CHAP 2-CELLULITIS INFECTIONS Flashcards
Development of periodontitis
1- Acute suppurative periodontitis or periapical abscess
2-Subperiosteal abscess (Pain+frequent in mandible because of periosteum thickness)
3-It breaks through the periosteum and reaches the soft tissue: cellulitis
4-Clearly limited purulent accumulation abscess
Suppurative periodontitis
1-Pain: acute, throbbing
2-Localization: affected tooth
3-Occlusion: increases pain==>(on contact with the 4-antagonist’s tooth)
4-Grown tooth sensation
5-Dull percussion sound
6-Tooth discoloration
7-Pressure, exit of purulent exudate by alveolar route
8-Negative vitality
9-Radiological exploration: periodontal ligament slightly increased or loss of definition of the lamina dura
P E R I C O R O N I T I S
- 3rd mandibular molar
- Acute infectious process
- 2º - 3º decade
- Acute or chronic exacerbation
C L I N I C
Congested and slightly detached mucosa
Spontaneous secretion or when pressure is applied
serous or suppurative
Retromolar area: pain
Trismus and biting of own gum
Evolution: stomatitis, abscesses, osteitis, cellulitis…
Constant Submandibular lymphadenopathy
Congestive Adenitis
1-Ganglion palpable (volume increase)
2-Slightly painful
3-Isolated from the adjacent planes
Suppurative Lymphadenitis
1)+ volume + pain
2)Loss of limit (no mobility)
3)Fluctuation
4)Altered general condition: Fever, tachycardia, and suppurated collection
A d e n o p h l e g m o n
1-Adverse effect on periganglionar tissue
2-Very painful and intense swelling followed by hardening of the tissue
3-Trismus and torticollis
4-Fluctuation, skin infiltration (fingerprint sign)
Affection of mucosa or cellular tissue
Adenoplegmon
Decay, periodontitis, osteitis
Decay, periodontitis, osteitis: no adenopathy
C E L L U L I T I S
Tissue inflammation in the regions of the mouth, face, and neck
It overwhelms the affected tooth causing disproportionate symptoms with respect to its volume, intensity , extension, and general affection
C E L L U L I T I S : coming from
-Periodontitis
-osteitis
-periostitis
-cellulitis
1- Pain: acute, pulsating, piercing, but not as intense/localized than periodontitis
2-Flushing
3-Heat, tumor, doughy hard erasing skin folds
4-Loss of function + alerted general condition
5-Overgrown tooth sensation
6-Trismus
C E L L U L I T I S : Stage
1) Not soft tissue destruction
2) Not pus collection
3)It can be transformed into abscess
4)Alarming general symptoms
5)Disproportionate symptoms
6)It can spread through distant areas
Abscess
1-L o c a l i z e d
2-Clinic: palpable , Fluctuation sign
3-Pain: deep, dull , continuous (less than in cellulitis : walling of ==> pressure goes out ), stabbong
4-intraoral drainage
5-Skin drainage : fistula => pus
6-Remote progression: continuity, lymphatic or haematic route
I-A.C.Se Cellulitis
(Acute Circumscribed Serous)
Phlegmon
1-Localized swelling (+or- intense) near the causing tooth
2-Increases with decubitus
3-Fills oral or facial lines and smooths out the contours: no limits
4-Tooth discoloration
5-Possible pain in the tooth where the process started
6-Edema
Good progression with the correct etiological treatment
phlegmon can turn into suppurative cellulits
II-A.C.Su Cellulitis
(Acute Circumscribed Suppurative cellulitis)
before abscess
1-Virulent microorganism mishandled antibiotic treatment, w/o appropriate drainage
2-More intense onset that the serous
3-Typical signs or periodontitis in causing tooth (pain, discoloration, + percussion)
4-Reddish swelling that fluctuates. Fluctuation_fingerprint sign
5-Malaise ( functional impotence , asthenia , abnormal blood count)
6-Remote general disorders ( cellular spaces , muscle insertions)
7-Fluctuation , function impotence , trismus
A.C.Se Cellulitis_Phlegmon Type
In MANDIBLE
ESCAT PHLEGMON
ESCAT PHLEGMON_Origin
mostly from 3rd molar infections , but sometimes is a 2ndary origin from submaxillary area
ESCAT PHLEGMON_CLINICS
No extraoral tumefaction
Intense Trismus
Pain on swallowing (Odinophagya) and in tonsilar area
Pain under Medial Pterygoidal muscle palpation
DD: with tonsils processes
A.C.Su Cellulitis_bf abscess Type
In MAXILLA
1) Buccal vestibule :
through BUCCINATOR => intobthe mouth or above the facial muscle => buccal root
can invade these space : C , nasopalpebral , Nasal floor , bridges spaces
2)Palatal :
cellulitis : palatal abscess => through palatal roots
A.C.Su Cellulitis_bf abscess Type
In MANDIBLE
1) CHOMPRET AND L’HIRONDEL: migratory abscess
2)Supramylohyoid
3)Inframylohyoid
1) CHOMPRET AND L’HIRONDEL: migratory abscess
Buccal localisation : origine in the third onferior molar , foward OOZING through the chompret quadrilateral
2)Supramylohyoid
Internal with elevation of the mouth and tongue uni or bilateral localisation => Severe , because it can get to the lingual spaces => I, C
3)Inframylohyoid
Suppuration propagates to cervical , pterygomandibular and parapharyngeal space
-Intense trismus
=>PM , M
Desseminated cellulitis
- They are always secondary from primary locations, through the aponeurotic
spaces - They are not spreading from the beginning
- Clinical symptoms depending on the region: parotid, zygomatic, temporal,
pharyngeal… - Risk depending on localisation
- General slight symptoms
Desseminated cellulitis
1) Parotid region
2) Infratemporal or zygomatic space
3) Temporal space: -superficial, -Deep
4)Parapharyngeal space :
-Lateral
-Retropharyngeal
-Mediastinisits:mediastinum
- Involvement of the carotid sheath
1) Parotid
Swelling from zygomatic arch to the inferior border of mandible, raising the earlobe.
