S19C238 - Face and Jaw Emergencies

Question 1

Erysipelas

Answer 1

-superficial infection
-involves epiderms, dermis and lymphatics
-most often found in lower extremities but also face
-etiology: strep pyogenes
-Sx: red, raised, puffy, sharply defined palpable border, advances rapidly
-tx: PCN
if suspicious for staph infxn (Bullae, trauma, FB) can give dicloxacillin, amox-clav, or keflex

Question 2

Impitigo

Answer 2

-superificial infection
-amber crusts or fluid-filled vesicles (bullous)
-etiology: staph +/- stre pyogenes (group A beta-hemolytic)
-localized lesions, vesicles form then crust over or may enlarge and become flaccid bullae with clear yellow fluid
-tx: cover strep and staph
topical for mild cases that are nonbullous (mupirocin)
PO: clox, amox-clav or keflex
if MRSA: Septra or clinda

Question 3

Salivary gland infections

Answer 3

• 3 glands: parotid, submandibular, sublingual
• related disorders: collagen vascular, nutritional d/o, toxins, DM, dehydration, meds, pregnancy, obesity
• DDx: infxs (mumps), immune (sjogren, SLE, sarcoid), neoplasm, sialolithiasis

Question 4

Mumps: presentaiton and Sx

Answer 4

• viral - paramyxovirus
  
  • (other viruses that cause parotitis: influenza, parainfluenza, coxsackievirus, echovirus, HIV)
• unilateral or b/l parotid swelling
• spread by air borne droplets
• incubates in URT for 2-3w then spreads
• Sx: prodrome of flu-like illness for 3-5d, then salivary gland swelling, tense painful gland w/o erythema or warmth with no pus from stenspn’s duct
• dx: clinical, amylase may be elevated, leukcytopenia with lymphocytes, viral serology can be obtained
• Tx: supportive
  
  • salivary swelling lasts 1-5d
  • pt is contagious for 9d after onset of parotid swelling
• often benign in children but severe in adults

Question 5

Complications of mumps

Answer 5

• unilateral orchitis occurs in 30% of males >8yo, oophoritis in 5% of females
• other complications: mastitis, pancreatitis, aseptic meningitis, sensorineural hearing loss, myocarditis, polyarthritis, hemolytic anemia, thrombocytopenia

Question 6

Suppurative Parotitis

Answer 6

–bacterial infxn of parotid gland in pts with decreased salivary flow, retrograde of bacteria occurs
-RF: anesthesia, dehydration, prematurity or elderly, sialolithiasis, oral neoplasms, duct strictures, trach, FB, meds that decrease flow (diuretics, antihistamines, TCA, BB, phenothiazines), HIV, DM, hypothy, sjogren, dpn, bulimia, anorexia, CF
-etiology: strep, staph, h flu, bacteroides
immunocompromised: e coli, pseudomonas
-Sx: rapid onset, red tender parotid, pus from duct, fever trismus
-Dx: pus, elevated amylase, Cx, imaging not helpful unless abscess suspected
-Tx: optimize salivary flow, hydrate, massage, heat, sialogogues, d/c dry mouth drugs
hospitalize those with trismuc
-Abx: amox-clav or clinda if PCN allg, or keflex+flagyl
-IV: vanco plus flagyl

Question 7

Sialolithiasis

Answer 7

• calculi at any age but often men b/w 30-60yo
• 80% occur in submandibular gland
• Sx: pain, swelling, tenderness, worsening with meals w/in minutes and usually unilateral
• Dx: clinical, palpate stone, gland is firm, intraoral XR, obtain u/s or CT if suspect abscess
• Tx: analgesics, massage, sialogogues, Abx if concurrent infxn

Question 8

Masticator space infection

Answer 8

• 4 spaces bounded by mscs of mastication
• etiology: dental infxn, trauma, surgery, injxn, usually polymicrobial and anaerobic (strep, peptrostrep, bacteroides, prevotella, porphyromonas, fusobacterium actinomyces, veillonella)
• Sx: swelling, pain, erythema, trismus, sepsis often present
• Dx: contrast CT
• Tx: airway protection, IV clinda, admit, may also use cefoxitin, Abx x10-14d, ENT consult

Question 9

TMJ dysfunction

Answer 9

• often associated with trauma, dental injury
• Sx: pain with chewing
• DDx: trauma, odontogenic pain, abscess, carie, otologic referred pain (OM, OE, FB), Temporal arteritis
• Dx: clinical
• XR: panorex (not needed for chronic infections)
• CT: if concerned for complex #, infxn, tumor
• Tx: uncomplicated # and noncomplicated conditions give analgesics (NSAIDS), soft foods
• for chronic conditions: refer to dentist, maxillofacial surgeon or pain specialist

Question 10

Mandible Dislocation

Answer 10

• etiology: trauma, seizure, yawning, laughing, vomiting, large bite, fellatio, trauma, GA, tonsillectomy
• posterior dislocation - check hearing
• posterior, lateral, superior result from severe trauma
• Dx: clinical if atraumatic, panoramic XR if trauma
• Tx: reduction if no fracture
• • post-reduction: soft diet, do not open mouth >2cm x2w, support mandible with hand when yawning, NSAIDs