Difference between revisions of "Mandibular Osteomyelitis"

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Also known as: '''''Lumpy jaw — Actinomycosis
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[[Image:Lumpyjaw1.gif|right|thumb|125px|<small><center>Lesion caused by Actinomyces Bovis(Courtesy of Alun Williams (RVC))</center></small>]]
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*"Lumpy jaw"
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====Clinical====
  
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==Introduction==
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*Seen mainly in cattle and exotics caused by ''[[Actinomyces bovis]]'' producing [[Bones Inflammatory - Pathology#Osteomyelitis|osteomyelitis]] of mandible.
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[[File:actinomyces bovis.jpg|right|thumb|250px|<small><center> bovine actinomycosis, 3-years-old bull, 2-month evolution. (L. Mahin
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*Mostly young animals.  
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2008, Wikimedia commons)</center></small>]]
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*Will not heal without treatment and jaw enlarges until animal cannot eat.
  
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'''Lumpy jaw''' is a chronic infectious condition which affects cattle. It is caused by the anaerobic filamentous bacteria [[Actinomyces bovis|''Actinomyces bovis'']].
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====Pathogenesis====
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Actinomyces is a normal commensal of the oral cavity, upper respiratory tract and digestive tract of cattle, it gains entry to underlying soft tissues when the mucosa is damaged by trauma or eruption of teeth. It causes an inflammatory reaction, the connective tissue proliferates and is followed by infiltration of leukocytes which results in the formation of a walled off granuloma. The granuloma invades the bones of the head, in particular the mandible, and continues to grow in size.
 
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Lesions are characterised by gross swelling, abscesses and draining fistulae overlying granulation of the mandible and maxilla. In some cases the [[Oesophagus - Anatomy & Physiology|oesophagus]] and [[Oesophageal Groove|oesophageal groove]] may become involved but the lymph nodes are not affected.
 
  
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==Signalment==
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*Starts as alveolar periostitis of lower cheek [[Oral Cavity - Teeth & Gingiva - Anatomy & Physiology|teeth]], due to ingestion of poor coarse roughage e.g. straw or hay with lots of thistles. 
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The condition affects cattle''' 2-5 yrs''' old. It is found worldwide but is most prevalent in Western and mid-western states of the USA.
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*Slowly enlarging [[Skull and Facial Muscles - Anatomy & Physiology#Mandible (mandibula)|mandible]] (occasionally [[Skull and Facial Muscles - Anatomy & Physiology#Maxilla|maxilla]]) due to granulomatous inflammation producing much fibrous tissue.
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*No real pus formation but "'''sulphur granules'''" in middle of lesion.
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*Organism causes "'''pyogenic granuloma'''."
  
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==Diagnosis==
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*Can grow to enormous size (e.g. size of grapefruit) and whole of mandible is blown apart by multiple foci of infection.
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The condition is easily diagnosed on clinical signs and can be confirmed by crushing and staining the yellow granules expressed with the pus from skin lesions to reveal '''gram-positive filamentous rods'''.
 
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===Clinical signs===
 
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*Facial distortment
 
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*Granuloma formation overlying the mandible and maxilla
 
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*Fistulae draining small amounts of thick pus with yellow granules
 
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*Difficulties with mastication
 
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*Loose teeth
 
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*Dyspnoea
 
  
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===Pathology===
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<small>Also see:[[Actinobacillosis|Actinobacillosis - "Wooden Tongue" (Courtesy of Alun Williams (RVC))</small>]]
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Osteomyelitis of the bones of the head with surrounding granulomatous tissue and fistulae draining pus containing small yellow granules. 
 
  
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==Treatment==
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====Pathology====
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Treatment is difficult due to the nature of the lesions and poor antibiotic penetration to the site of infection.
 
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In less severe cases where infection of the bones is not advanced treatment with [[Penicillins|penicillin]] or [[Tetracyclines|tetracyclines]] is recommended. Previously it has been suggested that systemic treatment with potassium iodide is successful but this is no longer recommended due to food safety concerns.
 
  
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==Prognosis==
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3 major features:
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Treatment is rarely successful in advanced cases and recurrence of lesions is common; slaughter is advised. 
 
