Thickening of the periosteum of the tibia. Periostitis: treatment and diagnosis. Types of inflammation of the periosteum

2. Chronic periostitis

Acute periostitis

Acute odontogenic periostitis of the jaws - inflammation of the periosteum of the jaw bones - an infectious and inflammatory process that occurs as a complication of diseases of the teeth and periodontal tissues.

Periostitis of the jaws most often develops as a result of an exacerbation of a chronic inflammatory process in the periodontium, suppuration of a radicular or follicular cyst, the spread of an inflammatory process from the tissues surrounding an impacted or semi-retained tooth.

Acute serous periostitis

Acute serous periostitis is considered as a phenomenon of perifocal inflammation in periodontal diseases.

In children aged 3-5 years, periostitis can develop with acute inflammation of the dental pulp. Acute periostitis with pulpitis in a child is a formidable symptom indicating a high activity of the inflammatory process associated with the virulence of the infection and the weak resistance of the child's body. Abundant blood supply and lymphatic circulation of the pulp, jaw bones and soft tissues during the period of formation, eruption, change of teeth and growth of the jaw bones contributes to the spread of the inflammatory process from the pulp or periodontium to the bone tissue and periosteum. The periosteum of growing bones is in a state of physiological excitement and easily reacts to any irritation.

In the initial stage of the disease, acute serous inflammation of the periosteum develops. At the same time, hyperemia of the vessels, edema and cellular infiltration of the periosteum are observed morphologically, which thickens, becomes loose, its fibers are separated by a serous effusion. With further development of the process, serous inflammation turns into purulent.

Clinic. Acute serous periostitis is manifested in the thickening of the periosteum, severe pain during its palpation in the area of the causative tooth. The mucous membrane of the oral cavity in the area of the inflammatory focus is brightly hyperemic and edematous. Inflammatory edema extends to the adjacent soft tissues of the oral cavity and face. Lymphadenitis develops in the regional lymph nodes.

Treatment. Treatment of the underlying disease (pulpitis or periodontitis), anti-inflammatory therapy.

Acute purulent periostitis

With the further development of the disease, serous inflammation turns into purulent. Purulent periodontal exudate spreads through the bone substance and bone marrow spaces to the surface of the bone, destroys the cortical layer and penetrates under the periosteum, exfoliating it from the bone. The periosteum is separated from the cortical plate and rises in one direction or another. Purulent exudate accumulates under the periosteum with the formation of a subperiosteal abscess. Acute purulent periostitis is characterized by the development of two multidirectional processes in the periosteum. On the one hand, the periosteum dies, melts and lacunar resorption with the formation of uzurs and the penetration of exudate under the mucous membrane. At the same time, experiencing irritation, the inflamed periosteum responds with the active construction of a young layered bone, which limits the pathological focus from the surrounding tissues. The more active the inflammation, the more pronounced the destructive processes and, conversely, the calmer the disease proceeds, the more proliferative processes come to the fore.

Clinic. The clinical picture of acute purulent periostitis of the jaw can be varied and depends on the etiological, pathogenetic factors, localization and extent of the inflammatory process.

The periosteum from the vestibular surface of the jaws is more often affected. Patients complain of pain in the area of the causative tooth, swelling of soft tissues, impaired general well-being, fever. On examination, swelling of the soft tissues of the face is determined. The edema is localized quite typically, depending on the location of the tooth that caused the purulent periostitis. So, for example, with periostitis from the upper incisors, there is a significant swelling of the upper lip. If the purulent process develops from the upper canine and premolars, then the edema is localized in the buccal, infraorbital regions, spreading to the lower eyelid. If the cause of inflammation is the upper molars - in the parotid-chewing, buccal areas. On the lower jaw, edema can be located in the region of the lower lip, cheeks, and spread to the submandibular region. It should be borne in mind that, unlike phlegmon, with collateral edema accompanying purulent periostitis, swollen tissues are collected in a fold, they are soft on palpation and only in depth, according to the location of the inflammatory focus, in the periosteum region, a painful infiltrate is found. Skin in color is not changed. The disease is often accompanied by lymphadenitis. When examining the oral cavity: hyperemia and swelling of the mucous membrane from the vestibular side of the alveolar process in the area of the "causal" tooth and for some extent, the transitional fold is smoothed, swells. On palpation, a limited painful infiltrate is determined. With a significant accumulation of purulent exudate and melting of the periosteum, fluctuation is felt. Percussion of the "causal" tooth is sharply painful.

