Infectious foci in chronic osteomyelitis of the jaws

Chronic osteomyelitis of the jaws has a varied clinical appearance and an unclear etiology. In a retrospective study based on case histories and histological material from 24 patients with chronic osteomyelitis, no specific correlation could be found between clinical symptoms and morphological changes in bone. In 10 patients, bacteria were found in certain foci such as osteocytic lacunae of necrotic bone and dentinal tubules of embedded tooth fragments. In these foci, the bacteria probably escaped the immunological response as well as the antibiotic treatment. From these foci, the bacteria might maintain an inflammatory reaction in the surrounding bone. In some patients, the mandibular canal seemed to be a pathway for the spreading of the inflammatory process.