Odontogenic infections Flashcards
What are the 4 stages of infection?
- Inoculation
- Cellulitis
- Abscess
- Rupture
When does the inoculation stage of infection occur?
Over 0-3 days
When does the cellulitis stage of infection occur?
-Over 1-5 days
When does the abscess stage of infection occur?
-Over 4-7 days
What is the difference between cellulitis and an abscess?
-An abscess has PUS
When an abscess ruptures where does it spread?
-Path of least resistance
What type of bacteria account for the majority of odontogenic infections?
-Aerobic and anaerboic mixed bacteria
What are the most common pathogens in orofacial infections?
- Strep. milleri
- Peptostreptococcus
- Other anaerobic streptococci
- Prevotella
- Porphyromonas
- Fusobacterium
Where can maxillary periapical abscesses spread?
- Canine space
- Infratemporal space
- Orbit via infratemporal space
- Buccal space
- Parotid space
Where can mandibular periapical abscesses spread?
- Poratid space
- Buccal space
- Submandibular space
- Sublingual space
- Lateral pharyngeal space
- Masticator space (masseteric Pterygoid Temporal)
What can cause a muffled voice?
-Epiglottitis
What spaces if infected can cause trismus?
- Masticator space
- Pterygomandibular
What is considered trismus?
-Opening mouth less than 30 mm
What is cellulitis?
-Inflammation spreads through the soft tissue or organ
How does the swelling develop in cellulitis and what might be associated with it?
-Develops rapidly with a high fever
T/F In cellulitis the skin becomes very red and there is no throbbing pain as the inflammation localizes
False
-There is severe throbbing pain
What type of bacteria do you see in Cellulitis?
-Mixed aerobic and anerobic
T/F Cellulitis associated with oral infections is potentially dangerous because it can travel quickly to sensitive tissues such as the eye or brain
True
When an infection from a mandibular periapical abscess goes to the submandibular or sublingual space where can it spread?
- Lateral pharyngeal space
- Masticator space
When an infection from a mandibular periapcial abscess goes to the lateral pharyngeal space where can it spread?
- Carotid sheath
- Retropharyngeal space
- Masticator space
- Submandibular and sublingual spaces
Where can an infection in the retropharyngeal space spread to?
- Mediastinum
- Carotid sheath
- lateral pharyngeal space
Where can infection in the carotid sheath spread?
- Cranium
- Mediastinum
- Retropharyngeal space
- lateral pharyngeal space
What clinical signs do you see with a vestibular space infection?
- Diffuse facial swelling
- Elevation of the oral vestibule
- May or may not have a draining sinus
In a vestibular space infection there is a potential space between what?
-Oral mucosa and muscles of facial expression
Sub-periosteal abscesses perforates what layer, but does not perforate this layer?
- Cortical layer
- periosteum
Where do you see a buccal space abscess?
-Subcutaneous space
What does the Buccal space connect to?
- Infraorbital space
- Periorbital tissues
- Superficial temporal space
What teeth can be involved in a buccal space infection?
- Maxillary molar and premolar
- Mandibular molar or premolar
- Canine teeth on both jaws
In children what are most buccal space infections caused by?
-H. influenze cellulitis (URI)
What is Ludwigs angina?
-Bilateral submandibular space with crossing over submental and sublingual
What are the clinical manifestations of Ludwigs angina?
- Mouth pain
- Stiff neck
- Drooling
- Dysphagia
- No trismus
- Woody inflammation
- Protruding tongue
- No lymph node involvement
Where can Ludwigs angina rapidly spread?
- Lateral pharyngeal
- Retropharyngeal space
What is worrisome about Ludwigs angina?
-Can rapidly obstruct upper airway
How do you get a submental space infections?
-Secondary spread from submandibular space
What spaces can the submental space be part of?
-Sublingual and Submylohyoid spaces
Where does a submental space infection come from?
-Periapical abscesses of mandibular molars (2nd and 3rd)
Maxillary molars and premolars will most likely cause abscesses in what area?
-Buccal space
What is your LA drug of choice for an infection?
-Carbocaine
What are the two areas in the retropharyngeal space?
- Anterior (muscular compartment)
- Posterior (neurovascular compartment)
Which areas would be safer of the two compartments to drain in the retropharyngeal space?
-Anterior is safer
What do you find in the posterior compartment of the retropharyngeal space?
- Carotid sheath
- 9-12 CN
- Sympathetic trunk
What are the clincial manifestations of an anterior compartment of a retropharyngeal infections?
- Dysphagia
- Trismus
- Pain
What are the clinical manifestations of a posterior compartment of a retropharyngeal infections?
- No trismus
- Neurologic/vascular
- Edema epiglottis/larynx
What is the potential complication of the posterior compartment?
-Vagal nerve damage
What is delinaeated by fascial planes: 3 layers of deep cervical fascia?
-Retrophyarngeal space/Prevertebral/Danger space
Where can the retropharyngeal space spread to?
- Mediastinal
- Pleural/pericardial spread
What is the location of the retropharyngeal space?
-Base of skull to C7/T1
What is the danger space?
-Base of skull to diaphragm
What is the prevertebral space?
-Between prevertbral fascia and vertebral bodies
Where can an Orbital space infection spread?
Cavernous sinus to cause Cavernous sinus thrombosis
T/F Orbital infection can spread directly to the brain
True
What three spaces come together to make the masticator space?
- Pterygo-mandibular space
- Superficial/deep Temporal space
- Masseteric space
What space is behind the 3rd molar?
-Pterygo-mandibular space
Where is the superficial/deep Temporal space?
-Side of the head by temporalis
Where is the masseteric space?
-Under masseter and over the ramus of mandibile
What can a masticator space infection cause?
-Severe trismus
T/F Anaerobic bacteria are mostly penicillin resistant
True
What is your antibiotic of choice for early infections?
- Penicillin (Pen VK)
- Clindamycin
- Keflex (cephalosporin)
If a pt has a penicillin allergy what do you use in early infections?
- Clindamycin
- Keflex
What is your antibiotic of choice for late infections (after 3 days)?
- Clindamycin
- Penicillin + Metroniadzole
- Ampicillin + sublactam
- Amoxicillin-Clavulanate
If a pt has a penicillin allergy what is your drug of choice in late infections?
=Clindamycin
- Cephalosproin IV
- Ciprofloxacin