From the teeth of the upper jaw, the subperiosteal abscess can be located in the region of the hard palate. At the same time, there are no changes on the face. The accumulation of purulent exudate under the periosteum of the hard palate leads to exfoliation of soft tissues from the bone. This is accompanied by pain, often pulsating in nature, aggravated by talking and eating. In the oral cavity: in the sky hemispherical or oval infiltrate, sharply painful on palpation. The mucosa above it is hyperemic, the transverse palatine folds are smoothed.

From the teeth of the lower jaw, an abscess can be localized on the lingual side of the alveolar process. The patient experiences pain when swallowing and talking.

The patient's condition with periostitis of the jaw bones of moderate severity, an increase in body temperature to 37-38º C is determined

In children younger age acute purulent periostitis develops acutely, quickly. The transition from the stage of acute periodontal inflammation to periostitis can occur in a few hours. The disease is characterized by a rise in body temperature to high numbers (38-38.5º C). The general condition of the child is moderate or severe. The outcome of acute periostitis in children may be chronic ossifying periostitis. It is manifested by excessive bone formation by the type of stratification, which causes thickening, deformation of the jaw. If this deformity is in the nature of a cosmetic defect, at the age of over 16 years, the newly formed bone can be removed.

Treatment consists in the removal of the causative tooth, opening and drainage of the subperiosteal abscess (operation - periostotomy)

In childhood, hospitalization is indicated. Treatment should combine emergency surgery and anti-inflammatory therapy. In view of the danger of the rapid development of osteomyelitis with damage to the rudiments of permanent teeth, milk teeth, which served as the entrance gates of infection, are subject to urgent removal.

Chronic periostitis

Chronic odontogenic inflammatory process that develops in the periodontal or jaw bone tissue is a source of irritation of the periosteum, which begins to produce an excess of young bone. The construction of the bone occurs by layering it on the surface of the jaw in the form of layers with varying degrees of ossification. Chronic periostitis can develop in chronic periodontitis, after acute periostitis, but is most pronounced in chronic forms of osteomyelitis of the jaws. In childhood, it often develops after a bone injury in response to mechanical irritation of the periosteum.

There are simple and ossifying periostitis. With simple periostitis, the newly formed bone undergoes regression after treatment. Ossifying periostitis is manifested by excessive bone formation according to the type of stratification, and ends, as a rule, with hyperostosis, which causes thickening and deformation of the jaw.

Clinic. In children, the primary chronic form of the disease, which develops with chronic periodontitis, is more common. Often the impetus for the development of the process is the exacerbation of chronic periodontitis. It is clinically expressed by mild pain, a slight increase in body temperature and the appearance of swelling in the region of the upper or lower jaw. Palpation from the first days of the disease is determined by an elastic infiltrate, tightly soldered to the jaw, slightly painful. Gradually, this infiltrate acquires well-defined contours, becomes denser. Soreness on palpation decreases, and then disappears completely.

The general condition of a patient with chronic periostitis is usually not disturbed. The picture of blood changes a little.

Treatment: elimination of the primary focus of infection, physiotherapeutic methods (potassium iodide electrophoresis), alcohol compresses, vitamins. With ossifying periostitis, if the bone deformation is in the nature of a cosmetic defect, at the age of over 16 years, the newly formed bone can be removed.

Periostitis is an inflammation of the periosteum, which originates in the outer layer of the bone, after which it penetrates inside. If timely treatment is not started, then osteoperiostitis may develop, when inflammation penetrates the bone tissue.

Characteristics of the disease

Periostitis is a sluggish or acute inflammatory process of the periosteum, which envelops the bones. According to ICD 10, the disease has the following codes:

If there was a lesion of the pelvic or thigh area - M 90.15;
With the localization of the inflammatory process in the lower leg - M 90.16;
Periostitis of the calcaneus - M 90.17;
With unspecified localization - M 90.19.

