Infection Flashcards
What is your initial subjective work-up of an infection?
Determine severity:
-History
-Onset
-Duration
-Rate of progression
-Previous treatment
-Medically compromised host
What is your physical exam for an infection?
-Pain, swelling, erythema, purulence, warmth, loss of function
-Vitals: Malaise, temp, tachycardia
-Labs: Leukocytosis
-Airway eval/management
How should airway be evaluated and managed in an infection?
Eval:
-Mallampati Class, obstruction (stridor, coarse airway sounds, sniffing position)
-Trismus (masticator/pterygomandibular)
-O2 sat <94%
Management:
-Pt should be sitting up with supplemental oxygen and suction
-Fiberoptic scope by ENT
-Early intubation (awake fiberoptic, tracheotomy)
What imaging do you obtain and what do you look for with an infection?
-CT with contrast
-Rim enhancing lesions, airway deviation, gas formation
-Obtain a new CT for any worsening scenerio
What is the pathogenesis of an odontogenic infection?
-Establishment of infection
-Spread through cancellous bone
-Erosion through cortical bone
-Enter soft tissue
-Facial plane infection
-Fascial spaces- Potential spaces between anatomic structures, act as barriers to limit spread of infection but do connect and allos spread of infection
What are the borders of the buccal space?
-Anterior: Corner of mouth
-Posterior: Masseter m, pterygomandibular space
-Superior: Maxilla, infraorbital space
-Inferior: Mandible tissue and skin
-Superficial: Subcutaneous
-Deep: Buccinator m
What are the borders of the infraorbital space?
-Anterior: Nasal cartilage
-Posterior: Buccal space
-Superior: Quadratus labii superioris m
-Inferior: Oral mucosa
-Superficial: Quadratus labii superioris m
-Deep: Levator anguli oris m, maxilla
What are the borders of the submandibular space?
-Anterior: Anterior belly digastric m
-Posterior: Posterior belly of digastric, stylohyoid, stylopharyngeus mm
-Superior: Inferior/medial surface of mandible
-Inferior: Digastric tendon
-Superficial: Platysma m
-Deep: Mylohyoid, hypoglossus, superior constrictor mm
What are the borders of the submental space?
-Anterior: Inferior border of mandible
-Posterior: Hyoid bone
-Superior: Mylohyoid m
-Inferior: Investing fascia
-Superficial: Investing fascia
-Lateral: Anterior bellies of digastric m
What are the borders of the sublingual space?
-Anterior: lingual surface of mandible
-Posterior: submandibular space
-Superior: Oral mucosa
-Inferior: mylohyoid m.
-Medial: Tongue muscles
-Lateral: Lingual surface of mandible
What are the borders of the pterygomandibular space?
-Anterior: Buccal space
-Posterior: Parotid gland
-Superior: Lateral pterygoid m
-Inferior: Inferior border of mandible
-Medial: Medial pterygoid m
-Lateral: Ascending ramus of mandible
What are the borders of the submasseteric space?
-Anterior: Buccal space
-Posterior: Parotid gland
-Superior: Zygomatic arch
-Inferior: Inferior border of mandible
-Medial: Ascending ramus of mandible
-Lateral: Masseter m.
What are the borders of the lateral pharyngeal space?
-Anterior: Superior and middle pharyngeal constrictor m
-Posterior: Carotid sheath
-Superior: Skull base
-Inferior: Hyoid bone
-Medial: Pharyngeal constrictors and retropharyngeal space
-Lateral: Medial pterygoid m
What are the borders of the retropharyngeal space?
-Anterior: Superior and middle pharyngeal constrictor m
-Posterior: Alar fascia
-Superior: Skull base
-Inferior: Fusion of alara and prevertebral fascia at C6-T4
-Lateral: Carotid sheath and lateral pharyngeal space
What are the borders of the pretracheal space?
-Anterior: Sternothyroid-thyrohyoid fascia
-Posterior: Retropharyngeal space
-Superior: Thyroid cartilage
-Inferior: Superior mediastinum
-Medial: Sternothyroid-thyrohyoid fascia
-Lateral: Visceral fascia over trachea and thyroid gland
What is Ludwig’s angina?
Bilateral submandibular, sublingual and submental space cellulitis may extend to epiglottis, rarely fluctuant. Hot potato voice
What are the borders of the deep temporal space?
-Anterior: Infratemporal surface of maxilla and posterior surface of orbit
-Posterior: Attachment to temporal bone
-Superior: Attachment to temporal bone
-Inferior: Lateral pterygoid muscle
-Medial: Temporal and sphenoid bone
-Lateral: Temporalis muscle
What are the classifications of the orbital space?
Preseptal: No involvement of EOMI, no change in vision, no globe issues
Postseptal: Proptosis, othalmoplegia, extension from sinuses
What are the bacterial differences between cellulitis and an abscess?
Cellulitis: Aerobic
Abscess: Anaerobic
What is the microbiology of infections?
Polymicrobial, mix of aerobic/anaerobic bacteria
Aerobic:
-Gram + cocci: Strep viridans, staph, eikenella
-Gram - rods: Haemophilus
Anaerobic:
-Gram + cocci: Strep, peptostrep
-Gram - rods: Prevotella, porphyromonas (bacteroides), fusobacterium
What is the pathobiology of an infection?
-Aerobic bacteria gain entrance into tissue
-Development of cellulitis leads to tissue hypoxia and acidosis with resultant favorable anaerobic environment
-Anaerobes follow with tissue destruction
-Development of purulence
What is bacteremia, sepsis, septic shock?
-Bacteremia: Bacteria in bloodstream
-Sepsis: Bacteremia causing systemic immune response
-Septic shock: Sepsis with drop in BP and organ failure such as vasodilation, renal failure, ARDS, DIC, release of tumor necrosis factor
What systemic diseases can affect the hosts defense in an infection?
-Uncontrolled metabolic/accquired immunodeficiency: DM, renal failure, ETOH abuse, IV Drug abuse, malnutrition, HIV, collagen vascular disease
-Suppressing diseases: Leukemia, lymphoma, malignant neoplasm
-Suppressing drugs: Cancer chemotherapy, immunosuppressive (transplant pts), chronic corticosteroids
What are the criteria for inpatient management of an infection?
-Toxic appearance
-Severe trismus (masseteric, temporal)
-Difficulty speaking/swallowing/handling secretions
-Temp over 101
-Rapid progression
-Compromised host
-Secondary facial space involvement
