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CHIR IV > CHAP 2-CELLULITIS INFECTIONS > Flashcards

CHAP 2-CELLULITIS INFECTIONS Flashcards

1
Q

Development of periodontitis

A

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

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2
Q

Suppurative periodontitis

A

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

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3
Q

P E R I C O R O N I T I S

A
  • 3rd mandibular molar
  • Acute infectious process
  • 2º - 3º decade
  • Acute or chronic exacerbation
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4
Q

C L I N I C

A

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

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5
Q

Congestive Adenitis

A

1-Ganglion palpable (volume increase)
2-Slightly painful
3-Isolated from the adjacent planes

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6
Q

Suppurative Lymphadenitis

A

1)+ volume + pain
2)Loss of limit (no mobility)
3)Fluctuation
4)Altered general condition: Fever, tachycardia, and suppurated collection

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7
Q

A d e n o p h l e g m o n

A

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)

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8
Q

Affection of mucosa or cellular tissue

A

Adenoplegmon

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9
Q

Decay, periodontitis, osteitis

A

Decay, periodontitis, osteitis: no adenopathy

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10
Q

C E L L U L I T I S

A

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

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11
Q

C E L L U L I T I S : coming from
-Periodontitis
-osteitis
-periostitis
-cellulitis

A

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

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12
Q

C E L L U L I T I S : Stage

A

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

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13
Q

Abscess

A

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

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14
Q

I-A.C.Se Cellulitis
(Acute Circumscribed Serous)
Phlegmon

A

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

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15
Q

II-A.C.Su Cellulitis
(Acute Circumscribed Suppurative cellulitis)
before abscess

A

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

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16
Q

A.C.Se Cellulitis_Phlegmon Type

A

In MANDIBLE
ESCAT PHLEGMON

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17
Q

ESCAT PHLEGMON_Origin

A

mostly from 3rd molar infections , but sometimes is a 2ndary origin from submaxillary area

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18
Q

ESCAT PHLEGMON_CLINICS

A

No extraoral tumefaction
Intense Trismus
Pain on swallowing (Odinophagya) and in tonsilar area
Pain under Medial Pterygoidal muscle palpation
DD: with tonsils processes

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19
Q

A.C.Su Cellulitis_bf abscess Type
In MAXILLA

A

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

20
Q

A.C.Su Cellulitis_bf abscess Type
In MANDIBLE

A

1) CHOMPRET AND L’HIRONDEL: migratory abscess
2)Supramylohyoid
3)Inframylohyoid

21
Q

1) CHOMPRET AND L’HIRONDEL: migratory abscess

A

Buccal localisation : origine in the third onferior molar , foward OOZING through the chompret quadrilateral

22
Q

2)Supramylohyoid

A

Internal with elevation of the mouth and tongue uni or bilateral localisation => Severe , because it can get to the lingual spaces => I, C

23
Q

3)Inframylohyoid

A

Suppuration propagates to cervical , pterygomandibular and parapharyngeal space
-Intense trismus
=>PM , M

24
Q

Desseminated cellulitis

A
  1. They are always secondary from primary locations, through the aponeurotic
    spaces
  2. They are not spreading from the beginning
  3. Clinical symptoms depending on the region: parotid, zygomatic, temporal,
    pharyngeal…
  4. Risk depending on localisation
  5. General slight symptoms
25
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
26
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
27
2) Infratemporal or zygomatic space
Extraoral swelling : above the sigmoid notch Intraoral swelling: maxillary tuberosity area ALWAYS TRISMUS
28
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.
29
4) Parapharyngeal space: Lateral
Pain , dysphagia , irradiation to the ear , trismus , tonsillar pillars moved inward , deviated uvula , normal tonsil
30
4) Parapharyngeal space: Retropharyngeal
Pain , dysphagia , dyspnea and stiff neck The swelling appears in the posterior pharyngeal wall
31
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
32
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
33
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
34
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
35
1) Ludwig’s Angina : Supramylohyoid EVOLUTION
* Pterygomandibular, peri pharyngeal space and mediastinum * Complications: suffocation, septicemia, mediastinitis
36
2)Infra mylohyoid Cellulitis (Patel y Clavel)
- Suprahyoid Cellulitis - Submandibular-submental-Submandibular
37
2)Infra mylohyoid Cellulitis (Patel y Clavel) EVOLUTION
- Yugular and carotid spaces
38
3) Peripharyngeal diffuse cellulitis of Senator
- Pharyngeal condition. 3º molar rare - Retro pharynx- tonsils- tonsillar pillars- soft palate
39
3) Peripharyngeal diffuse cellulitis of Senator -CLINICAL SYMPTOMS
- Pain (thyroid cartilage), dysphonia, dyspnea - Bilateral submandibular and anterior cervical edema - Edema of glottis
40
4) Diffuse Facial Cellulitis
-Superior (Buccal) - Invasion of hemiface_submasseteric_parotid _submandibular_temporal spaces -Sometimes deep origin from pterygomaxillary space
41
4) Diffuse Facial Cellulitis Clinical symptoms
-Extensive edema with purple skin (necrotizing) pain and trismus
42
5) Cervicofacial necrotizing fasciitis
-Dental or cutaneous origin -Rapid invasion of the neck (fascias and muscles) -Necrosis and fistulas COMPLICATIONS : -Thrombophlebitis-Septicaemia
43
CHRONIC CELLULITIS
Slow evolution, different etiology, similar clinic Chronic beginning or after an acute form Different forms and origins but same clinic
44
CHRONIC CELLULITIS
1. CIRCUMSCRIBED CHRONIC CELLULITIS 2. ACTINOMYCOTIC CHRONIC CELLULITIS 3.WOOD-LIKE/FUNGAL CHRONIC CELLULITIS
45
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
46
2. 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
47
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

CHIR IV (5 decks)

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