Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BDS M5 Oral Surgery > Management of the spread of infection > Flashcards

Management of the spread of infection Flashcards

1
Q

What are examples of bacterial odontogenic infections?

A
  • caries
  • peri-apical periodontitis —> abscess
  • periodontisis
  • pericoronitis
  • osteomyelitis (bone infection, man. > max.)
  • maxillary sinusitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does sequelae of infection depend on?

A
  • virulence of the organism involved
  • host resistance to infection (local and systemic)
  • local anatomy
  • treatment of infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is an example of reduced local resistance to infection in the head/neck?

A

after radiotherapy, vasculature to area reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why can antibiotics not effectively treat odontogenic infection?

A

can’t reach the inside of the tooth due to lack of vascular supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What areas can maxillary odontogenic infection spread to?

A
  • buccal sulcus (relatively short buccal root, apex below muscle attachment)
  • buccal space (relatively long buccal root, apex above the muscle attachment)
  • maxillary antrum (apex close to antrum)
  • nasal passage (apex close to nose)
  • palatal (root closer to palatal shelf)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What areas can mandibular odontogenic infection spread to?

A
  • buccal sulcus (relatively short buccal root, apex above muscle attachment
  • submandibular space (relatively long root, apex below muscle attachment)
  • sublingual space (relatively short lingual root, apex above muscle attachment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

If a pt present with a swelling on the buccal gingiva/sulcus, what does that tell you about the anatomy of the tooth?

A

root relatively short and above buccinator muscle attachment, root closer to buccal plate than lingual plate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is cellulitis?

A

diffuse inflammation of the soft tissues which is not circumscribed or confined to one area but tends to spread through tissue spaces along fascial planes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why does cellulitis encourage spread of infections?

A

opens up fascial planes allowing bacteria spread more freely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In cellulitis, why is it particularly worrying to see peri-orbital oedema?

A

could potentially spread to cavernous sinus and cause cavernous sinus thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What can spread of infection around the laryngeal inlet cause?

A

asphyxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Ludwig’s angina?

A
  • severe cellulitis
  • bilateral involvement of the submandibular, submental, sublingual and parapharyngeal and retropharyngeal spaces - rapid, board like swelling of FOM, elevation of tongue, dysphagia, dysarthria, trismus
  • glottal oedema - can lead to asphyxia
  • can lead to mediastinitis
  • anaesthetic emergency to secure airway before it is lost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What effect on the eyes may cavernous sinus thrombosis have?

A
  • difficulty in moving eyes
  • build up of pressure behind the eye —> proptosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is sepsis?

A

life-threatening organ dysfunction caused by a dysregulated host response to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the possible symptoms of sepsis?

A
  • slurred speech
  • extreme shivering
  • passed no urine in a day
  • severe breathlessness
  • illness so bad they feel they’re dying
  • skin mottled/discoloured/ashen
  • rash doesn’t blanch with pressure
  • cyanosis of lip/skin/tongue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the signs of sepsis?

A
  • temp >38 or <36
  • HR >90
  • RR > 20
  • WCC >12 or <4
  • BP systolic <100
17
Q

How is sepsis managed?

A
  • Take blood cultures ideally before antibiotics
  • Take serum lactate >2mmol/l
  • Give oxygen
  • Give empirical intravenous antibiotics
  • Give IV fluids
  • Monitor urine output
18
Q

What are the 4 principes of management of odontogenic infection?

A
  • eliminate the cause of the infection ASAP
  • provide a path of least resistance
  • symptomatic management
  • review
19
Q

What is a sinus?

A
  • tract between tooth and oral cavity
  • indicates chronic infection
  • lined with granulation tissue and allows pus to be discharged
20
Q

What is a orocutaneous fistula?

A
  • fistula from tooth to outside of the mouth (extra-oral e.g. on chin)
  • epithelial lined, started as a sinus but developed over time
  • needs surgery to repair due to epithelial lining
21
Q

What is often seen with infection of the canine space?

A
  • infraorbital swelling
  • obliteration of nasolabial fold

happens when canine root long enough to pass muscles of facial expression

22
Q

How can infection in the infratemporal fossa space present?

A
  • severe trismus
  • bulging of temporalis
  • can lead to cavernous sinus thrombosis

rare but serious infection, usually from upper 8

23
Q

Why should you not leave an access cavity open after draining an abscess?

A

to prevent bacteria from the mouth entering the tooth and causing reinfection

24
Q

What method of drainage should be used when pus is present in soft tissues?

A

Hiltons method
- find most gravity dependent point of abscess
- incise through mucosa and periosteum with No 11 blade
- avoid vital structures
- blunt dissection to break down locules of pus
- same principles applied for extra-oral drainage
- avoids scarring which often follows natural rupture

25
Q

What should be done with pus that has been drained from an abscess?

A

collected for culture and sensitivity testing which allows appropriate antibiotics to be prescribed

26
Q

What is a down side of taking up pus with a syringe for culture and sensitivity testing?

A

can expose pus to air, killing anaerobic bacteria

27
Q

What general measures should a pt undertake after local measures and drainage etc?

A

supportive
- adequate fluid intake
- rest
- soft diet
- analgesics

28
Q

What are the indications for providing antibiotics in addition to local measures?

A
  • systemic involvement
  • significant cellulitis
  • compromised host defences
  • involvement of fascial spaces
29
Q

When should a pt with infection be referred?

A
  • rapidly progressing infection
  • difficulty in breathing
  • difficulty in swallowing
  • involvement of fascial tissue spaces
  • temp >39
  • severe trismus
  • compromised host defences
  • infection to responding to Rx
30
Q

What sites of drainage would LA be sufficient for?

A
  • buccal/labial sulcus
  • palate - parallel to vessels
  • SL space - buccal and parallel to sublingual folds
31
Q

What is the management of Ludwig’s angina?

A

airway emergency
- bilateral Hilton’s drainage to decrompress the next
- tracheostomy ? - may not be possible
- IV steroids to reduce inflammatory drive
- IV high dose combination antibiotics
- irradiate cause once patient stable

32
Q

Why is Pen V now preferred as first line instead of amoxicillin?

A

try to use narrow spectrum rather than broad spectrum to minimise antibiotic resistance

BDS M5 Oral Surgery (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions