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Oral Surgery > Management of odontogenic Infection > Flashcards

Management of odontogenic Infection Flashcards

1
Q

diagram about infection

- ven diagram encompesses - just keep in mind..

A

infection in middle with

  1. patient health
  2. anatomical factors
  3. microbial factor
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2
Q

etiology of odontogenic

A

pulpal

periodontal

peri-coronal
- subset of the periodontal like in3rd molars

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3
Q

abscess

A

localized collection of pus due to the breadown of infected tissue involved

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4
Q

cellulitits

A

diffuse inflammatory characterized by extensive hard swelling, induration and erythema

MORE DIFFUSE than than an abscess

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5
Q

pt. presents stressed and discomfort on lower left

now difficulty swallowing and a lot of swelling

trismus
convexity

A

pterygoid space infection secondary to the pericoronitis

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6
Q

10-11 year old boy with swelling around inferior of eye

firm swelling closer to maxilla and soft swelling near the infraorbital region

hit with hockey stick around maxillary incisors

A

canine space infection

NO INFECTION IN EYE – palpating lymphatic space - built up pressure from apical abscess / cellulitis

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7
Q

microbiology of odontogenic infection

A

higher % of ANAEROBIC involved than aerobes

many are POLYMICROBIAL

prominent aneerobes are
- bacteriocides, peptostreptococus , actinomyces, (the general microbial that we see in the mouth)

Aerobe = treptococcus

so management – not really doing the culture and specifying the treatment
- make assumption that we need polymicrobial

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8
Q

spread of infection usually through

A
  1. direct extension
  2. hematogenous – bacteremia
  3. lymphatic - lymphadenopathy
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9
Q

anatomical considerations for DIRECT extension for vestibular abscess

A

APEX of teeth are housed within the normal structure

most likely peri-apical infections break out to the buccal side into vestibule

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10
Q

peri-apoical infections usually break out

A

towards the buccal

  • remember that posteiror mandibular molars are close to mylohyoid line and can break out into the submandibular space
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11
Q

palpate swelling for abscess

A

balloon - feel like the fluid

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12
Q

palpate cellulitis

A

no give – more like a baseball not as fluctuant

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13
Q

basal bone and alveolar bone in relation to the molars

A

alveolar bone is more lingual in this location of the molars

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14
Q

mylohyoid line and implication with apex of teeth (posterior lower molars) breakout of infection

A

break out into the SUBMANDIBULAR SPACE –

the first and second molar is very close to this mylohyoid line

the molars are situated more over the mylohyoid line above alveolar bone than the basal bone

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15
Q

most likely teeth to break out into the vestibule

A

the maxillary teeth

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16
Q

so typical alveolar abscess breaks out

A

toward buccal into the vestibule

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17
Q

mandibular molars will break out

A

submandibular space

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18
Q

posteiror molar that broke out buccally was from?

A

the furcation - not a peri-apical

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19
Q

mandibular anterior / incisor region - anatomic considerations for direct break out

A

mandibular incisors – spread into the MENTALIS SPACE

- since this muscle attaches relatively high – may break out into this space versus the oral cavity

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20
Q

direct FACIAL spaces to consider

A
  1. buccal
  2. pterygomandibular
  3. masseteric
  4. submandibular
  5. sublingual
  6. canine space
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21
Q

buccal facial space - genreal

A

superficial to the buccinator muscle
- roots of teeth insert above usually

more in children into buccal space infection

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22
Q

lower third molars can spread directly into what facial space

A

pterygomandibular space

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23
Q

pterygomandibular space infectin symptoms may present with

A

difficulty swallowing and opening
- muscle is inflammed

may not present with swelling – more convex

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24
Q

space lateral to the body of the mandible is

A

submasseteric space

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25
Q

submasseteric space potential symptoms

A

swelling externally

may be trismus

but not really airway problems

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26
Q

impacted 3rd molar that is placed more buccally could have more tendency to go towards ____ space as compared to _____ space even though this space is more common

A

may go towards the submasseteric space

vs the pterygomandibular space (more likely)

probably wont feel a fluctuant swelling

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27
Q

apical abscess on the mandibular molars likely spread to

A

submandibular space

probably wont feel fluctuance at first

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28
Q

sublingual space infectino - general

A

NOT common

lower anterior and pre molar peri-apical disease more likely to spread out towards the vestibular space - more simple vestibular abscesses

so think about other things if lingual floor swelling – like stone / trauma / of the salivary gland

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29
Q

canine space

A

in the infraorbital area or canine fossa

more likely in children – apex could be above the insertion of the muscles

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30
Q

masticatino and swallowing not involved in

A

canine space / infraorbital area

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31
Q

SECONDARY fascial spaces

A
  1. peritonsilar
  2. lateral pharyngeal
  3. retropharyngela
  4. temporal
  5. infratemporal
  6. parotid
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32
Q

massive swelling in tonsilar area - but no teeth involved

A

peritonsilar space infection

and rule out maxillary molars pathology

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33
Q

behind the pterygoid space?

