I & D Flashcards
A. What are the diagnostic criteria for performing I&D?
A patient presenting with swelling can have multiple manifestations.The swelling may be fluctuant or firm. It can also be localized or diffuse, also referred to as cellulitis. Localized swellings are confined within the oral cavity, whereas cellulitis can spread to adjacent soft tissues along fascial planes (Natkin 1974; Sandor et al. 1998). Incision and drainage is indicated when soft tissue swelling is present and drainage through the canal system cannot be achieved. I&D is most effective when the swelling is localized, soft and fluctuant (Frank et al. 1983).
B. What are the advantages of I&D?
Incision and drainage allows for decompression of the edematous tissues and provides significant pain relief for the patient. I&D also prevents further spread of infection through fascial planes and muscle attachments. I&D provides a portal for irrigation and placement of the drain. During I&D, a pathway is created for bacterial by‐products, as well as inflammatory mediators (Wolcott, Rossman & Hasselgeren 2011). However, I&D allows for the collection of samples for culturing the offending microorganisms. More importantly, I&D will alter the chemical environment to one that is more aerobic, thus less optimal for the more virulent anaerobic bacteria.
C. What are the main principles of I&D?
The main principles for performing I&D are:
• A stab incision needs to be made through the
periosteum, at the point of greatest fluctuance.
• The incision should be parallel to the blood
vessels.
• The incision should avoid any vital structures
(Siqueira & Rocas 2011).
• The incision should be made on healthy skin or
mucosa, as incising areas manifesting breakdown, such as a sinus tract, will delay healing and may lead to scar formation.
• All areas of the abscess cavity should be explored, allowing for compartmentalized areas to be evacuated.
• Warm saltwater rinses should be used to keep the incision site clean, and also to increase blood flow o the area, intensifying host defenses (Harrington & Natkin 1992).
D. What are the main adjuncts to performing I&D?
No pain medication or antibiotic can replace the role of debridement of the root canal system or of I&D of the associated soft tissues. However, both classes of medications are important adjuncts that can be used to provide more rapid and consistent relief to the patient.
The prescription of antibiotics should always be judicious and reserved for patients presenting systemic involvement. Symptoms such as high fever, trismus, and malaise warrant the prescription of antibiotics. Patients who show signs of progres- sive infection when all above‐mentioned interven- tions have been performed or immunocompromised patients are also indicated for antibiotic treatment (Harrington & Natkin 1992; Sandor et al. 1998).
NSAIDs, and especially ibuprofen, are the drug of choice for acute dental pain. Because of their anti‐ inflammatory effect, NSAIDs can suppress swelling and have analgesic and antipyretic properties.
E. Describe the armamentarium for I&D.
The instrument tray for I&D should hold:
• Aspirating syringe for local anesthesia
• #15 blade and blade holder
• Curved and/or straight mosquito hemostat • Gauze director
• Needle holder, suture material, and scissors
• One‐quarter inch Penrose drain
• Culture bottle and/or a syringe to aspirate pus to
send for culture
• Gauze dressing, bandage, tape, etc.
• Skin scrub preparation, alcohol sponge,
disinfectant
F. Which are the fascial spaces of the head and neck?
A case presenting with swelling can develop into a life‐threatening medical emergency. Depending on the location of the apices of the infected tooth as it relates to the muscular attachments, the swelling can be localized or it can extend into a fascial space.
An odontogenic infection can spread through these potential anatomic areas:
Mandible and below (buccal vestibule, body of mandible, mental space, submental space, sublin- gual space, submandibular space)
• Cheek and lateral face (buccal vestibule, buccal space, submasseteric space, temporal space)
• Pharyngeal and cervical areas (pterygomandibu- lar, parapharyngeal, cervical)
• Midface (palate, base of upper lip, canine spaces, periorbital spaces) (Hohl et al. 1983)
Any swelling involving the submental, sublingual, and submandibular spaces is diagnosed as Ludwig’s angina.These cases should be immediately referred to the hospital, ER, or an on‐call oral surgeon, as they can advance into the pharyngeal and cervical spaces, obstructing the patient’s airway.
