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Oral Surgery III > Management of Complex Orofacial Infections > Flashcards

Management of Complex Orofacial Infections Flashcards

1
Q

spread of odontogenic infections may involve:

A
  • soft tissue/fascial spaces- more common
  • osseous structures (osteomyelitis)- less common
  • vital structures- orbits, CNS, thoracic cavity
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2
Q

generally infections follow the path of:

A

least resistance

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3
Q

what is the spread of oro facial infections dictated by

A

anatomic location of teeth, position of muscle attachments, bone density

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4
Q

infective processes can spread by:

A

disruption of intervening fascial planes

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5
Q

what are fascial spaces

A

potential spaces between the fascia and underlying organs/tissues

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6
Q

when do fascial spaces not exist

A

in a healthy state

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7
Q

fascial spaces can distended by:

A

fluid or infective process

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8
Q

infective process can be spread from one area to the adjoining ones by:

A

disruption of intervening fascial plane or around perforating blood vessels and nerves

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9
Q

what are the spaces involved in odontogenic infections

A
  • primary maxillary spaces: canine, buccal, infratemporal
  • primary mandibular spaces: submental, buccal, submandibular, sublingual
  • secondary fascial spaces: masseteric, pterygomandibular, superficial and deep temporal, lateral pharyngeal, retropharyngeal, prevertebral
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10
Q

what are the boundaries of facial space

A
  • fascial layers or planes
  • muscles
  • bone
  • skin
  • mucous membranes
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11
Q

what is considered in determining whether to be treated by dentist or a oral and maxillofacial surgeon

A
  • rapidly progressing infection
  • difficulty breathing
  • difficulty swallowing
  • fascial space involvement
  • elevated temperature- greater than 101F
  • trismus (less than 10mm)
  • toxic appearance
  • compromised host defense
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12
Q

what types of drains are available

A
  • penrose drain
  • corrugated drain
  • glove drain
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13
Q

space infections that can arise from a maxillary odontogenic infection

A
  • canine/infraorbital space
  • buccal space
  • infratemporal space
  • temporal space
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14
Q

infection spreads to the canine/infraorbital space through:

A

the root apices of the maxillary teeth usually the canine

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15
Q

I and D of the canine/infraorbital space achieved through ____ approach

A

intra oral

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16
Q

direct surgical access in I and D of the canine/infraorbital space is achieved via:

A

incision in the depth of the maxillary labial vestibule adjacent to the tooth causing the infection

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17
Q

buccal space infection presents as:

A

dome shaped swelling

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18
Q

where is the buccal space

A

between the buccinator muscle and overlying skin and the superficial fascia

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19
Q

the buccal space may become involved via:

A

upper jaw or lower jaw molars

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20
Q

buccal space I and D is achieved through ___ approach

A

intra oral

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21
Q

temporal space infection I and D achieved through ______ approach

A

extra oral

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22
Q

how are the bacteria in I and D identified

A
  • representative specimen collected: aspiration, swab
  • examine specimen
  • aerobic and anaerobic culturettes
  • submit for culture and sensitivity
23
Q

what is the purpose of gram staining

A
  • early dx
  • guides AB therapy
24
Q

what are the common mandibular space infections

A
  • sublingual space
  • submandibular space
  • submental space
  • buccal space
25
Q

where is the submandibular space

A

between the mylohyoid muscle and skin and superficial fascia- primarily 2nd and 3rd molars infect it

26
Q

what are secondary space infections

A
  • masticator (sub masseteric) space
  • pterygomandibular space
  • lateral pharyngeal space
  • retropharyngeal space
27
Q

what is the common progression of the masticator space

A

masticator space -> lateral pharyngeal space -> retropharyngeal space -> danger space -> mediastinitis

28
Q

what is the common progression of the submandibular space

A

submandibular space -> submental space -> contralateral submental space -> sublingual ludwig’s angina ->airway obstruction

29
Q

what is the common progression of the canine space

A

canine space -> infraorbital space -> angular vein -> cavernous sinus thrombosis

30
Q

what needs to be done in the assessment of a patient with complex oro-facial infections

