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OMFS > Odontogenic infection & Other infections > Flashcards

Odontogenic infection & Other infections Flashcards

1
Q

What are common microorganisms for odontogenic infection

A

mixed aerobe and anaerobe -60%
aerobe - 7%
anaerobe - 33%

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2
Q

differential diagnosis of cellulitis

A

inflammation of the derm (dermatitis), fascia (fascitis)
DVT
neoplasm (malignancy)

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3
Q

signs of septic shock

A 
High temperature >38.5C
Hypotension
Warm peripheries
Malaise
Altered mental status
Dyspnea
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4
Q

What are presentation of cellulitis?

A 
Infection occurring 3-5 days 
Severe pain
Large and diffuse swelling 
Firm and erythematous on skin
Minimal to moderate serosanguinous fluid with or without pus locules
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5
Q

When a ptn presents to you with infection in the head and neck. What is your mx?

A
  1. assessment of emergency level - consciousness & airway
  2. history taking
    - chief complaints and assoc sx
    - medical and drug hx
    - hydration and nutritional status which maybe affected by pain or LOA, trimus, dysphagia
  3. examination
    - general ex: appearance of toxic, malaise, high fever, septic looking, dehydration
    - vital signs:
    tachy and hpt due to pain and anxiety
    septic shock causing hypotension and increased respi R
    spo2 desat due to airway obstruction
    tempt >38.5
    - regional assessment for swelling, stage of infection either in cellulitis or abscess.
    - regional lymphadenopathy
  4. investigations
    - plain films
    OPG to identify source of infection
    Lat neck to assess obstruction of airway
    - CT scan with contrast
    to identify extent of infection, involvement of spaces, localziation of pus, airway patency
    - Blood labs: CBC to assess leukocytosis, ESR or CRP to indicate inflammation and for baseline to assess treatment response.
    - C&S through aspiration if able to locate pus locule or thru pus swab during I&D
  5. Treatment involves
    - emergency tx maintaning patent airway thru OPA or Trachy in Ludwigs angina,
    - surgical treatment for removal of source of infection, I&D, with rigorous debridement until infection is cleared
    - fluid replacement
    - nutritional support
    - analgesia
    - antibiotics
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6
Q

what are indications of hospitalization

A 
Compromised host defense
rapid progressing infection
involvement of secondary spaces
temp >38.5C
toxic appearance
trismus
difficulty breathing
difficulty swallowing
does not respond to antibiotics
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7
Q

investigations required in spreading infection

A

OPG to find offending tooth or cause of infection
Lateral neck to see potential airway obstruction
CT scan with contrast to assess extent of infection, localization of pus (shows “ring” enhancing lesion & abscess collection)

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8
Q

what are indications of radiographic imaging (CT with contrast) in infection

A

rapid increase in swelling
involvement of secondary spaces such as masseteric, pterygomandibular space, parapharyngeal space, canine fossa,
rapid deterioration of general condition despite lacking in increase in swelling
suspecting cavernous sinus thrombosis
able to assess airway patency

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9
Q

What are indications of C&S

A 
rapid spread of infection
poor immune system
no response to prior antibiotics
recurrent infection
osteomyelitis
Suspecting actinomycoses
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10
Q

when should antibiotics be prescribed

A 
Cellulitis 
involvement of fascial spaces
poor immune system
severe pericoronitis
osteomyelitis
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11
Q

What is Ludwigs angina

A

A spreading infection into fascial spaces involving submandibular, sublingual and submental spaces bilaterally, with airway obstruction caused by swelling of all these spaces and extension of infection posteriorly to the epiglottis leading to epiglottis edema.

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12
Q

What is the sequalae of ludwigs angina

A

Airway obstruction

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13
Q

How would you treat Ludwig angina

A

ABC. maintenance of airway, ventilation support and preventing circulatory collapse of cardiac arrest.
Airway - OPA intubation; tracheostomy

Once stabilized:
Removal of source of infection
I&D
Antibiotics
Medical support - fluid, ventilation
Analgesias
Nutritional support
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14
Q

What is woody tongue

A

Presentation of Ludwig angina:
Elevation of the floor of mouth and tongue
Protrusion of tongue
Posterior enlargement of tongue

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15
Q

How do you manage infection cases in the long run?

What should be reevaluated on follow up after treatment?

