiotics and anti-inflammatory medications in an uncontrolled manner. At the same time, the described clinical symptoms have a significantly lower degree of severity and are observed only at the beginning of the pathological process.

The hypoergic variant of the acute phase of odontogenic osteomyelitis is very common today. Hypoergy (reduced body response to inflammation) can be primary or secondary (after hyper- or normoergy). This option is often observed due to the presence of various immunodeficiency conditions in a large number of people. Symptoms in such cases are very mild, but the pathology lasts a long time. Patients do not seek medical help, which leads to the formation of chronic osteomyelitis.

Subacute stage

During the transition of the disease from the acute to the subacute stage, the patient's condition improves significantly. Almost all general signs of intoxication disappear, only local changes remain. Some patients remain low-grade fever for some time. If surgery was performed, the postoperative wound is gradually cleaned.

In cases where treatment was not started on time, the spread of purulent inflammation with the formation of facial phlegmon and fistulous tracts may occur.

Chronic stage of odontogenic osteomyelitis

In some cases, the subacute stage of odontogenic osteomyelitis smoothly turns into chronic. In this case, nothing bothers the patient until the moment of exacerbation. Inflammation occurs according to the hypoergic type. Often in such patients there is one or more fistulas, from which purulent contents periodically begin to be released. Over time, deformation of the jaw bones develops in the area of ​​inflammation, contracture masticatory muscles and restriction of mouth opening, disruption of the process of swallowing food, cosmetic defect of the face.

During exacerbations, body temperature rises, pain appears, general malaise is observed, pus is delayed through the fistulous tracts, abscesses and phlegmon of the soft tissues of the face may develop. A dental examination can reveal relevant pathological changes.

How to make a diagnosis?

For the diagnosis of odontogenic osteomyelitis, patient examination data are very important, including dental examination, medical and life history data, laboratory tests and some instrumental diagnostic techniques.

IN general analysis blood, the doctor’s attention should be drawn to a shift leukocyte formula to the left, the appearance of immature forms of leukocytes in the peripheral blood (band cells, metamyelocytes, myelocytes), the presence of leukocytosis (with generalized forms, leukopenia may also develop). ESR increases within 20-50 mm/hour, sometimes higher. The content of SRB increases sharply.

In a general urine test, nonspecific signs of inflammation may be observed - the appearance of protein, leukocytes, red blood cells, casts. It is also possible to observe specific changes in the case of acute renal failure in hyperergic forms of the disease.

Biochemical analysis reflects the development of the inflammatory process in the body; it is also possible to identify a violation of a particular organ (liver, kidneys, heart) in the case of a hypertoxic course of the disease.

An important place in the diagnosis of osteomyelitis is given to jaw radiography, with which specific changes can be identified. Computed tomography scanning is also considered very informative.

In some cases, a puncture of bone tissue and bone marrow may be necessary to confirm the diagnosis.

An important stage of diagnosis is also the inoculation of discharged pus or punctate into nutrient media. This is necessary in order to determine the etiology of the infection and determine the sensitivity of the isolated microorganisms to antibacterial drugs.

Complications of odontogenic osteomyelitis

Possible complications of the disease include:

• septic shock, which often leads to rapid death;
• diffuse purulent inflammation of the soft tissues of the face, head, neck (phlegmon);
• abscess formation;
• formation of fistula tracts;
• deformation of the upper or lower jaw;
• contracture of the masticatory muscles;
• violation of the process of chewing and swallowing;
• pathological fractures of the jaw;
• formation of false joints of the jaw.

Principles of treatment

Basic Rule modern treatment odontogenic osteomyelitis is an integrated approach, that is, drug therapy must be combined with surgical intervention.

If the disease is diagnosed, immediate removal of the culprit tooth is necessary. After its removal, the hole is regularly washed with antibiotics and antiseptics. Be sure to carry out regular wound sanitation and a long course of antibiotic therapy, taking into account the antibiogram data. Treatment is supplemented with restorative, immunomodulatory therapy, the use of analgesics and anti-inflammatory drugs.

In the case of chronic osteomyelitis, treatment consists of opening foci of chronic infection, removing necrotic tissue and pus. Therapy is necessarily supplemented with sanitation of the postoperative wound with antiseptics and rational antibiotic therapy. IN complex treatment Each patient should additionally receive detoxification therapy, vitamins, and restoratives.