The foci of inflammation are located in the inner or outer layer, then they spread to the surrounding tissue. Treatment of periostitis of the periosteum is carried out by different specialists, based on the cause that caused the pathology. You may need help with this:

Orthopedist;
Phthisiatrician;
Rheumatologist;
Traumatologist;
Oncologist;
Venerologist.

The pathological focus can spread in different parts of the bone, depending on which the following types of disease are distinguished:

Periostitis tibia;
Periostitis of the fibula;
Periostitis of the foot;
Periostitis of the leg;
Periostitis of the knee.

On a note!
The localization of the pathological process affects the symptoms of the disease and the choice of treatment tactics.

The shape of the flow is distinguished:

Acute periostitis of the periosteum, which is characterized by the presence of a purulent process in the bone;
Chronic periostitis is a kind of complication of an acute process.

Doctors distinguish the following classification:

A simple view is often formed on the olecranon or tibia, formed as a result of trauma, prolonged inflammation in the periosteum;
Purulent is formed in the tubular bone, occurs after the penetration of infection, bacteria, staphylococci, streptococci through a wound, hematoma;
Fibrous develops against the background of prolonged irritation;
Ossifying periostitis of the periosteum is caused by prolonged irritation with subsequent growth bone tissue;
Post-traumatic is provoked by injuries, characterized by the presence of a serous-mucous substance;
Tuberculous develops against the background of tuberculosis, differs in the formation of purulent clots, fistulas. More often diagnosed in children;
Syphilitic is formed against the background of venereal diseases;
Serous is formed on the injured area, it is characterized by painful swelling, elevated body temperature, which later normalizes. At the initial stage, the swelling is characterized by a dense consistency, which later softens and becomes liquid;
Linear, which on an X-ray image looks like a single line along the bone. It is observed against the background of a long-term sluggish inflammation of the periosteum, at the beginning of the formation of osteomelitis;
Load periostitis occurs in places of increased load, foot, lower leg as a result of injury. It is characterized by pain, seals.

Causes

Medicine identifies the following causes of periostitis:

Injuries that may appear as bruises, dislocations, bone fractures, sprains, soft tissue injuries;
Inflammation of a nearby tissue that occurs against the background of a pathological focus, which is located near the periosteum;
Toxic. Some diseases provoke the formation of toxins in the body, their entry into the periosteum. Toxic substances are formed in a diseased organ, then they are carried throughout the body with the help of the circulatory or lymphatic system;
Allergic. Thus, the periosteum reacts to allergens penetrating into it;
Specific, in which the disease is formed against the background of tuberculosis, syphilis.

Symptoms

Usually, the symptoms of periostitis of the bone depend on its type and manifest themselves in the following reaction of the body:

In the acute form of the disease, a slightly limited swelling occurs. When it is palpated, a feeling of pain is manifested, a local increase in temperature is determined. The symptom is lameness;
With a fibrous form, a swelling is determined, which has a dense texture, not painful on palpation. There is no local increase in temperature, the mobility of the skin over the affected area is formed;
With ossifying, a swelling appears with a sharp limitation, a hard consistency, an uneven surface. On palpation, pain is not determined, there is no local increase in temperature;
Acute purulent periostitis is manifested by severe pain, deterioration of the general condition, fever, increased respiration, pulse, weakness, fatigue, depression. A painful swelling is determined, hot to the touch, with tension of the inflamed tissue.

Diagnosis

Diagnosis of periostitis of the periosteum varies from its form and type:

In the acute form, the patient is examined and questioned. The most important aspect is the delivery of the CBC (general blood test), which will reveal the presence of inflammation. Fluoroscopy will be uninformative, since the disease is determined on an x-ray photo 2 weeks after formation;
The chronic type is determined on an x-ray, which allows you to determine the exact localization of the process, the boundaries, shape, size, what character the layering has. The picture determines the degree of pathology of the lower extremities, how much it has penetrated into the cortical layer, the presence of necrosis. Layers can be lacy, linear, needle-shaped, fringed, layered, comb-shaped.

Treatment

Treatment of the disease depends on its type and stage of the pathological process. In most cases, pathology can be dealt with with the help of conservative therapy.

