orbital osteomyelitis
Introduction
Introduction to osteomyelitis Orbital osteomyelitis is a rare eyelid inflammation that can occur at any age, but children may be susceptible to this disease. The second is the outer wall of the ankle, while the lower and inner walls of the ankle are rarely affected. basic knowledge The proportion of illness: 0.02% Susceptible people: no specific population Mode of infection: non-infectious Complications: eye movement disorders
Cause
Causes of osteomyelitis
(1) Causes of the disease
The infection originates from: 1 infection of adjacent tissues, especially the spread of inflammation of the frontal sinus and ethmoid sinus; 2 foreign bodies caused by trauma, especially woody, bamboo sticks and other plant-like retention sputum, or surgery to put foreign objects into the eyelids, such as rubbing Blood gauze remains around the wall of the iliac crest to cause local ipsilateral infection; 3 blood-borne, such as cold fever or other bacteremia cause inflammation of the tibia. Common bacteria are Staphylococcus aureus, Streptococcus and Haemophilus influenzae. The most common cause of spastic osteomyelitis is sinusitis, especially the frontal sinus. Toxins and bacteria in frontal sinusitis directly invade the barrier vein through the valveless vein, producing suppurative or septic embolism phlebitis, causing inflammation of the bone marrow. The ethmoid sinus infection can spread from the very thin inner wall of the iliac crest to the eyelids, so the osteomyelitis of the inner wall is rare. The maxillary sinus artery is rich in anastomotic branch, and the single arteriovenous sepsis thrombosis does not produce necrosis of the infraorbital wall, so the inferior wall osteomyelitis is less common.
(two) pathogenesis
It is an infectious inflammation with the same pathogenesis as infectious diseases.
Prevention
osteomyelitis prevention 1. Patients should maintain a good mentality during their recovery. They can usually listen to music or chat with family members and do some pleasant things. This can prevent patients from feeling depressed and depressed. 2, patients should pay attention to daily eye health, do not read books or watch TV for a long time, do not stay in the dark room for too long, patients in daily life can do some eye massage, about 1 to 3 minutes each time Just fine. 3, after the dismantling and discharge, patients should pay attention to develop good habits, to maintain adequate sleep, not too tired, and do not drink a large amount of water at the same time.
Complication
Osteomyelitis complications Complications, eye movement disorders
Periostitis and sacral fissure occur in the oculomotor nerve, the trochlear nerve and the paralysis of the nerve, and there is eye movement disorder. In severe cases, it spreads to the intracranial meninges, and there are symptoms of meningeal irritation and symptoms of systemic poisoning.
Symptom
Medicinal symptoms of bone marrow Common symptoms Eyeball displacement Eyeball prominent Orbital malformation Corneal ulcer Congestive keratitis valgus Epilepsy discharge Edema Periostitis
In the acute phase of osteomyelitis, there are symptoms of systemic poisoning, fever, discomfort, headache, etc. Local skin congestion, edema, tenderness, pus outflow after rupture, eye movement, eye movement limitation, and patients often see chronic phase At this time, there is no systemic symptoms. The skin at the rim of the rim is recurrent with congestion and edema, ulceration, pus, and healing of the fistula. The time is good and bad. After a long time, the scar around the fistula is contracted to form an orbital deformity. Fissure can not be closed or valgus valgus, exposed keratitis, corneal ulcer, decreased vision, severe cases can form endophthalmitis, bacterial culture of purulent discharge can be positive.
Periostitis at the temporal margin shows local pain, congestive edema of the eyelids, tenderness, and fluctuating mass can be reached when the abscess is formed. The eyeball is displaced to the opposite side. After the abscess is broken, the fistula is formed. The periostitis in the middle part of the sac is deep. There are still congestion and edema in the eyelids, the eyeball is prominent, the eyeball shifts to the contralateral side and the eye movement disorder. The reason is due to the thickening of the periosteal inflammation and the formation of abscess; on the other hand, the inflammation affects the soft tissue inside the sputum, affecting its function, Symptoms and signs of apical periostitis are more serious. The pain is located behind the ball, and the oppression of the eyeball is exacerbated. The periostitis involves the periosteum of the palate. The periosteum of the optic nerve and the optic nerve hole continues, and the optic nerve fibers are thickened by the inflammatory edema. And periosteal compression or nerve fibers are affected by inflammation, resulting in decreased vision, optic disc edema or atrophy.
Examine
Examination of osteomyelitis
1. Bacterial culture of pus
The detection rate of bacteria is not high.
2. Blood routine examination
In acute osteomyelitis, the total number of peripheral white blood cells increased and the proportion of neutrophils increased.
3. Pathological examination
The pathological data of osteomyelitis is extremely rare, the bone cortex and bone marrow necrosis are absorbed, the surrounding bone marrow and cortical bone have neutrophils, lymphocytes, plasma cells infiltration; fibroblast proliferation forms a membrane to separate the purulent cavity, and the bone cells around the lesion proliferate to form new bone. The edge is hardened, the bone cells, osteoblasts and osteoclasts in the dead bone disappear, the squamous epithelium on the surface of the fistula is covered, the acute and chronic inflammatory cells infiltrate in the soft tissue, and the bone cells are surrounded by bone destruction. Calcification forms new bone.
4. X-ray inspection
It shows that the humerus is destroyed, but there may be dead bone formation, but it is rare. There is bone hyperplasia around it. It shows that the density of bone destruction is increased, the lesion range is small, and the X-ray shows normal.
5. Ultrasound exploration
It shows that the soft tissue changes in the iliac crest can not be displayed on the bone destruction, and the echogenic unevenness area with irregular shape and unclear boundary is seen in the soft tissue.
6.CT scan
It shows bone destruction, thickening of periosteum, low-density area under periosteum, and low-density area inhomogeneity in the history of trauma, suggesting the presence of foreign bodies, caused by sinus inflammation, and can show high density of sinus lesions.
7.MRI
The bone and thickened periosteum showed no signal or low signal. The osteomyelitis necrosis was moderate in T1WI, T2WI was high signal, and paranasal sinus lesions could indicate diagnosis. No foreign matter showed any signal on T1WI and T2WI.
Diagnosis
Diagnosis and differentiation of sputum osteomyelitis
diagnosis
The diagnosis can be confirmed based on the clinical manifestations and the results of the auxiliary examination.
Differential diagnosis
The acute phase needs to be differentiated from cellulitis. The chronic phase needs to be differentiated from the residual plant-like foreign body in the sputum. The imaging examination shows that the soft tissue inflammation in the sputum is not accompanied by bone changes.
