Mandibular osteomyelitis in adults and children
Mandibular osteomyelitis may have an infectious or noninfectious aetiology.
Noninfectious mandibular osteomyelitis includes inflammatory conditions, such as diffuse sclerosing osteomyelitis and chronic recurrent multifocal osteomyelitis. These forms of mandibular osteomyelitis are not infective and the use of antibiotics is not recommended. Seek expert advice for information on imaging, biopsy and management.
This topic addresses infectious mandibular osteomyelitis.
Infectious mandibular osteomyelitis is most commonly associated with contiguous spread from odontogenic infection or after oral surgery, particularly if the patient has an underlying condition (eg compound fracture) or is receiving radiotherapy. Oral organisms are the most common pathogens involvedJohnston, 2022. Mandibular osteomyelitis in the setting of concurrent odontogenic infection or after oral surgery often requires surgical debridement and removal of any bony sequestration. Culture of tissues and any purulent discharge should be collected during surgery to guide antibiotic therapyJohnston, 2022.
Actinomyces species can cause mandibular osteomyelitis and may complicate medication-related or radiotherapy-associated osteonecrosis. Actinomyces is part of the normal oropharyngeal flora, so if it is isolated from microbiological specimens, clinical correlation is required to determine its significance. If Actinomyces is considered to be the causative organism, initial treatment with benzylpenicillin, amoxicillin or ampicillin is usually preferred. To reduce the risk of recurrence, a prolonged course of oral therapy should follow. Seek expert advice.
For the management of mandibular osteomyelitis in adults and children when the pathogen is not known, use the regimens described in Acute odontogenic infections.
The optimal duration of antibiotic therapy is not clearly defined, but 6 weeks of therapy (intravenous + oral) should be sufficient. If intravenous therapy is required initially, switch to oral therapy when the patient has clinically improved. For further information, see How to choose the duration of therapy for osteomyelitis in adults and children.
If definitive surgical treatment has been undertaken, the benefit of postoperative antibiotic therapy is not certain – consider stopping antibiotics.