A
  • determine the severity of the infection
  • complete history
  • clinical exam
  • determine the state of the patients host defense
  • advances radiography - CT scan with contrast
31
Q

what are the danger signs in the clinical exam

A
  • trismus
  • inability to palpate inferior border of mandible
  • visual changes
  • malaise with or without fever
  • shortness of breath
  • difficulty in swallowing with secretions
32
Q

what does trismus indicate

A

involvement of muscles of mastication, difficulty airway access

33
Q

what does the inability to palpate inferior border of mandible indicate

A

spread to the submandibular space

34
Q

what do visual changes indicate

A

ocular involvement

35
Q

what does malaise with or without fever indicate

A

advanced disease with systemic response

36
Q

what does shortness of breath indicate

A

airway embarassment

37
Q

what does difficulty in swallowing with secretions indicate

A

oro pharyngeal involvement

38
Q

what radiographs should be ordered

A
  • PA
  • pano
  • plain films
  • CT scan with contrast
39
Q

how does the CT scan with contrast help

A
  • clearly delineates the position and size of the infection process as well as its relationship with the adjacent anatomic structures
  • useful to evaluate any changes to the patients upper airway (due to edema) as it occurs in more advanced infections of the head and neck
40
Q

what is a rim enhancement used for

A
  • around the area of infection whenever a CT scan is used with contrast
41
Q

what is ordered in the lab analysis and what does it tell us

A

CBC with differential - large outpouring of immature granulocytes indicate severe infection

42
Q

maxillofacial infections are:

A

surgical problems

43
Q

how are complex orofascial infections treated

A
  • treat the cause of infection - etiology
  • treat the infection surgically - I and D
  • send the purulent discharge for culture and sensitivity
  • support the patient medically - infectious disease consult
  • choose and prescribe the appropriate antibiotic - culture and sensitivity - IV antibiotics
  • re eval frequently
44
Q

what are the serious space infections

A
  • ludwigs angina
  • cavernous sinus thrombosis
45
Q

what is ludwigs angina

A
  • a fulminating, bilateral sublingual, submndibular, submental and cervical infection or cellulitis displacing the tongue with potential airway obstruction
  • life threatening
46
Q

what is the etiology of ludwigs angina

A

related to PA abscess related to the lower molar teeth

47
Q

what is the management of ludwigs angina

A
  • pt hospitalized immediately
  • CT scan with contrast
  • consultative services- infectious diseases and respiratory therapy
  • blood and tissue culture and sensitivity test specifically for anaerobes
  • IV antibiotic therapy
  • extensive surgical drainage
  • close monitoring- airway
48
Q

what is cavernous sinus thrombosis

A

serious condition that is recognized by the appearance of marked edema and congestion of the eyelids and conjunctiva as a result of impaired venous drainage

49
Q

cavernous sinus thrombosis starts as:

A

unilateral and rapidly becomes bilateral

50
Q

is ludwigs angina or cavernous sinus thrombosis more common

A

ludwigs angina

51
Q

what is the etiology of cavernous sinus thrombosis

A
  • hematogenous spread of infection from the jaw to the cavernous sinus may occur anteriorly via the inferior or superior opthalamic vein or posteriorly via emissary veins from the pterygoid plexus
  • direct extension through the opening of the cranial bones
52
Q

what are the signs and symptoms of cavernous sinus thrombosis

A
  • ocular pain
  • high fluctuating fever, chills and sweating
  • periorbital and conjunctival edema, starting unilaterally and progressing to bilateral as a result of thrombophlebitis
  • pulsating exophathalmos and retinal hemorrhage
  • opthalmoplegia, paralysis, dialted pupils and loss of corneal reflexes
  • other cranial nerve involvement - trigeminal nerve
53
Q

what is the management of cavernous sinus thrombosis

A
  • hospitalization
  • neurosurgical consult
  • intensive AB therapy
  • heparin to prevent extension of thrombosis
54
Q
A

Oral Surgery III (12 decks)

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