OS- spread of infection Flashcards
What does the spread of infection depend on?
Path of least resistance
Location of the perforation of infection compared to the muscles
We have an infected maxillary.
The infection breaks through above the insertion of the buccinator.
What anterior areas will it spread to?
Into buccal space.
Or patatally- less likely as the palatal bone is more dense so a more resistant path- This is also more painful.
We have an infected maxillary tooth. The infection spreads below the insertion of the buccinator. What anterior areas will it spread to?
It drains into the mouth via a draining sinus (there is a bad taste in the patient’s mouth)
We have an infected mandibular tooth.
The infection perforates above the mylohyoid. What anterior areas will it spread to?
It spreads into the sublingual space producing a sublingual abscess.
We have an infected mandibular tooth.
The infection perforates below the mylohyoid.
What anterior areas will it spread to?
It spreads into the submandibular space producing a submandibular abscess.
Why is buccal spread of infection from a lower tooth less common than lingual spread?
Because the bone is thicker on the buccal- meaning there is a greater resistance to movement buccally.
Identify and name the posterior spaces that the infection can spread to in the face?
What happens if infection spreads to these areas?
We get spasms of the muscles causing severe trismus.
how does a facial infection spread back from the posterior spaces?
It spreads to:
- Lateral pharyngeal space (important blood vessels are located here)
- Retropharyngeal space
- Prevertebral space.
Identify these spaces
Why are we worried about the spread of infection to the:
Lateral pharyngeal space, the prevertebral space and the retropharyngeal space?
These travel vertically so the infection can spread to the skull (putting pressure on the brain) or to the inferior sinus (putting pressure on the heart)
What is the risk of the spread of infection to the infratemporal space?
The pterygoid venus plexus is located here so infection can spread to the cavernous sinus of the brain causing cavernous sinus thrombosis.
An upper anterior tooth is infected. Typically, where will the infection spread?
Lips
Lower eyelid
Nasolabial region.
Where could an upper lateral incisior also spread and why?
Palatally because the apex of the tooth is more palatally placed.
An Upper premolar is infected, typically where would the infection spread?
Cheek
Infratemporal region
Palate
Maxillary antrum (rare)
An upper molar is infected.
Typically, where would the infection spread?
Cheek
Infratemporal region
Maxillary antrum (rare)
Palate.
Name the abscess pictured.
Palatal abscess
Name the abscess pictured?
Labial/ intraoral abscess
Name the abscess pictured
Buccal abscess
There is infection in a lower anterior tooth. Where will this infection spread?
Mental and submental space.
There is an infection in the lower premolar tooth. Where will this infection spread?
Buccal space
Submasseteric space
sublingual space
Submandibular space
Lateral pharyngeal space.
There is an infection in the lower molar. Where will this infection spread?
Buccal space.
submandibular space
Submasseteric space
lateral pharyngeal space.
Sublingual space
Name the abscess shown.
submental swellling.
Identify the type of abscess
Submandibular
Identify the type of swelling.
Buccal and submandibular
What is the arrow pointing to?
Submandibular sinus tract to the skin.
Where should be position our incision for exra-oral drainage and why ?
2 fingers breadths below the inferior border of the mandible to prevent damage to the marginal mandibular branch of the facial nerve.
How can we drain out the abscess from the hole?
Using our fingers
Using the hilton technique- use an instrument (howarth’s elevator) to stretch open the hole and allow pus to drain out.
What is this and what is it used for?
An extra-oral drain
This allows further drainage of the area.
We put a dressing on it and change the dressing.
We only remove the extra-oral drain when we go to change the dressing and it is still clean. Then we can suture up the incision.
When would we not need to provide antibiotics for the infection?
If we have removed the cause, drained the infection AND the patient is systemically well.
Identify this condition and discuss:
I/O signs
E/O signs
Systemic signs.
This is ludwings angina- bilateral cellulitis of the sublingual and submandibular spaces.
I/O
- raised tongue
- Difficulty breathing
- Difficulty swallowing
- Drooling.
E/O
- Diffuse redness and swelling in the submandibular region.
Systemic:
Increased temp. Increased HR. Increased respiratory rate. Increased WBC count.
