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DMD3 sem 2 > MaxilloFacial Infections > Flashcards

MaxilloFacial Infections Flashcards

1
Q

What are the 3 factors that should be considered when looking at the immunology of infectious disease?

A

Host - hummoral and cellular immunity

Environment

Organism - Virulence and quantity

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2
Q

How does the host and microorganism interaction take place during infection?

A

Initial contact between host and microorganism can be transient with elimination of organism.

If organism can grow in host they can cause an infection.

Host may eliminate the organism or host may die.

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3
Q

Which organisms can cause infections?

A

Infections can be caused by exogenous organisms or invasion by external organisms.

Organism can become a pathogen if moved from one place to another within the body.

Some infections can result from disruption of normal flora.

Infections can occur when natural defences are compromised.

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4
Q

How can flora be disrupted in the body?

A

Use of antibiotics

Immunosuppression

Chemotherapy

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5
Q

What are the non-specific effects of infection on the host body?

A

Inflammation

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6
Q

What are the specific effects of infection on the host?

A

Release of toxins or inducing altered host inflammatory response

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7
Q

What is SIRS?

A

Systemic Inflammatory Response Syndrome in response to severe clinical insults.

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8
Q

What are the features of SIRS?

A

Temperature above 38 or below 36 degrees celsius.

Heart Rate >90 beats/min

Resp rate >20 breaths/min

WBC > 12000 or < 4000 per mm3

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9
Q

What is the difference between sepsis and SIRS?

A

Sepsis is systemic inflammatory response to a documented infection

Severe sepsis occurs with associated hypotension, hypoperfusion or organ dysfunction

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10
Q

What are the types of immunological injury?

A

Type 1 reaction (Anaphylactic)

Type 2 reaction (IgG-Mediated Cytotoxic antibody)

Type 3 reaction (immune complex mediated)

Type 4 reaction (Delayed type hypersensitivity caused by Th1 cell activation)

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11
Q

How does type 1 immunological injury occur?

A

IgE-Mediated hypersensitivity. Allergen binds to IgE antibody which binds to an Fc receptor stimulating degranulation.

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12
Q

How does type 2 immunological injury occur?

A

IgG antibody binds Fc receptor and surface antigen on target cell leading to cytotoxicity

This can also be activated by complement.

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13
Q

What are the possible locations of maxillofacial infection?

A

Dental pulp

Periodontium

Odontogenic infections of fascial spaces

Osteomyelitis of the jaws

Salivary gland infections

Infections of the facial skin and scalp

Orbital infections

Infections of the ear and mastoid

Nasal and Para-Nasal Sinus infections

Oropharyngeal and Tonsillar infections

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14
Q

What are fascial spaces seen in the maxillofacial regions?

A

Potential spaces between layers of fascia that do not exist in healthy individuals but become filled during infections.

Spaces have boundaries formed by muscles, fascia, periosteum, bone, and mucous membranes

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15
Q

How does infection of fascial spaces typically progress?

A

Infection in these spaces may progress from superficial infection to cellulitis to the formation of an abscess requiring immediate drainage
Spread of infection between spaces depends on anatomic location

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16
Q

What are the complications of maxillary periapical abscesses that could arise?

A

It can spread to the sinuses, nasal palate, sublingual space, and submandibular space.

Can spread to buccal sulcus between buccinator and skin. Does not extend beyond lower border of the mandible. Upper or lower molars.

Mylohyoid line.

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17
Q

How far can a maxillary periapical abscess extend?

A

Upper lips

Canine fossa

Cheek

Orbits (orbital cellulitis)

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18
Q

What complications can arise from orbital cellulitis?

A

Can include optic neuropathy

Retinal vein occlusion

Cavernous sinus thrombosis

Meningitis

Death

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19
Q

How does orbital cellulitis arise from odontogenic infection?

A

Acute spread of infection into orbit from either the adjacent sinuses or the blood

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20
Q

Where is the infratemporal space located?

A

Buccal sulcus around maxillary 3rd molars. Between the buccinator muscle and the the temporal fossa.

Deep to the ear. Infection can extend directly into the orbit - proptosis, optic neuritis, VI palsy.

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21
Q

Where can pericoronitis spread to?

A

Can spread to pterygomandibular space, lateral pharyngeal space, buccal, submandibular, and sublingual space

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22
Q

What causes deep neck space infections?

A

Commonly from septic focus of mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, or sinuses.

This then spreads to submandibular space, lateral pharyngeal space, retropharyngeal space. Can progress to life threatening complications due to proximity to airway and potential spread into carotid sheath, cavernous sheath, cavernous sinus, cranium and mediastinum.

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23
Q

What are the cervical fascia that can house infections?

A

Between investing and muscular pretracheal. Typically stops at the manubrium

Between investing and visceral pretracheal will likely spread to the anterior thorax.

Within retropharyngeal space (Swelling affects swallowing, speech and may spread to thorax)

24
Q

What is ludwig’s angina?

A

Cellulitis of sublingual and submandibular space.

Life threatening infection because it can compromise airway.

25
Q

Which organisms cause ludwig’s angina?

A

Strep viridans

Staphylococcus aureus

26
Q

What does a peritonsillar abscess look like?

A

Soft palate gets a bulge around the tonsils.

27
Q

What are the potential complications of a peritonsilar abscess?

A

Can cause airway obstruction and sepsis

28
Q

What causes parotid gland infection?

A

Ascending infections, bacteria from oral cavity ascend through parotid duct to the partid gland causing infection.

29
Q

What are the complications of parotid gland infection?

A

Can cause neck swelling and block respiration.