Treatment of periostitis without the involvement of a purulent process

If periostitis of the periosteum occurs without the involvement of a purulent process, then therapy is carried out at home. The doctor prescribes antibacterial drugs, if necessary, painkillers. Cold compresses are applied to the inflamed joint.

After removing the symptoms, after 3-4 days, physiotherapy is prescribed, which improves blood circulation, relieves inflammation, swelling, and improves tissue regeneration. As physiotherapy for periostitis of the bone is used:

electrophoresis;
Magnet;
Paraffin therapy;
Ion therapy with 5% potassium iodide;
Laser therapy promotes resorption of seals, restoration of the affected periosteum.

On a note!
Within a few days it is necessary to provide complete rest to the leg.

To achieve the desired result, the following are assigned:

Sulfamide, Sulfadimetoksin, Sulfadimezin, Biseptol;
Antihistamine, Suprastin, Diazolin;
Anti-inflammatory drugs - Lornoxicam;
Preparations that strengthen bone tissue - Calcium gluconate, Calcium chloride, Calcium lactate;
For resorption of serous exudate in the affected area are used local funds that are applied by application, Beloderm, Advantan;
Non-steroidal drugs (Nurofen, Ibuprofen) contribute to the suppression of foci of inflammation, relieve pain;
Restore the integrity of bone tissue wound healing agents Levomekol, Argosulfan;
Treatment of periostitis of the lower leg is carried out by applying antiseptic, anesthetic ointments, Miromistin, Ketoprofen;
Vitamin complexes.

Treatment of purulent periostitis

If the periosteum is damaged by purulent periostitis, then a surgical intervention. The patient undergoes an opening of the abscess, drainage, followed by washing the cavity. This procedure is performed using aseptic solutions, antibiotics. After the operation, daily replacement of drainage and sanitation is required for a week. For treatment is used:

Antibiotic therapy with broad-spectrum drugs;
antiallergic drugs;
Vitamin complexes with zinc, fluorine, calcium, vitamin C.

After the removal of acute symptoms, the patient needs physiotherapy, which promotes tissue healing. If the process of suppuration is just beginning, then a compress with Dimexide, Vishnevsky ointment may be prescribed. The chronic stage of the disease requires the appointment of antibiotics, restorative agents, absorbable physiotherapy.

Cold is applied to the affected area to reduce pain. It is forbidden to use a warm compress, as it provokes the spread of inflammation.

ethnoscience

Traditional medicine is allowed as an additional method to drug therapy periostitis of the leg, physiotherapy. The following methods help to relieve pain, resorption of seals, hematomas:

100 gr. butter mix with livestock root. Apply as a compress to a sore spot;
100 gr. chop comfrey root, melt in a water bath 200 gr. butter. Mix everything. After cooling, apply the ointment to the affected area;
Grate Adam's root to get 200 gr. raw materials, pour ½ l. alcohol. Insist 5 days. The resulting infusion rub the affected area.

Possible Complications

If you do not pay attention to the acute course of the disease, then serious complications can develop:

Phlegmon, affecting the soft tissues located next to the diseased periosteum, characterized by purulent spillage, inflammation of the cell space and the absence of clear boundaries. This pathology of the bone has a rapid spread, occurs with fever, general malaise, lowering blood pressure, weakness, palpitations, inflammation of the lymph nodes located near the process;
, causes necrosis of the bone marrow, bone, surrounding tissues. The patient has an increase in body temperature up to 40 degrees, a pronounced pain process occurs. If treatment starts late, then a fistula is formed;
An abscess with clear boundaries and localization, accompanied by the formation of pus, a general deterioration in the condition, body aches, insomnia, the spread of pus into a nearby tissue;
Sepsis, which is a severe condition caused by the penetration of the pathogen into the blood. This condition is characterized by a high risk of death as a result of spreading the infection throughout the body;
Mediastinitis or acute periostitis is associated with infection in the mediastinum. Against the background of which there is shortness of breath, headache, chills, fever up to 40 degrees. If the patient is not provided with urgent assistance, then a fatal outcome is possible.

It is possible to cure periostitis at the initial stage, until the pathology has passed into the purulent stage. In this way, complications that are life-threatening for the patient can be avoided.

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Often a person, feeling pain in a leg or arm, thinks about or an ordinary bruise.

