Bacterial Infections of Orofacial Tissues 1

Question 1

Define bacterial load

Answer 1

Quantity of bacteria in/around tissues

Question 2

Define virulence factors

Answer 2

factors make the bacteria more harmful/more invasive e.g. producing enzymes/ antigenicity

Question 3

Yes/No - do fascial spaces have their own blood supply?

Answer 3

Fascial spaces DO NOT have own blood supply

Question 4

What are the 5 parts of Inflammation?

Answer 4

 Calor (hot)
 Dolor (pain)
 Rubor (redness)
 Tumor (swelling)
 Functio laesi (loss of function)

Question 5

Define abscess

Answer 5

Localised collection of pus (bacteria, tissue, white cells)

Question 6

Define Cellulitis

Answer 6

Spreading infection (No collection of pus but may localise after a few days)

Question 7

What does local infection include?

Answer 7

Redness, pain, induration (hardness), heat, swelling

Question 8

What does regional infection include?

Answer 8

Trismus,
Dysphagia (difficult swallowing),
Difficulty breathing (due to swelling obstructing airway),
Lymphadenopathy (reactive lymph nodes)

Question 9

What is the true regional sign of infection?

Answer 9

LYMPHADENOPAHY

Question 10

How to check the features of infection?

Answer 10

• Is pus present?
• Clinical suspicion
• Spiking temperature (!)
• Aspiration
• Ultrasound (hospital)
• CT (hospital)

Question 11

Why are infections important?

Answer 11

 Common
 Most not life -threatening
 Airway
 Cosmetic complications – e.g. scarring.
 Complications related to local spread -e.g. trismus.
 Confusion with other infections: difficult to work out cause of infection.
 Risk of systemic sepsis- reduce chance of survival, can lead to multiple organ failure, pt ill v quickly and die.

Question 12

Where is the cavernous sinus?

Answer 12

cavity inside brain drains blood, part of venous drainage system of head and neck, located at back of eyes near optic chiasma.

Question 13

Name some of the infections of dental origin

Answer 13

-Gingival abscess
-Sublingual space infection
-Submandibular space infection
-Facial space infection
-Submasseteric abscess
-Upper teeth: Gingival abscess, Sinusitis, Facial space infection

Question 14

How should you manage infections in terms of treatment?

Answer 14

o DO I NEED TO SEND THIS PATIENT TO HOSPITAL?
o Check ABC- Difficulty breathing, swallowing, speaking
o Not 2 week pathway: call ambulance + transfer pt immediately. OR pick up phone and ask for advice from local hospital.
o Cellulitis = Antibiotics
o Pus = relieve + drain pus

Question 15

How do you drain pus?

Answer 15

Local anaesthesia:
o Distant from abscess
o Or Surface only
o Ethyl chloride

Use a knife to make an incision and drain pus.

Question 16

When should you consider antibiotics?

Answer 16

if pus/cellulitis or regional/systemic effects

Question 17

Name examples of antibiotics for bacterial infections

Answer 17

o Amoxicillin 500mg TDS
o Metronidazole 400mg TDS
o Erythromycin 500mg QDS – if allergic to penicillin

Question 18

Which type of people are medically compromised?

Answer 18

▪ Neutropenic (chemotherapy)
▪ Head and neck radiotherapy
▪ Bisphosphonates treatment (cancer/osteoporosis)
▪ Immune compromised
▪ Diabetes

Question 19

What is Ludwigs angina?

Answer 19

Bilateral submandibular space infection with or without sublingual space infection.

Question 20

Why should you refer to hospitally immediately for Ludwigs angina?

Answer 20

Can compromise airway!! Incision and drainage