Deep Neck Infections Roop/Jaffe Flashcards
What is Keflex? What type of bacteria does it work best with (gram pos or neg?) What generation is it?
a cephalosporin antibiotic that works best with gram positive bacteria
cephalexin is a class of meds called cephalosporin
its a 1st gen antibiotic
How many generations are there of cephalosporin?
5
How many generations are there of cephalosporin against MRSA?
5
What is inspiratory stridor and what does it most likely indicate?
test q!!!!!!
-an abnormal, high-pitched respiratory sound
-noisy breathing usually due to obstructed airflow through narrowed airway
-most commonly caused by
1) an object blocking the airway
2) swelling in throat or upper airway
3) trauma to the airway
-indicates airway obstruction above the glottis
Define dyspnea
difficulty breathing
define dysphagia
difficulty swallowing
What is trismus?
-jaw muscles become so tight that you cannot open mouth
-muscle spasms in temporomandibular joint (TMJ)
-commonly referred to as “lockjaw”
-normal motion of the mandible is reduced as a result of sustained, tetanic spasm of the masticatory muscles mediated by the trigeminal nerve
Erythema, edema, and pain- what do they indicate?
inflammation!
Pt had an infected tooth which turned into an abscess. It has progressed to the soft tissue. What is this known as?
cellulitis!
The submandibular space extends from….
hyoid bone up to the floor of the mouth
The submandibular space is bound by what?
-anteriorly and laterally by the mandible
-inferiorly by superficial layer of deep cervical fascia
-medially by the anterior belly of the digastric muscle
-posteriorly by submandibular gland
-superiorly by the mylohyoid muscle
The three paired neck triangles are the…… and the unpaired triangle is the…..
paired=
-submandibular (digastric) triangle
-carotid triangle
-muscular triangle
unpaired= submental triangle
The submandibular space communicates with what spaces?
-Lateral pharyngeal space (also known as parapharyngeal space)
-Pterygomandibular space
-Retropharyngeal space
-Sublingual space
What caused deviation of the trachea for the pt with the infected tooth that got abscess and spread? What would show this in tests?
the deviated trachea indicates a compression or blockage
the infection that formed the abscess, spread and compressed the trachea, causing it to deviate
will be seen in x-ray and stridor breath sounds
Deep neck problems fall into 4 major categories. What are they?
1) congenital
2) vascular
3) infectious (pt case study had this one)
4) neoplastic
Congenital deep neck problems can lead to what 2 things?
1) aphasia/hypoplasia of salivary glands
2) dermoid/epidermoid cyst
Vascular deep neck problems will lead to what?
low or high blood flow, which will have its own set of issues
Low blood flow vascular deep neck problems will lead to what 2 things?
venous or lymphatic malformations
High blood flow vascular deep neck problems will lead to what?
arterial malformations
Infection/inflammation deep neck problems will lead to what?
-cellulitis
-ludwig angina
-abscess ranula
-sialadenitis
What are the 2 types of neoplastic deep neck problems?
benign or malignant
What are the types of benign neoplasms in the deep neck?
-lipoma
-primary salivary gland tumors
-neurogenic tumors
What are the types of malignant neoplasms in the deep neck?
-squamous cell carcinoma
-primary salivary gland tumors
-lymphoma
What is sialadenitis? What is it caused by?
-refers to a swollen salivary gland
-salivary infection most commonly affecting the parotid glands or submandibular salivary glands
-can spread to the deep tissues of the head and neck
-caused by bacteria or viruses
What are the symptoms of sialadenitis?
-Pain, tenderness and redness
-Hard swelling of the salivary gland and the tissues around it
-Fever and chills
-Drainage of infectious fluid from the gland
What is ludwig angina?
-type of bacterial infection that occurs in the floor of the mouth, under the tongue
-often develops after an infection of the roots of the teeth (such as tooth abscess) or a mouth injury
-most commonly affected space= submandibular
-uncommon in children
-chest pain
What are the symptoms of ludwig angina?
1) swelling of the tongue
2) neck pain
3) breathing problems
4) chest pain
What is abscess ranula?
-clear or bluish cysts caused by a blocked salivary gland in the mouth
-slow-growing benign growths found on the floor of the mouth and can vary in size (some cysts remain small, whereas others enlarge and cause problems)
-saliva-filled cyst due to leakage from a damaged salivary gland
-can be due to trauma, injury, or spontaneous
What are the symptoms of abscess ranula?
-clear or bluish lump on the floor of mouth (most common symptom of a ranula under tongue)
-swelling that goes up and down
-usually start out around 2-3 inches in diameter (sometimes they empty, but then fill up again and they can grow larger over time)
What is the first priority in management of the pt with tooth abscess/deep neck infection?
-Make sure pt has an airway (avoid doing intubation bc you can rupture the abscess)
-treatment= tracheostomy and extraction
What is the full treatment plan for the pt with tooth abscess/deep neck infection?
1) tracheostomy
2) tooth extraction
3) incision and drainage
4) penrose drain placement
5) antibiotics and/or steroids
What is a penrose drain?
-surgical incision is made to keep area open (cannot close it because pt has infection)
-its a soft, flat, flexible tube
-penrose drain allows any unwanted bodily fluids to drain/come out (like blood)
What are the boundaries of the oral cavity?
oral labia to oropharynx
(oropharynx is separated from oral cavity by palatopharyngeal arches)
What oral cavity structures are implicated in a tooth abscess infection?
upper (maxilla) and lower jaw (mandible) bones
What is the normal dentition for an adult? Child?
adult= 32 teeth
child= 20 primary teeth by 3 y/o
What are the 4 different types of teeth?
1) incisors
2) canines
3) premolars
4) molars
The three main parts or regions of a tooth include the…
1) crown
2) neck
3) root
Teeth are composed of 4 tissues. Name them
1) enamel
2) dentin
3) pulp cavity (the center of the tooth that contains nerves, blood vessels and connective tissue)
4) apical foramen (connects the nerves and blood vessels from the pulp cavity to join the gingiva)
What is the nerve supply to the gingiva and teeth?
all the nerves supplying the gingival mucosa originate from the mandibular and maxillary branches of the trigeminal nerve (CN V)
What is the blood supply to the gingiva and teeth?
branches of the maxillary artery:
-posterior superior alveolar artery (upper posterior teeth and upper molars)
-inferior alveolar artery
-buccal artery
-greater and lesser palatine arteries
-sphenopalatine arteries
What is the lymphatic drainage of the gingiva and teeth?
-lymph vessels from the teeth usually run directly into the submandibular nodes on the same side
-lymph from the mandibular incisors drains into the submental nodes
-occasionally, lymph from the molars passes directly into the jugulodigastric group of nodes
Is the mandible or maxilla fixed in place?
maxilla
What is a useful landmark on the mandible for palpation?
brim of mandible
Is a tooth in its socket considered a joint?
yes
What are the 3 functional classifications of joints? Which one is teeth?
1) synarthrosis (immovable), ex: teeth
2) amphiarthrosis (slightly moveable)
3) diarthrosis (freely moveable)
What is gomphoses?
a fibrous mobile peg-and-socket joint
The roots of the teeth (the pegs) fit into their sockets in the mandible and maxilla and are the only examples of this type of joint
What is cementum?
connective tissue holding tooth to the gum line (periodontal ligament is what attaches to tooth)