No one even suspects that pain in the leg and tooth pain can have one reason for such a manifestation.

It's all about such a disease as periostitis, about which ordinary people should know more information.

The concept and other characteristics of the disease

Periostitis - inflammation of the periosteum, leading to serious complications in case of untimely treatment.

The periosteum is closely connected with the bone, so the development of the disease affects the soft tissues. The inflammatory process can start on the outer layers or the inner ones, which leads to significant distinctive features and the nature of the treatment.

Inflammation often occurs on the jaw bones, which provokes an increase in the gums and subsequent suppuration. The simple name for this manifestation is flux. It can be easily cured through physiotherapy.

Periostitis of other bones occurs less frequently, but also contributes to the emergence of great dangers.

Causes of the disease

Inflammation of the periosteum is preceded by such aspects as:

and contusions, or tendon ruptures;
diagnosed allergic or rheumatic inflammations;
toxins accumulated in the body that poison the internal organs and upper layers of bones;
taking drugs with a high content of harmful chemical substances and toxins.

If a person falls into a risk group, he needs to see a doctor for examination at the first manifestations of periostitis - pain in the extremities.

Features of periostitis of the lower leg

The periosteum is a thin but dense membrane that covers the surface of the bone.

It contains a huge number of blood vessels and nerves.

Inflammation of the periosteum only at the initial stage is localized in the inner or outer layer of the membrane.

Subsequently, the inflammation grows and can affect the bone itself, which leads to osteoperiostitis.

In a particularly advanced case, inflammation already passes to the bone marrow, contributing to the occurrence.

In the photo, periostitis of the lower leg

Despite the above causes of the pathology, there are several features in the "vulnerability" of the periosteum.

Inflammation can provoke regular running on an asphalt or concrete road.

It should also be noted that most coaches claim the benefits of running on the forefoot.

As for the benefits of such a run for the legs, no positive aspect can be singled out here. This method of landing on a paved surface leads to inflammation of the periosteum.

Parkour is a modern hobby of young people, among whom there are many patients diagnosed with periostitis. The inflammation of the periosteum is affected by a sharp and hard landing on the foot during jumps. Here, direct blows to the lower leg often occur, which provokes the development of the disease.

Disease classification

The inflammatory process can be localized in different parts of the body.

Depending on the site of inflammation of the periosteum, periostitis is isolated:

tibia;
tibia;
fibula;
humerus;
calcaneus;
periostitis of the jaw;
periostitis of the nasal bones.

The localization of the inflammation process directly affects the symptoms of the disease, as well as the choice of treatment methods. Signs and treatment also depend on the form of the disease.

Distinguish between chronic and sharp shape inflammation. Acute periostitis, characterized by purulent inflammation, often turns into a chronic course of the disease, since in most cases timely treatment is not provided.

Types of periostitis:

Types of disease can drastically change the standard course of treatment, especially if there is a change in them.

How to detect the disease in time?

The initial symptoms of periostitis include pain that occurs every time you move or palpate.

A person will not see any inflammation until a certain point. Such symptoms are attributed to a bruise or sprain.

Usually, the inflammatory process due to bruises and sprains ends 2-3 weeks after the injury.

The disease does not have the properties of self-elimination, therefore, if untimely drug treatment"gaining momentum" and changing shape.

At the next stage of its development, periostitis passes into a chronic ossifying form, where, through the growth of bone tissue, a person notices inflammatory foci with characteristic redness.

If measures are not taken in time and treatment is not started, the inflammation begins to suppurate, which leads to a purulent type of inflammation. In the affected area, the presence of ulcers and thickenings is noted.

The suppuration that has begun in the process of spreading affects the bone marrow, and this is fraught with lameness - there is a violation of the functions of the lower limb.

Diagnosis of the disease

When a patient comes to the clinic, the doctor conducts a complete and thorough examination.

Sometimes only one examination of a specialist can diagnose the onset of inflammation of the tibia. To make a diagnosis and the nature of inflammation, some laboratory tests should be carried out, on the basis of which the doctor will determine the cause of the pathology that has arisen.

Here we check indicators such as:

the level of immunoglobulins;
check for the presence of rheumatoid factor;
if you suspect the presence of syphilis or gonorrhea, PCR studies are performed;
consider the index of C-reactive protein.