A

response to treatment (improvement of pain, swelling and other subjective symptoms)
Subsiding infection or persistent infection
Reccurence
Toxicity of antibiotics or drug allergy
Concomitant secondary infection such as Candida

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16
Q

What are the causes of failure of treatment

A

Inadequate surgical treatment
Poor host defense
Presence of foreign body
Issues with antibiotics: poor patients compliance, resistance, wrong use of antibiotic

17
Q

How does cavernous sinus thrombosis occur

A

Valveless veins
Allowing retrograde flow of infection of face to sinus
Common veins involved:
- Anterior pathway: angular and ophthalmic veins (upper lip, tip of nose, paranal region)
- Posterior pathway: pterygoid plexus & transverse facial vein

18
Q

Presentations of CST

A 
Signs of CN VI palsy - loss of lateral gaze (earliest symptom)
Periorbital edema unilateral
Proptosis
Pupillary dilation
Photophobia
Headache
19
Q

Whats the early signs of CST

A

Signs of CN VI palsy - loss of lateral gaze

20
Q

Structures present in the cavernous sinus

A

CN III, CN IV, CN V1, CN VI
ICA
Cavernous sinus plexus

21
Q

Diff dx of CST

A

Orbital cellulitis
Meningitis
Stroke

22
Q

How do you diagnose CST?

A 
Clinical finding
MRI (using flow parameters)
- thrombosed vascular sinuses
- deformity of ICA within the cavernous sinus
Lumbar puncture - TRO meningitis
23
Q

What is tx of CST

A

I&D at the source of infection

Antibitotic IV 6-8 weeks (empirically, then specific after c&s)

Anticoagulation

Steroids

24
Q

Whats the danger of Actinomycoses infection

A

its an infection by Actinomyces israeli that causes multiple painful abscesses containing sulfur-like granules
In which chronic infection will cause multiple fistuales

Tx requires long term penicillin (6 weeks) & debridement and fistulectomy

24
Q

How do you manage fascial space infection

A
  1. Airway management
  2. Adequate diagnosis with CT/MRI
  3. Close monitoring of condition
  4. Early I&D even in no apparent abscess
  5. Aggressive A/b IV
  6. Supportive care with hospitaliztion
  7. Correct any immunocompromising factors (diabetes, leukopenia etc)
25
Q

Common fungal infections

A

Candiadiasis

Mucormycosis

26
Q

3 clinical types of candidiasis

A
  1. Pseudomebranous
  2. Erythematous (atrophic)
  3. Hyperplastic
27
Q

Give the presentation of pseudomembranous candidiasis

A

White lesion that can be scraped off leaving raw bare surface
Asymptomatic

28
Q

Features of erythematous candidiasis

A

Red and painful burning mouth
Angular cheilitis
Median rhomboid glossitis
Denture related stomatitis

29
Q

Hyperplastic candidiasis presents with

A

White plaque or white lesion that cannot be scraped off

Diff dx includes leukoplakia, endocrine associated candidiasis (endocrine-candidiasis syndrome), lichen planus (reticular form), verrucous ca

Dx by biopsy. tro malignancy.

30
Q

What is mucormycosis

A

Fungal infection. Invades thru blood vessels. Causes thrombosis and necrosis of surr tissues.

Diagnosis is by biopsy - broad nonseptate hyphae with right angle branching

31
Q

Give 2 common types of mucormycosis

A

Rhinocerebral
Rhinomaxillary

Usually begins with nasal obstruction, bloody nasal discharge, facial pain, facial swelling (cellulitis), involvement of CN (paralysis, numbness, visual disturbance).

Rhino-cerebral: Spread of infection to cranial vault - blindness, lethargy, seizures

Rhino-maxillary: Spread to maxillary sinus - intraoral maxillary or palatal swelling, ulceration and black necrotic lesions.

32
Q

Risk factors of mucormycosis

A
  1. “Iron-related”
    - IDDM & ketoacidotic (ketoacidosis inhibits binding of iron to transferrin leads to increase serum iron)
    - iron-chelating agents in thalassemia
  2. Immunocompromised
    - AIDS
    - BMT patients
    - Diabetic
    - Steroid therapy
33
Q

Tx of mucormycosis

A

IV amphotericin B

Surgical debridement of necrotic tissues with reconstruction once infection resolved

34
Q

Presentation of Noma

A

Noma = orofacial gangrene
Caused by multiple bacteria (polymicrobial) opportunistic infections

Leads to painless tissue degradation

Fusobacterium necrophorum
Prevotella intermedia

36
Q

Risk factors of noma

A 
Immunocompromised
Poor oral hygiene
Nutritional deficiency
Kids <12
African or Asians (underdeveloped countries)
37
Q

Tx of noma?

A

IV penicillin
Surgical debridement with reconstruction after infection subsides
Nutrition and hydration

OMFS (54 decks)

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