Wednesday, January 25, 2012

Symptoms-sinus infections causing osteomyelitis

Symptoms-sinus infections causing osteomyelitis

Although osteomyelitis is rare now-a-days, the past medical records confirm that the physicians were aware of the disease even in the first century A.D. For instance, Celsus, the Roman physician, mentioned about osteomyelitis in 1st century A.D and suggested surgical removal of the affected bone.  In 17th century, Fabricius Hildanus described the osteomyelitis of the frontal bone.

The frontal sinuses’ mucous membranes have veins. These veins communicate with the sinus’s diploic veins draining the frontal bone and the marrow cavity. Since the intracranial venous sinus system and the veins have a direct contact, the veins deposit bacteria in the frontal bone’s marrow space and cause thrombophlebitis, and thereby spread the frontal sinus infection.
Spread of sinus infection into the cranial bone marrow via diploic veins causes local osteitis, the bone inflammation. The diploic veins, draining the frontal sinus via bone marrow, do not have valves, so spreading of the infection is easier. The frontal bone erosion may further the process and true osteomyelitis signs may develop.  The infection may even cross the suture lines, spreading the infection in vast area. The infection removes the dura matter from the bone’s inner surface. The loss of dura matter results in bone devascularization because the dura supplies blood to the bone.  As a result, signs of vascular necrosis (i.e. changes in morphology indicating death of the cells) appear and thereby the infection reaches the devascularized tissues easily.
To treat osteomyelitis, the affected bone is removed completely and the frontal sinus is obliterated. Post surgery, antibiotics are administered up to six weeks. The advent of antibiotics has checked the number of incidences, especially of the frontal osteomyelitis. The related mortality rate has declined from 60% before the invention of antibiotics to just about 4% in the post antibiotic era. Sooner the disease is diagnosed, lesser the chances of complications.
Symptoms-sinus infections, trauma, including surgical trauma, and the frontal sinus fracture can cause frontal osteomyelitis. The disease may appear after the first instance of the frontal sinusitis even if there is no trauma. Alternatively, it may occur when chronic symptoms-sinus infections are accompanied by acute infection. A number of osteomyelitis patients might have suffered from allergic rhino sinusitis in the past. Vascular insufficiency and immunodeficiency may aggravate the problem and reduce the effect of treatment therapy. Thus, these deficiencies should also be treated simultaneously. Generally, young adults and adolescents suffer from osteomyelitis. Divers and swimmers having acute bacterial sinusitis are prone to osteomyelitis.

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