Prevention

Unfortunately, there are no methods that are 100% guaranteed to protect a person from the development of odontogenic osteomyelitis. But following a number of rules will help to significantly reduce the risk of developing this unpleasant and life-threatening disease:

• you need to regularly visit the dentist not only for therapeutic purposes, but also for preventive purposes;
• brush your teeth thoroughly and regularly, use dental floss and mouthwash;
• avoid injury to teeth and jaws;
• increasing the immune defenses by healthy image life and proper nutrition;
• timely treatment of dental diseases and dental prosthetics;
• compliance with all rules and recommendations of the doctor after dental procedures.

The prognosis for odontogenic osteomyelitis depends entirely on the timeliness of diagnosis. The earlier the disease is detected and adequate treatment is started, the greater the patient’s chances for a full recovery. An inflammatory process that is not detected in time will, at best, turn into chronic stage, and at worst can result in septic shock and death.

Therefore, in no case should you neglect regular dental examinations and preventive blood tests. They will help determine the initial stage of the disease even without the occurrence of warning signs.

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Hernial protrusions in the intervertebral spaces appear in many people aged 40 years and older. Most are not even aware of their presence, but some patients actively complain of constant and severe back pain after a working day and when changing body position. They believe that the reason for this is increased physical activity and accumulated fatigue in the back.

Local clinic doctors are trying to treat them for radiculitis. But we must understand that these symptoms primarily indicate the presence of a defect. intervertebral disc. Advances in medical science in recent years allow us to confidently say that surgical removal of intervertebral hernias helps to cure patients with spinal pathology.

Which patients require surgery?

Indications for surgical treatment are conventionally divided into two groups. If it is impossible to do anything for a hernia without surgery, then these will be absolute indications:

• severe severe pain that cannot be removed by other methods;
• major changes in pelvic organs, leading to the inability to hold urine and feces.

When surgery is not yet absolutely necessary, the patient may refuse surgery. Although there are some symptoms that indicate the presence of a protrusion in the intervertebral space. These will be relative readings:

• pain in any part of the spine that the patient is still able to tolerate;
• partial violation motor activity lower extremities, for example, paralysis of the foot;
• weakness in the leg muscles, leading to atrophy due to impaired innervation;
• lack of positive changes after 3 months of treatment using conservative methods.

The most commonly used surgical techniques today include:

1. Microdiscectomy

The “gold standard” for the treatment of intervertebral defects is neurosurgical intervention, during which the herniated disc is removed. This is a low-traumatic operation through a small incision. Thanks to this, a quick recovery after hernia repair is achieved, and the patient is practically not bothered by pain.

The operation to remove a vertebral hernia is performed under visual control of a microscope using a set of microsurgical instruments. In this case, the adjacent bones of the spine are not damaged and compression of the spinal nerves is eliminated.

After the operation, the patient can sit down. Rehabilitation takes no more than 2-3 weeks. Next, the patient is recommended to wear a special corset for up to 3 months.

1. Endoscopic surgery

Removing a herniated disc using endoscopy has become possible in recent years, when fiber optic technologies began to be widely used in medicine. Special neurosurgical equipment is capable of visualizing the formation between the vertebrae with minimal damage to the skin at the operation site.

The operation itself to remove an intervertebral hernia is practically no different from a conventional microdiscectomy. The size of the skin incision is no more than 2.5 cm. The entire progress of the intervention is displayed on the monitor.

One day after the operation, the patient can walk, and discharge from the hospital occurs on the 4th day. The risk of postoperative complications and the duration of the recovery period are reduced several times.

1. Laser irradiation

Laser removal of a vertebral hernia is one of the modern methods of treating spinal problems. The method has certain limitations, but can replace radical intervention.

Using a puncture, a light guide tip is inserted through a special needle. With its help, the hernia formation is heated in several places up to 70 degrees. In this case, destruction of the disk structure is not allowed. Due to the evaporation of the liquid, the size decreases and the reparative processes of the intervertebral space are stimulated.

The recovery period after laser irradiation takes much longer. The patient's spinal pain completely goes away after a few months.

Removal of an intervertebral hernia, as a conventional surgical technique, can be supplemented with laser therapy. This helps strengthen the bone tissue of the spine, reduces the likelihood of disc destruction and prevents the possibility of recurrence of the bulge.

1. Destruction of intervertebral nerves

The main goal of the technique is to relieve pain in the patient caused by damage to the articular surfaces of the spine. First, it is necessary to block the receptors of the intervertebral space using a periarticular blockade with an anesthetic. After this, the surgeon can see that the cause of severe pain is not a hernia at all; surgery to remove it will not give the desired result and it is necessary to use the method of nerve destruction.