A

lateral pharyngeal

retropharyngeal space

34
Q

lateral pharyngeal space

A

can coincide with the pterygoid space infection

35
Q

just medial to the lateral pharyngeal space

A

retropharyngeal space –so could spread here too

36
Q

spread of infection from pterygoid to ___ space

A

lateral pharyngeal space

37
Q

spread of infection to the temporalis space likely from

A

submasseteric space
AND
pterygomandibular space

superficial to or deep to the ZYGOMATIC ARCH A

38
Q

swelling at location of zygomatic arch

A

temporalis space infection likely from submasseteric space or pterygomandibular space

39
Q

lymphatic spread

- general outline

A

consider chain posterior to sternocleidomastoid and anterior to it

submandibular

submental

into anterior cervical

40
Q

most of the area of head and neck drain into

A

submandibular / submental

41
Q

submnetal node drainage primary

A

mid lower lip

chin

tip of tongue

lower incisor and ginginva

42
Q

submental node drainage

secondary

A

submandibular and superior deep cervical nodes

43
Q

submandibular node drainage

A

just about everything else
upper and lower jaw (BESIDES INCISORS)

LIPS - EXCEPT MID LOWER

anterior nasal cavity

anterior palate

body of tongue

44
Q

secondary drainage for submandibular node drainage

A

deep cervical nodes

45
Q

lower incisor lymph drain?

A

to the SUBMENTAL

46
Q

tip of tongue lymph drains

A

to the SUBMENTAL

47
Q

SUBMANDIBULAR LYMPHADONPATHY from maxillary?

A

yes– drains all maxillary

48
Q

primary drainage of the deep cervical node

A

base of tongue

posterior palate

sublingual region

49
Q

secondary drainage of the deep cervical node

A

submental, submandibular and accessory nodes

50
Q

drainage of tongue

A

tip = submental

body = submandibualr

base = deep cervical

51
Q

drainage of the tongue

A

can cross over - so variable

52
Q

T/F antibiotics are essential in the treatment of odontogenic infections

A

FALSE – are NOT

53
Q

essentials in treatment of odontogenic infections

A
  1. eliminate the source of the infection

2. establishment of drainage

54
Q

fistula drainage?

A

if fistula present – drainage has already been established –

manifest as pain swelling off and on
drainage off and on

re-establish drainage

55
Q

treatment for fistula

A

endo tx

patient already has established drainage and may be off and on so treat the source of infection

56
Q

pt has bump of granulation tissue

tx?

A

put gutta percha point and take x-ray to confirm which tooth it is associated with and perform endo tx

57
Q

incision and drainage use noramally - general

A

modality of tx

WITH FLUCTUANT SWELLING

If rock hard – probably not

58
Q

incision with

A

15 blade into abscess cavity

just at the surface!
then can follow up with a more blunt instrument to chase it - but NO sharp disection to establish drainage

59
Q

if establish drainage then decompresses / heals then comes back?

A

consider leaving something in the space for drainage

  • latex rubber drain and suture to keep drainage
60
Q

remove drain after?

A

usually 48 hours
- if really deep could be left longer

now treat the tooth usually after drainage has been established

61
Q

peri-coronal infection - most likely from

A

tends to be almost exclusively with impacted 3rd molars

gets better and worse

recurrent swelling

62
Q

symptoms of pericorintis

rx too?

A

temporalis muscle could be involved

can see loss of bone radigrpahically as well

63
Q

initial tx of peri-corinitis

A

antibiotics
rinses

perio-probe to lift tissue

not take tooth out – traumatic extraction

want to get rid of acute infection first

64
Q

if peri-coronitis and hurts mostly when closes down? what to do

A

remember do not want to extract the acutely infected tooth

take upper third molar out – may be supra-erupted and traumitizing the lower

65
Q

antibiotic dose for penicillin V

A

500 q4-6h

66
Q

antibiotic dose for erythromycin

A

250 q6h

67
Q

antibiotic dose for doxycycline

A

100 q12h x 2 then 50 q12

68
Q

antibiotic dose for keflex

A

500 q 6hrs

  • like penicillin V
69
Q

antibiotic dose for metronidazole

A

250 q8h

70
Q

antibiotic dose for clindamycin

A

150 q6 hr

71
Q

antibiotic dose for amaxicillin

A

500 Q8HR

72
Q

complications of odontogenic infectinos

A
  1. airway obstruciton
  2. mediastinitis
  3. osteomyletitis
  4. sinusitis
  5. cavernous sinus thrombosis
  6. endocarditis
  7. systemic sepsis
73
Q

osteomyelitis usually seen with

A

pt. that is not as healthy

74
Q

a bilateral sublingual and submandibualr space cellulitis

A

LUDWIG’S ANGINA

75
Q

Ludwig’s angina is?

A

a bilateral submandibualr and sublingual space cellulitis

needs to have all 4 spaces involved

struggles to breathe and keep mouth closed

76
Q

radiation patient?

A

antibiotic tx probably necesary

77
Q

evident cloudiness in one of the sinuses?

A

potential sign of root fragment displacment in into the sinus

78
Q

if cavernous sinus infection?

A

probably from midface odontogenic if occurs

but dont rule out lower face infection

79
Q

dx of cavernous sinus infection

A

muscle and a lot of nerves and muscles there

ecchymosis of eyes

80
Q

eagleston’s criteria for

A

cavernous sinus thrombosis

81
Q

eagleston’s criteria for cavernous sinus thrombosis

A
  1. site of infection
  2. evidence of bloos stream invasion (liek presence of fever)
  3. venous obstruction of retina conjunctiva, eyelid
  4. paresisi of nerves 3, 4, 6
  5. abscess formation in adjacent soft tissue
  6. evidence of meningeal irritiation
82
Q

pt with cavernous sinus thrombosis close their eye?

A

YES – facial (VII) nerve closes eye

droopy eyelid - b/c patient cant open

Oral Surgery (26 decks)

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