Mgmnt of Complex orofacial infections Flashcards
Spread of odontogenic infections most commonly spreads via:
– Soft tissue/fascial spaces –
Potential spaces between the fascia and underlying organs/tissues.
In a healthy state, these spaces do not exist. However, these spaces can be distended by fluid or infective process. Thus infective process can spread from one area to the adjoining ones by disruption of intervening fascial planes or around perforating blood vessels and nerves.
Fascial spaces
What are the 3 primary spaces in maxilla?
Buccal
Canine
Infratemporal
What are the 4 primary spaces in mandible?
Submental
Buccal
Submand
Sublingual
The ___ lies btwn buccinator muscle and overlying skin and superficial fascia. This space can become involved via upper or lower molars
Buccal space
Does buccal space carry infection from upper or lower molars?
Both
Where is the sublingual space in regard to mylohyoid muscle?
Above mylohyoid
Where is the sub mandibular space in relation to mylohyoid?
Below mylohyoid
What teeth are more common to see sublingual infection with?
Mandibular premolars
What teeth are more common to see sublingual infection with?
Mandibular premolars
If you can’t palpate lower border of mand, what should you do?
Refer to hospital due to submandibular space infection
this space lies btwn the mylohyoid muscle and skin and superficial fascia. Primarily 2nd and 3rd molars
Sub mand space
Which I and D spaces in max and mand require extraoral drainage?
Sub mand, sub mental, temporal
What are the 4 2ndary space infections?
Masticator
Pterygomandibular
Lateral pharyngeal
Retropharyngeal
Any time an extra oral I&D, what should be done with the specimen?
Culture of the specimen
Masticator Space Lateral Pharyngeal Space Retropharyngeal Space Danger Space
_________
MEDIASTINITIS
Submandibular Space Submental Space Contralateral Submental Space Sublingual
Ludwigs Angina _______
AIRWAY OBSTRUCTION
Canine Space Infraorbital Space Angular Vein ____
CAVERNOUS SINUS THROMBOSIS
Indicates involvement of muscles of mastication, Difficult airway access
Trismus
Indicates spread to the submandibular space
Inability to palpate inferior border of mandible
Indicates ocular involvement
Visual changes
Indicates advanced disease with systemic response
Malaise +/- Fever
Indicates airway embarrassment
Shortness of breath
Indicates oro-pharyngeal involvement
Difficulty in swallowing with secretions
-It clearly delineates the position and size of the infection process as well as its relationship with the adjacent
anatomic structures.
-It is also useful to evaluate any changes to the patient’s upper airway(due to edema) as it occurs in more advanced
infections of the head and neck.
helps us to evaluate the extent of the complex oro-facial infection in the head and neck
region.
A rim enhancement around the area of infection is observed
CT w contrast
is a fulminating, bilateral sublingual, submandibular, submental
and cervical infection or cellulitis displacing the tongue with potential airway
obstruction.
Life-threatening condition
Aetiology: Usually related to periapical abscess related to the lower molar teeth.
Ludwig’s angina
- Serious condition that is recognised by the
appearance of marked oedema and congestion of
the eyelids and conjunctiva as a result of
impaired venous drainage. - This start as a unilateral and rapidly becoming
bilateral.
Cavernous venous thrombosis
Is Ludwig’s angina or cavernous sinus thrombosis more common?
Ludwig’s angina
- Hematogenous spread of infection from the jaw to
the cavernous sinus may occur anteriorly via the
inferior or superior opthalmic vein or posteriorly via
emissary veins from the pterygoid plexus.Direct extension through the
opening in the cranial bones.
Cavernous sinus thrombosis
– Ocular pain.
– High fluctuating fever, chills, and sweating.
– Periorbital and conjunctival oedema, starting unilaterally and progressing to bilateral
as a result of thrombophlebitis.
– Pulsating exophthalmos and retinal haemorrhage
– Ophthalmoplegia, paralysis, dilated pupils and loss of corneal reflexes
– Other cranial nerve involvement e.g. trigeminal nerve
– Hospitalization.
– Neurosurgical consultation.
– Intensive antibiotic therapy.
– Heparin to prevent extension of thrombosis.
Cavernous sinus thrombosis