  
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==Literature Search==
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#Inflammatory removal of bone. As cortex of bone is pushed out by central inflammation produces thinning of bone cortex with proliferation of new periosteal bone. The centre of the [[Skull and Facial Muscles - Anatomy & Physiology#Mandible (mandibula)|mandible]] is eroded forming a honeycomb-like bone. Eventually will erode through bone producing [[Granuloma|granulomatous]] lesion on bottom of [[Skull and Facial Muscles - Anatomy & Physiology#Mandible (mandibula)|mandible]] and eventually eroding through skin.
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[[File:CABI logo.jpg|left|90px]]
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#Granuloma with micro abscess's in centre with greenish / yellow granules in middle of pus. These granules known as "sulphur bodies". Sulphur body is a colony of tangled mass of Actinomyces filaments. This is surrounded by [[Neutrophils|neutrophils]] and [[Macrophages|macrophages]] forming a pyogenic granuloma. 
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#Masses of fibrous tissue surround the granuloma and fill the spaces where bone has been destroyed.
  
  
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Use these links to find recent scientific publications via CAB Abstracts (log in required unless accessing from a subscribing organisation).
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*May extend to muscles, especially masseters, from [[Bones Inflammatory - Pathology#Osteomyelitis|osteomyelitis]]
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<br><br><br>
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*Histologically:
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[http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=%22Mandibular+Osteomyelitis%22&occuring1=title&rowId=2&options2=OR&q2=%22Lumpy+jaw%22&occuring2=title&rowId=3&options3=AND&q3=&occuring3=freetext&x=39&y=13&publishedstart=yyyy&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all Mandibular Osteomyelitis publications]
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**Caseous or suppurative centres of lesions
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**Epithelioid and giant cells at periphery
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**'Sulfa granules' at centre - gram-positive branching rods
  
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==References==
 
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* Andrews, A.H, Blowey, R.W, Boyd, H and Eddy, R.G. (2004) '''Bovine Medicine''' (Second edition), ''Blackwell Publishing''
 
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* Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''' ''Merial''
 
  
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{{review}}
 
 
[[Category:Teeth_-_Inflammatory_Pathology]]
 
[[Category:Teeth_-_Inflammatory_Pathology]]
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[[Category:Musculoskeletal Diseases - Cattle]][[Category:Oral Diseases - Cattle]][[Category:Respiratory Diseases - Cattle]][[Category:Bacterial Myositis]]
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[[Category:Cattle]]
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[[Category:Brian Aldridge reviewing]]
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[[Category:To_Do_- lizzyk]]

Revision as of 11:10, 25 July 2010

Lesion caused by Actinomyces Bovis(Courtesy of Alun Williams (RVC))
  • "Lumpy jaw"

Clinical

  • Seen mainly in cattle and exotics caused by Actinomyces bovis producing osteomyelitis of mandible.
  • Mostly young animals.
  • Will not heal without treatment and jaw enlarges until animal cannot eat.

Pathogenesis

  • Starts as alveolar periostitis of lower cheek teeth, due to ingestion of poor coarse roughage e.g. straw or hay with lots of thistles.
  • Slowly enlarging mandible (occasionally maxilla) due to granulomatous inflammation producing much fibrous tissue.
  • No real pus formation but "sulphur granules" in middle of lesion.
  • Organism causes "pyogenic granuloma."
  • Can grow to enormous size (e.g. size of grapefruit) and whole of mandible is blown apart by multiple foci of infection.

Also see:Actinobacillosis - "Wooden Tongue" (Courtesy of Alun Williams (RVC))

Pathology

3 major features:

  1. Inflammatory removal of bone. As cortex of bone is pushed out by central inflammation produces thinning of bone cortex with proliferation of new periosteal bone. The centre of the mandible is eroded forming a honeycomb-like bone. Eventually will erode through bone producing granulomatous lesion on bottom of mandible and eventually eroding through skin.
  2. Granuloma with micro abscess's in centre with greenish / yellow granules in middle of pus. These granules known as "sulphur bodies". Sulphur body is a colony of tangled mass of Actinomyces filaments. This is surrounded by neutrophils and macrophages forming a pyogenic granuloma.
  3. Masses of fibrous tissue surround the granuloma and fill the spaces where bone has been destroyed.


  • May extend to muscles, especially masseters, from osteomyelitis
  • Histologically:
    • Caseous or suppurative centres of lesions
    • Epithelioid and giant cells at periphery
    • 'Sulfa granules' at centre - gram-positive branching rods
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