infections (zebra stuff), and osteomyelitis

Question 1

palatal ulceration differential

Answer 1

salivary gland pathology
salivary gland malignancy including mucoepidermoid carcinoma
squamous cell carcinoma
fungal infection
injection necrosis

Question 2

mucormycosis

Answer 2

• can present as black necrotic eschar in the oral cavity - causes tissue necrosis because the hyphae invade the walls of blood vessels. (hyphae are 90 degree, right angle septations)
• diabetic ketoacidosis, diabetics
• can be locally invasive into bones.
• fungal cultures may not reveal mucor so need biopsy.
• identify if there is any immune compromise going on and treat.
• tx with amphotericin B 5 mg/kg liposomal formulation AND aggressive surgical debridement!

Question 3

cervicofacial necrotizing fasciitis:
more common in:
types
clinical signs
radiographic signs
laboratory signs
tx

Answer 3

necrotizing fasciitis!
- more common in diabetics, alcoholics, malnourished, malignancy, obese, immunocompromised
- clinical signs: erythematous skin, eventually vesicles/blisters, the ducky purple, can have crepitus from air
-radigroaphic signs - soft tissue edam and possibly gas bubbles
- lab studies - extreme leukocytosis, hypocalcemia, elevated blood glucose, elevated BUN, elevated Cr.
tx: debridement, can preserve muscle, biopsies of fascia to identify organism, frozen of skin to determine level of PMN to guide debridement. broad spectrum antibiotics, hydrogen peroxide and iodine and HBO if available.
LRINEC score is CRP, WBC, Hg, Na, Cr, Glucose to help decide if necrotizing fasciitis

Question 4

mediastinitis (infection of) - signs - clinical, radiographic and how to tx

Answer 4

mediastinitis:
clinical signs that would set it apart - chest pain (would do ddx for chest pain - MI, etc, Gerd, costochondritis, etc)
widening mediastinum, increase in size in the alar fascia.
will need cardiothoracic surgeon for mediastinal drainage.

Question 5

osteomyelitis - categories, imaging, tx

Answer 5

categories: acute vs chronic (greater than 1 month)
- suppurative and non suppurative

• v3 hypoesthesia

other imaging modalities:
screening pano
MRI only if no crowns
CT scan - need 30% demineralization
radio nucleotide imaging - tech 99 and gallium 67
white blood cell tagging.
PET-CT

tx: decortication, marrow derided till bleeding bone, removal of infected teeth/affected teeth. can do corticotomies as well? irrigation, and send bone for path and micro - aerobe, anaerobe , fungal.
will likely need IV antibiotics - start with broad and narrow based on micro -