The technique is good when surgical treatment is not temporarily required, and the patient is bothered by severe pain during flexion-extension movements in the spine.

1. Plastic surgery

In case of damage to bone tissue and the need to strengthen the spine, the vertebroplasty method is used. Surgery to remove an intervertebral hernia does not solve all problems if the patient has a vertebral fracture due to osteoporosis, after an injury, or when affected by a tumor.

Strengthening the bone surfaces with special plastic or bone cement helps prevent further deformation of the intervertebral discs and stabilize the spine.

Advantages of surgical techniques

Surgical removal of an intervertebral hernia makes it possible to ensure a patient’s recovery with a high degree of probability. What are the positive effects modern methods surgical treatment:

1. quick relief of pain in the patient using standard and endoscopic techniques;
2. minimum time spent in hospital;
3. high probability of complete recovery;
4. Rehabilitation after surgery takes little time, which ensures a relatively quick restoration of performance.

Each method has its disadvantages

Removal of a vertebral hernia, like any surgical intervention, can lead to complications. Some of them are related to the very fact of surgical effects on the human body. The most serious complications after surgical intervention with herniated disc protrusions there will be:

• infectious and inflammatory processes (epiduritis, spondylitis, osteomyelitis), the prevention of which is carried out by the timely administration of antibacterial drugs;
• formation of scars and adhesions in the spinal canal, which significantly worsens and prolongs the recovery and rehabilitation of patients;
• deterioration of the condition of the vertebrae, leading to further subsidence of them in relation to each other;
• motor disorders in the lower extremities, which are possible when spinal cord tissue is damaged during surgery;
• changes in the function of the pelvic organs, as a result - injuries to the spinal nerves.

What is the probability of recurrence after surgical removal of a hernia?

This is one of the most important and frequently asked questions which occurs in a patient after surgery.

Fortunately, according to statistics, the percentage of relapses after operations does not exceed 5%. Re-formation of a hernia is possible in the area of ​​the same disc, but on the other side. If the hernia defect forms again, then this is an indication for hospitalization and repeated surgical treatment.

Surgical removal of intervertebral hernia of the spine, with strict consideration of all indications and contraindications, is an effective method of treatment. It should be understood that the effect of the operation will not be ideal.

Hyperostosis- this is osteosclerosis plus an increase in volume, thickening of the bone. This condition is exactly the opposite of atrophy. Hyperostosis is a thickening of the bone due to periosteal bone formation; it is observed in chronic osteomyelitis, syphilis, and Paget's disease.

Distinguish hyperostosis one or more bones, for example, with syphilis, Paget's disease and generalized hyperostosis, when damage to all long bones of the skeleton is observed in chronic lung diseases: chronic abscess, long-term chronic pneumonia, lung cancer.
There are also hormonal hyperostosis, for example, an increase in bone volume with acromegaly.

Enostosis is an increase in bone mass due to endosteal sclerosis.

Bone destruction- this is the destruction of bone with its replacement by some pathological tissue, which appears on an x-ray as clearing of varying severity. Depending on the nature of the pathological tissue replacing the bone, destruction is divided into inflammatory, tumor, degenerative-dystrophic and destruction from replacement with a foreign substance. All these pathological structures are a “soft tissue” substrate that determines the general symptom complex - clearing. Various expressions the latter on radiographs depends on the size of the focus of destruction and the thickness of the overlying mass of the rest of the bone and all surrounding muscles, as well as other soft tissues.
Thorough Analysis skialological data, characterizing the symptom complex of lucency in the bone, often allows us to establish its pathomorphological essence.

Inflammatory destruction. There are specific and nonspecific inflammatory destruction. The basis of nonspecific inflammatory destruction is pus and granulation tissue, which characterizes the essence of purulent osteomyelitis. At the beginning of the process, the contours of the lesion are unclear and blurred; Subsequently, the bone tissue around the site of destruction becomes denser, sclerotized, and the site of destruction itself turns into a cavity with thick, dense, well-formed walls, often with sequestral contents. The periosteum is involved in the process, and extensive periosteal growths occur.

Direct radiograph of the pelvis and hip joints.
A sharp deformation of the pelvic ring is determined. The right one is normal. Pronounced changes in the left hip joint: the articular cavity is deepened, the articular space cannot be traced, the head is deformed with multiple foci of destruction. Regional osteoporosis, atrophy femur. Left-sided tuberculous coxitis.

