Comparative diagnostic radiology features of chronic osteomyelitis and maxillary osteonecrosis

Introduction. Recent decades have seen changes in the structure of inflammatory diseases of the maxillofacial region associated with the non-medication use of synthetic drugs, which leads to the development of atypical forms of osteomyelitis with aggressive destruction of bone tissue. Comparative analysis of diagnostic radiology techniques, including CT and MRI, allows us to identify specific signs of chronic osteomyelitis and osteonecrosis of the maxilla, which is of key importance for early diagnosis and choice of treatment tactics. The aim of the study was to investigate the clinical features of the course of and perform a comparative analysis of the diagnostic radiology data in chronic osteomyelitis and osteonecrosis of the maxilla, developed as a result of exposure to various pharmacological drugs, as well as during radiation therapy. Materials and Methods. The study included 57 patients with chronic inflammatory lesions of the maxilla developed under the influence of pharmacological drugs or radiation therapy, who underwent a comprehensive clinical and laboratory examination and dynamic follow-up from 1 month to 4 years. Digital radiography and multispiral CT with 3D-reconstruction were used to assess the structural changes in bone tissue, which allowed detailed visualization of pathological processes. Results and Discussion. The study included 57 patients with chronic osteomyelitis (n=38, 66.7%) and osteonecrosis (n=19, 33.3%) of the upper jaw, accompanied by prolonged pain, tooth mobility, bone exposure, and purulent discharge. Computed tomography revealed that osteomyelitis was characterized by diffuse rarefaction of the bone structure (89.5%), zones of osteolysis with alternating areas of sclerosis (76.3%) and sequestrations (65.8%), whereas osteonecrosis was more often characterized by well-defined zones of necrosis (89.5%), pronounced osteosclerosis (78.9%), and no diffuse bone rarefaction (73.7%). Conclusions. Computed tomography has a high diagnostic value in differentiating chronic osteomyelitis and osteonecrosis of the maxilla, making it possible to detect characteristic destructive changes in bone tissue. Osteomyelitis is characterized by diffuse rarefaction and alternating zones of osteolysis and sclerosis, whereas osteonecrosis is typified by well-defined limited areas of necrosis and pronounced osteosclerosis.