Severe pain radiating to the ear, exacerbated by chewing.
NO TRISMUS
2) Infratemporal or zygomatic space
Extraoral swelling : above the sigmoid notch
Intraoral swelling: maxillary tuberosity area
ALWAYS TRISMUS
3) Temporal space
Swelling between the upper limit of the temporal aponeurosis and the zygomatic arch.
Superficial cellulitis: Pain and trismus.
Deep cellulitis: less swelling.
Trismus and pain.
When it coexists with buccal cellulitis: swelling with an hourglass shape.
4) Parapharyngeal space: Lateral
Pain , dysphagia , irradiation to the ear , trismus , tonsillar pillars moved inward , deviated uvula , normal tonsil
4) Parapharyngeal space: Retropharyngeal
Pain , dysphagia , dyspnea and stiff neck
The swelling appears in the posterior pharyngeal wall
DIFFUSE ACUTE CELLULITIS
- Rare process today
-Serious toxic shock syndrome of sudden onset
-It doesn’t respect any anatomic barrier
-AP: muscular necrosis preceding suppuration
==>Not due to a bad treatment
DIFFUSE ACUTE CELLULITIS
1)Ludwig’s Angina
2)Infra mylohyoid Cellulitis (Patel y Clavel)
3)Peri pharyngeal diffuse cellulitis of Senator
4)Diffuse facial cellulitis
5)Cervicofacial necrotizing fasciitis
1) Ludwig’s Angina : Supramylohyoid Origin
- Swelling of the sublingual, submandibular, and submental space
- 6 INF.
- Hard and painful swelling: no fluctuation. It gets established and spreads rapidly
1) Ludwig’s Angina : Supramylohyoid
-Clinical symptoms
- Open mouth, raised floor of the mouth, protrusion and upward
displacement of the tongue - Breathing, swallowing, and phonatory difficulty
- Trismus and fetid saliva
1) Ludwig’s Angina : Supramylohyoid
EVOLUTION
- Pterygomandibular, peri pharyngeal space and mediastinum
- Complications: suffocation, septicemia, mediastinitis
2)Infra mylohyoid Cellulitis (Patel y Clavel)
- Suprahyoid Cellulitis
- Submandibular-submental-Submandibular
2)Infra mylohyoid Cellulitis (Patel y Clavel)
EVOLUTION
- Yugular and carotid spaces
3) Peripharyngeal diffuse cellulitis of Senator
- Pharyngeal condition. 3º molar rare
- Retro pharynx- tonsils- tonsillar pillars- soft palate
3) Peripharyngeal diffuse cellulitis of Senator
-CLINICAL SYMPTOMS
- Pain (thyroid cartilage), dysphonia, dyspnea
- Bilateral submandibular and anterior cervical edema
- Edema of glottis
4) Diffuse Facial Cellulitis
-Superior (Buccal)
- Invasion of hemiface_submasseteric_parotid
_submandibular_temporal spaces
-Sometimes deep origin from pterygomaxillary space
4) Diffuse Facial Cellulitis
Clinical symptoms
-Extensive edema with purple skin (necrotizing) pain and trismus
5) Cervicofacial necrotizing fasciitis
-Dental or cutaneous origin
-Rapid invasion of the neck (fascias and muscles)
-Necrosis and fistulas
COMPLICATIONS :
-Thrombophlebitis-Septicaemia
CHRONIC CELLULITIS
Slow evolution, different etiology, similar clinic
Chronic beginning or after an acute form
Different forms and origins but same clinic
CHRONIC CELLULITIS
- CIRCUMSCRIBED CHRONIC CELLULITIS
- ACTINOMYCOTIC CHRONIC CELLULITIS
3.WOOD-LIKE/FUNGAL CHRONIC CELLULITIS
1.CIRCUMSCRIBED CHRONIC CELLULITIS
1) Due to: Inadequate treatments
2) Slow and insidious onset
3) Firm node, regular contour, painless
4) Not movable
5) Fistulae-Intraoral fibrous cord
6) No altered general condition
- ACTINOMYCOTIC CHRONIC CELLULITIS
1) Chronic granulomatous lesion
2) Many fistulae and pus production ; Sulfur grain appearance
3) It coexists with abscesses ,
4) 75% of all actinomycosis in maxillofacial region
5) Background of trauma of tooth extraction
6) Subcutaneous swelling:
-Elevated plaque - Not Painful - Unclear limits
Fistula : serous or pus
3.Wood-like/fungal Chronic cellulitis
1) Multiple germs associated to fungi
2)Secondary to an acute cellulitis or form its starting point
3)Hard and adhered swelling
4)Purple and painless skin ( necrosis) Slow evolution
5)Fluctuation areas , abscesses , blind pr purulen fistulae
6)Great extension , compressing neighbour nerves and vessels
7)Capacity of recurrence and fistulization
9)Scares
