are predisposing factors to infection 5
.
Bone TB is a relatively uncommon form of
extrapulmonary tuberculosis seen in approximately 1% of
children with TB
7
. It is more frequently seen in children
as compared to adults because of highly vascularized
bone in infants and children
8
. Tuberculous osteomyelitis
is quite rare and constitutes less than 2% of skeletal TB.
Jaw involvement is even rarer and affects older individual
3,9,10
and also children
3, 5
The involvement of the mandible by TB infection is
extremely rare as it contains less cancellous bone. But the
mandibular involvement is more frequent than maxilla
11
and the alveolar and angle regions have greater affinity.
The infection may extend to the mandible by:
1) Direct transfer from infected sputum or infected raw milk
of cow through an open pulp in carious tooth, an
extraction wound or gingival margin or perforation of an
erupting tooth
2) Regional extension of soft tissue lesion to involve the
underlying bone
3) Haematogenous route
11
Chapotel
12 described four clinical forms of
tuberculosis of the mandible.
1. The superficial or alveolar form in which the alveolar process
is involved either by direct extension of the tuberculous
gingival tissues or by way of a deep carious tooth. The
course is usually chronic, and necrosis of bone is
progressive, with the formation of abscesses and fistulae.
2. The deep or central form, in which the lesion involves the
angle of the mandible. It is found, according to Chapotel,
almost exclusively in children during the period of eruption of molar teeth.