The patient then undergoes X-ray examination. It should be noted that the presented method is ineffective at the initial stages, because it helps to establish a diagnosis only after two weeks of the onset of the inflammatory process.

In rare cases, the patient is sent for a duplex ultrasound scan. It is used only in case of suspicion that the patient has varicose veins, which led to inflammation of the periosteum.

How to choose an effective therapy?

Treatment of periostitis assumes a complete absence of load on the leg during the first days or until the complete elimination of the presented disease.

The patient undergoes additional examination and treatment in the hospital.

Only in the initial stages of the development of periostitis, the doctor can allow treatment at home.

The treatment itself includes medications administered intramuscularly or intravenously, as well as in the form of tablets.

Here, anti-inflammatory and anti-allergic drugs are taken, calcium and vitamins are taken.

Additionally, physiotherapy is used:

massage;
application of dry heat;
paraffin therapy;
physiotherapy.

In no case should you self-medicate. The treatment regimen and the dosage of the medications used are prescribed only by the attending physician, who has conducted an appropriate examination and identified the type of disease.

In some cases, surgical intervention is used - with purulent inflammation, with the presence of purulent discharged clots. Tibia not subject to surgery. Doctors make an incision on the leg and eliminate purulent accumulations.

Through the operation, recovery will take a longer time.

Complications and prevention of the disease

With untimely intervention or an error, purulent periostitis can lead to a chronic course of the disease and lead to the occurrence of diseases such as:

In order to prevent the described inflammation of the periosteum, it is necessary to follow the recommendations of a specialist, which are based on wearing only orthopedic shoes, with low heels and in size.

When playing sports, follow the instructions of the trainer and do not allow excessive stress on the legs.

If you feel pain in your leg, contact your doctor for a full examination and identification of the causes. The sooner periostitis is diagnosed and treated, the less time will be spent on recovery.

Periostitis is an inflammatory process that occurs in the periosteum (a film covering the bone over its entire surface). Usually, periostitis initiates swelling of the gums, accompanied by intense pain. The "folk" name for periostitis, which affects the periosteum of the jaw, is flux.

Causes or Why periostitis occurs

It is worth starting with the most common causes of periostitis. Periostitis can occur due to other inflammatory diseases, such as periodontitis, periodontitis and pulpitis, in particular if they are not completely cured or occur with complications. Also, periostitis can occur due to damage alveolar processes bones during tooth extraction.

Another cause of periostitis is various traumatic lesions of the jawbone and soft tissue wounds. Periostitis in this case develops when an infection enters the affected area.

Also, the cause of periostitis can be an infection through the circulatory system or lymph in case of infectious disease other organs.

What's happening? or How periostitis arises and develops

Periostitis can be acute and chronic.

Acute periostitis usually divided into two stages - purulent and serous.

serous stage is a little less common and is a strong inflammatory process in the periosteum, which occurs simultaneously with acute or chronic periodontitis. Serous periostitis develops within 1-3 days. Often this inflammation subsides quickly, but it can become complicated, flowing into fibrous growths or causing ossifying periostitis (that is, the formation of new bone tissue).

The inflammatory process begins in the upper layers of the periosteum. This causes a slight swelling of the gums, accompanied by minor discomfort or slight soreness.

With the development of periostitis, inflammation spreads to the deeper layers of the periosteum. In this case, the swelling increases, the pain becomes more intense.

The further course of the disease provokes the occurrence purulent periostitis, which is an acute inflammatory lesion of the periosteum, accompanied, in addition to swelling, by acute pain and fever.

In this case, a purulent abscess usually occurs, from which not only the gum swells, but also nearby tissues - lips, cheeks. If the abscess appeared on the upper jaw, then the "flux" covers the cheek and the undereye part of the face. If the inflammation is located on the bone of the lower jaw, then the tissue area under the lower jaw swells.

Pain with such periostitis can manifest itself up to the ear, eye, temporal region. The temperature usually rises to 38-38.5 o C.