Jugular thrombophlebitis

Septicaemia

Osteomyelitis

VII palsy

Fevers and chills

Painful swelling

30
Q

What causes floor of the mouth swelling?

A

Calculi and drainage of pus from blocks SM duct

31
Q

What complication can arise from FoM swelling?

A

Potentially causes airway compromise

Infection can spread into submandibular space

32
Q

What are the potential complications of middle ear infection?

A

Can spread to middle cranial fossa.

Can cause fever and pain

33
Q

What are the potential complications of mastoiditis?

A

Meningitis and intracranial abscess

34
Q

What are the orbital complications of sinusitis?

A

Orbital cellulitis

Intracranial infections

Cavernous sinus thrombosis

Septic emboli of optic nerve

Optic nerve ischaemia may result in visual loss

35
Q

What is cavernous sinus thrombosis?

A

Fevers, rigors, malaise, severe frontal and periorbital pain

Exophthalmos

Oedema of eyelid and chemosis of conjunctiva

Ophthalmoplegia

Ptosis

Dilated pupil with loss of accomodation reflex

36
Q

What complication can arise from herpes zoster opthalmicus?

A

Can lead to chronic ocular complications, reduced vision, and even blindness

37
Q

What are the types of necrotising fasciitis?

A

Type 1 = polymicrobial flora

Type 2 = Group A beta- haemolytic streptococcus bacteria

Type 3 = Gas gangrene due to clostridium

38
Q

What is cancrum oris?

A

Orofacial gangrene which causes mutilating destruction of soft and hard tissues of the oral and perioral structures.

Typically affects children who are malnourished with poor oral hygiene and concurrent debilitating illnesses

39
Q

What factors should be considered in management of odontogenic infections?

A

Severity of infection

Host defences

Setting of care

Surgical management

Medical support

Antibiotics

Frequent evaluation

40
Q

When should action be taken to prevent deep space infection?

A

The possibility of deep space infection should be considered in any patient who does not respond to the usual treatment of an abscessed tooth or tonsillitis.

This type of infection also should be considered in a toxic patient who has a fever of unknown origin, with or without blood cultures that show anaerobic organisms.

41
Q

How are fascial space infection severity ranked?

A

According to risk of airway or vital structure blockage:

Severity score 1 = low risk. Vestibular, subperiosteal, space of the body of the mandible, infraorbital, buccal

Severty score 2 = Moderate risk. Buccal, submandibular, submental, sublingual, pterygomandibular, submasseteric, superficial temporal, deep temporal.

Severity score 3 = Lateral pharyngeal, retropharyngeal, pretracheal.

Severity score 4 = Mediastinum, intracranial infection

According to severity of infection: Rapidly progressive NF shows dusky discolouration, anaesthetic and frank necrosis in immunosuppressed. Seen most commonly in diabetes and alcoholism

42
Q

What treatment is given when there is airway compromise?

A

Tracheostomy to secure the airway

43
Q

What sign should we look for for immediate establishment of a secure airway?

A

Ominous sign- Pulse oximeter O2 saturation of below 94% in an otherwise healthy patient
Indication for immediate establishment of a secure airway

44
Q

How can host defenses exacerbate the problem for patients?

A

Increased cardiac and resp demands of severe infection may deplete scarce physiological reserves in a pt with COPD or atherosclerotic heart disease

45
Q

When should a patient be admitted to hospital?

A

Temperature >38.3 degrees Celsius

Dehydration

Threat to airway or vital structures

Infection in moderate or high severity anatomic spaces

General anaesthesia

Inpatient control of systemic disease

46
Q

What surgical treatment is given for infection?

A

Airway security through early intubation or tracheostomy.

Surgical drainage early

This reduces the mortality of Ludwig’s to 10%

47
Q

How is surgical drainage of infection done?

A

Extraoral incision then explore likely path of infection

48
Q

What makes it hard to treat a deep space infection?

A

Deep space infection requires a high index of suspicion for diagnosis but requires early treatment and recognition to prevent tissue damage, airway compromise and bacteremia

49
Q

When should culture and sensitivity testing be completed?

A

Infection involves anatomic spaces of moderate or greater severity

Significant medical or immune system compromise

Chronic infections recalcitrant to therapy

50
Q

What additional medical treatments should be done in addition to surgical debridement of gas gangrene?

A

Hydration, nutrition, control of fever.

This is because lots of fluid loss occurs and fever increases metabolic and cardiovascular demands.

51
Q

What antibiotics should be given for deep neck infections?

A

Empiric antibiotics for odontogenic infections requiring only outpatient management:

  • Penicillin, Clindamycin, Cephalexin

Empiric antibiotics for odontogenic infections requiring inpatient management:

  • Clindamycin, Third generation cephalosporin Intravenous route, Metronidazole
52
Q

What should be evaluated when treating deep neck infections?

A

Improvement in signs and symptoms: Decreased swelling, cessation of wound drainage, declining white cell count, decreased malaise, decreased airway swelling.

53
Q

What causes osteomyelitis?

A

Bacteria induced inflammatory process (extractions, RCT, fractures )

Inflammation of the bone marrow and extending to involve periosteum

Incidence higher in the mandible

Diminished host defences, medications, local pathology, odontogenic infections, trauma

Acute or chronic ( 1 month duration )

Pain, swelling, lymphadenopathy, fever, paraesthesia, trismus, malaise, fistulas

54
Q

How should osteomyelitis be evaluated and managed?

A

CT evaluation

Medical mangement with antibiotics.

Surgery

Hyperbaric oxygen treatment

55
Q

What surgery can be done for osteomyelitis?

A

Sequestrectomy

Reconstruction type plate to prevent pathological fracture

DMD3 sem 2 (69 decks)

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