Specific inflammatory destruction- this is tuberculosis, syphilis, etc., in which bone tissue is replaced by a specific granuloma. Destruction in these diseases differs in localization, shape, size and nature of the lesions, as well as the peculiarity of the reaction from the surrounding bone tissue and periosteum. The focus of destruction in tuberculosis, as a rule, is located in the spongy substance of the epiphysis; it is small in size, round in shape, without or with a very slight sclerotic reaction around. The reaction of the periosteum is often absent.

Gummous syphilis, on the contrary, is characterized by multiple small foci of destruction of an oblong shape, located in the cortical layer of the diaphysis and accompanied by significant reactive thickening of the cortical layer due to endosteal and periosteal bone formation.

Tumor destruction. Destruction due to a malignant tumor is characterized by the presence of continuous defects due to the destruction of the entire bone mass of both the spongy and cortical layers due to its infiltrating growth.

With osteolytic forms destruction usually starts from the cortex and spreads to the center of the bone, has blurry, uneven contours, and is accompanied by breakage and splitting of the marginal compact bone. The process is mainly localized in the metaphysis of one bone, does not spread to another bone and does not destroy the end plate articular head, although the pineal gland or part of it may be completely melted. The preserved free end of the diaphysis has an uneven, corroded edge.

Destruction in osteoblastic or mixed type osteogenic sarcomas characterized by a combination of areas of bone destruction, which are characterized by the presence of a chaotic bone structure with excessive atypical bone formation; manifested as a round or spindle-shaped shadow around the slightly destroyed base of the bone. The main sign indicating the malignant nature of these tumors remains the absence of a sharp boundary between the areas of destruction and unchanged bone, as well as destruction of the cortical layer.

They have a lot in common osteolytic metastases and myeloma according to the picture of destructive clearing, which manifests itself in the form of rounded, sharply defined bone defects and is characterized by multiplicity and polymorphism (of different sizes) of the lesion.

Benign tumors, anatomically and morphologically constructed from a soft tissue substrate (chondromas, hemangiomas, fibrous dysplasia, etc.), radiographically also manifest as a destructive symptom complex. However, there is no direct and immediate destruction of the bone by pathological tissue, but there is essentially atrophy from pressure by the tissue of the bone itself (fibrous, cartilaginous, vascular). Therefore, for these diseases, it is legitimate to use the term “areas of clearing”, this thereby emphasizes the benign quality of the existing process.

Areas of enlightenment for benign tumors of the indicated type have an oval-rounded correct form, uniform structure of the pattern, smooth and clearly defined contours, clearly demarcated from the bone. The tumor cortex is a continuation of the compact bone of healthy areas; there are no reactive bone changes in the form of osteoporosis in the tumor circumference and periosteal layers. The cortical layer of bone in the area of ​​the tumor may be sharply thinned, but it always maintains its integrity. If a gap or interruption is detected, this is often evidence of a malignant transition and then it is legitimate to assume true tumor destruction.

Bone destruction, in which bone beams are destroyed and replaced by pathological tissue, always occurs during inflammatory and neoplastic processes. Focal destruction, depending on the etiology, has a unique appearance on the radiograph. The contours of the lesion are usually blurred and vague.

Extensive bone destruction (destruction) of the vertebral bodies with the formation of large sequesters

Relatively large destructive lesions with a diameter of more than 5-6 mm are easily detected by X-ray examination. The ability to recognize destructive foci depends not only on their size, but also on their location in the bone.

Foci located in the central sections of a normal bone mass may go unnoticed even if they are relatively large in size, while foci located in the cortex are detected relatively easily. To successfully recognize destructive foci, especially in the early phases of development, a thorough methodological examination of the bone is necessary not only in two, but sometimes in additional special projections. Tomography is especially useful.

In the X-ray image, destruction may be varying degrees focal, extensive and can be located centrally (inside the bone) or superficially.

Huge cavities (cavities) in the femur and tibia with multiple tuberculous osteitis

Depending on the cause that caused it, destruction is called inflammatory, tumor, etc. However, destruction is a symptom, and in order to correctly identify it, you must first accurately establish the diagnosis. Therefore, it is unlikely that destruction should be characterized etiologically before establishing a diagnosis. You should simply describe its size, shape, contours, location, and the reaction of the surrounding bone.

Bone cavities, or caverns, are formed with the complete destruction of all bone beams in the area of ​​​​the destructive focus with the formation of more or less clearly defined walls. They can have different shapes and sizes. Naturally, bone cavities are easier to detect during x-ray examination than small destructive foci, although even here the size of the cavities and the depth of their location in the bone, as well as the thickness of the affected bone, are of great importance.