It is also possible with periostitis that a fistulous passage occurs, which allows pus to come out. This course of the disease reduces swelling and sometimes relieves pain. But getting rid of pus is not getting rid of infection. In addition, in this case, periostitis often develops into a chronic form, and inflammation can spread to nearby tissues, complicating the course of the disease.

Chronic periostitis

The chronic form of periostitis is quite rare. Of these rare cases, the most common chronic form of the disease affects the mandible. This inflammation is characterized by dense swelling of the affected area, thickening of the bone and enlargement of the lymph nodes.

Chronic periostitis is quite "long-playing" - it develops from 4-8 months to several years, periodically reminding of itself with exacerbations.

How to understand that you have periostitis? / Symptoms of periostitis

Different types of periostitis have different clinical

picture. Common symptoms for all types of periostitis are:

- edema of various sizes and density;

- pain of varying severity;

- possible redness of the oral mucosa.

More frequent symptoms characteristic of a later stage of periostitis or its complicated form are:

- sharp pain radiating to the ear, temple, eye;

What it is? The name of the diagnosis "periostitis" capaciously and fully reflects, on the one hand, the nature of the process, and on the other hand, does not say anything about the localization of the lesion. And this is true, because this disease can occur anywhere in the body where there is bone tissue.

"Periosteum" in Latin means "periosteum". That's how it's marked outer layer bones, which is very important. It is through the periosteum that the vessels and nerves that feed the bone pass. The periosteum connects the bone with the surrounding tissues - it is the periosteum that ensures the vital activity of the bone, without it the bone could not function and would die.

Periostitis is a disease in which the periosteum becomes inflamed. Certainly, we are talking about a limited lesion of any part of the bone or, in extreme cases, the process can extend to a large part of the bone. There can be no "general periostitis" of the body, unlike, for example, gastritis.

Most often this condition occurs in dentistry. If you open the Internet, then the vast majority of articles will just talk about the connection of periostitis with flux, caries, pulpitis, periodontitis. This is understandable, since the oral cavity is the residence of many microorganisms, including those that can cause an inflammatory process.

In the international classification of diseases (ICD 10), this "special status" of periostitis for dentistry is specifically emphasized. So, this disease can be coded separately for dentistry:

K 10.2 - inflammatory diseases of the jaws;
M 90.1 - periostitis in other infectious diseases.

In the second case, nothing is said about the localization of the process, which means that all cases of the pathological process, except for the jaws, can be coded according to the second point, especially if the pathogen is isolated and identified. Of course, there are cases of aseptic periostitis, when the infectious process does not develop. But for this there is no separate code in the ICD, since even such a detailed classification cannot provide for all possible cases.

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Causes of periostitis

Most often there is an acute process. There are three groups of the main causes of the development of the disease, which are characteristic of inflammation of the periosteum anywhere in the body:

Traumatic periostitis. It occurs as a result of trauma, and an open lesion of the periosteum. For example, the characteristic "bumper-fracture" of the leg bone when hit by a car. In the event that the fracture is open, then contamination of the wound is possible with the subsequent development of not only periostitis, but even osteomyelitis, if competent primary surgical treatment of the wound is not performed.
Hematogenous - develops if there is any septic focus in the body, from which pathogens are carried through the blood, that is, hematogenously. Most often, the source is trophic ulcers, thrombophlebitis in vascular lesions, diabetes and progressive "".
Specific the nature of the lesion develops with certain infections, for example, with tuberculosis, or systemic. For example, tuberculous lesions of the periosteum may occur.

All these reasons are characteristic of any localization, but there is also a “special” reason for periostitis of the jaw: just local inflammation that exists for a sufficient time in the oral cavity and is localized near the ligament - periodontium, which ensures the transition of inflammation to the bone.

Chronic and acute forms

Like any inflammatory disease, it can be classified into different categories. So, there is acute periostitis, which occurs most often, and chronic. For chronic inflammation"co-existence" with osteomyelitis is characteristic.

As a rule, in chronic periostitis, osteomyelitis (that is, inflammation of the bone marrow) first occurs hematogenously, and then, after the onset of sequestration, the periosteum is involved in inflammation.

That is, at chronic course damage to the periosteum is possible not from the outside, as in an acute process, but from the inside.

