Explain how mandibular space infections can become life threatening
start from submand/ sublingual
- submandibular & sublingual spaces coalesce to form buccopharyngeal gap
- infections from these 2 places can spread through the gap to the pterygomandibular space (right behind)
- continues spread medially towards parapharyngeal space and towards retropharyngeal space
- leads to swelling impinging on pharynx causing airway compromise
what are the perimandibular spaces?
- submandibular
- sublingual
- submental
name the 5 complications of deep neck space infections
- descending mediastinitis
- ludwig angina
- cavernous sinus thrombophlebitis
- necrotizing fasciitis
- sepsis
explain descending mediastinitis
an infection that spreads downwards (descending) towards the mediastinum
- infection spreads from retropharyngeal space –> inferiorly towards mediastinum where heart and impt organs are
- commonly causes short of breath
- may present as supraclavicular swelling (sign of parapharyngeal infection)
*Mediastinum contains impt organs: heart, trachea
symptoms of parapharyngeal infection
- trismus due to involvement of medial pterygoid
- facial swelling
- supraclavicular swelling
- dysphagia, dysphonia, high grade fever
- swelling impinges on pharynx –> airway compromise
- erosion of carotid sheath
sequlae of retropharyngeal space infection
- internal jugular vein thrombosis
- carotid artery erosion
- impingement on cranial nerve 9, 10 ,12
Explain ludwig angina
- life threatening, severe cellulitis (bacteria soft tissue infection) that affects FOM, under tongue and neck
- involvement of all perimandibular spaces
- usually starts from dental infections
- common symptoms include raised FOM, bilateral neck swelling, trismus, fever
- high risk for airway obstruction
- potential spread to retro and parapharyngeal space and further causing airway compromise
- ## if spread to retropharyngeal can lead to potential descending mediastinitis
explain cavernous sinus thrombophebitis
- when a blood clot forms in the cavernous sinus, often due to bacteria infection
- cavernous sinus plays crucial role in venous drainage from brain (LOCATED BEHIND EYES)
- infection spreads from max sinus/ infraorbital/ infratemporal space
- infection spreads to brain through cavernous sinus
- also affects cranial nerves supplying the eye: eyelid droop, vision loss, dilation of pupils –> potential blindness
- can cause brain infection, abscess
- can increase intracranial pressure –> headache, nausea, neurological symptoms!!
explain necrotizing fasciitis
a severe, rapidly progressing soft tissue infection characterized by tissue necrosis
- bacteria can release toxins that induce tissue damage and eventually tissue necrosis
- rapidly spreads, requires emergency surgery
- requires aggressive AB and multiple surgeries
- pt presents with skin changes, pus and skin necrosis
explain septic shock
a life threatening condition, caused by the body’s extreme response to infection
leads to widespread inflamation, organ damage and failure
patient has deranged vitals: hypotensive, tachycardia, tachypnea
potentially fatal