Since any inflammation is accompanied by edema in soft tissues, and exudation in others, for example, in connective tissue, then periostitis can be classified according to the nature of the exudate into:

fibrinous;
serous;
purulent.

There is a process and aseptic, which will be discussed below. Most often, it is a kind of traumatic, in which there is no violation of the integrity of tissues and microbial infection of the wound.

Acute purulent periostitis is the most common purulent disease, just in maxillofacial surgery. Since it occurs most often, we will dwell on the description of this localization in more detail.

Periostitis of the jaw (acute, purulent)

The second name for inflammation, which is accepted in dentistry, is a subperiosteal abscess. Of course, both periostitis of the lower jaw and the upper jaw can occur. Most often, the pus that accumulates during periodontitis enters under the periosteum through the bone tubules and perforating canals (Haversian and Volkmann).

In the event of a limited acute purulent periostitis, there are strong, throbbing pains in the area of a particular tooth. On examination, it is possible to reveal edema and hyperemia of the gums, a pronounced smoothness of the transitional fold. There is an increase in temperature to 38 and even up to 39 degrees.

Symptoms increase as the size of the abscess increases. In the event that it breaks into the vestibule or oral cavity, this can be considered a favorable outcome, since self-drainage occurs. In the event that the abscess finds its way into the soft tissues surrounding the jaw, the infection will progress and may be life-threatening.

In the treatment of purulent periostitis (and not only in dentistry, but also in other localizations), the main task of treatment is to establish an outflow of purulent exudate and prevent its spread to soft tissues.

Other localizations

In addition to inflammation of the periosteum of the jaw, sometimes periostitis of the joint develops, more precisely, periarticular tissues. The reason for this is most often purulent inflammation of the articular apparatus: bursitis, tendovaginitis.

In the event that the purulent process progresses, then its breakthrough occurs either between the muscle sheaths with the development of phlegmon, or in the immediate vicinity of the periosteum. Most often it occurs in such joints in which bags are well expressed, for example, in the knee and elbow joints.

Sometimes an aseptic process occurs that is not associated with microbial inflammation and intoxication. It includes periostitis of the tibia, as well as periostitis of the foot. It is associated with trauma and the appearance of a shock load on the bone.

As a result, periosteal thickening appears, which leads to pain, swelling, and possible compensatory growth of osteophytes in the area of bone damage.

The most important thing in the diagnosis of such a lesion is the distinction between periostitis and osteogenic sarcoma, which are early stages run almost the same.

Treatment of periostitis - drugs and methods

For any acute purulent periostitis, surgery. As a rule, after local anesthesia, a subperiosteal abscess is opened, with a periosteal incision. Already this simple manipulation reduces pressure.

After that, the cavity is washed with antiseptics, and drainage is applied, through which the exudate is separated. Usually a rubber strip is used for this. In some cases, the cavity is periodically washed with a weak solution of hydrogen peroxide, or furacillin.

In the event that there is a general inflammatory reaction, then the patient is prescribed intramuscular antibacterial drugs. In the event that periostitis develops in children, then you need to be very careful about the dosage. After all, there are ototoxic antibiotics that contribute to damage to the auditory nerve.

In the case of aseptic, post-traumatic inflammation, it is necessary to give rest to the leg, and reduce to a minimum physical activity. It is necessary that the periosteum "comes to its senses", local local cooling is shown to relieve inflammation, taking NSAIDs (Movalis, "").

After removal acute pain and reduce edema, physiotherapy can be prescribed: UHF, magnetotherapy, paraffin and ozokerite therapy. Applications of dimexide are shown, as well as the application of ointments with an anti-inflammatory effect to the site of the lesion.

Risk of complications

The most formidable complication of periostitis is osteomyelitis, and in case of inflammation of the periosteum of the lower jaw, a breakthrough of pus into the cellular spaces of the floor of the mouth with the formation of phlegmon, and purulent mediastinitis.

This is a very serious disease, which is characterized by the formation of numerous purulent-septic foci, and high mortality.

Therefore, it is necessary to treat all diseased teeth in a timely manner, avoiding complications, and in case of pain in the legs, and the occurrence of such symptoms of inflammation as redness, swelling, soreness and heat in the leg, especially after an injury, an urgent need to contact a traumatologist, and undergo an X-ray examination.