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BDS4 CDS Oral Surgery > spread of infection > Flashcards

spread of infection Flashcards

1
Q

palatal bone Vs buccal bone

A

palatal bone tends to be more dense

so less likely to spread that way as looks for path of least resistance

(more likely if palatal root or lateral incisor as palatally placed root)

more painful palatally as less space than buccally

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2
Q

below buccinator maxillary abscess infection spread

A

Could go below buccinator, draining sinus – bad taste, painless, can go a while before tx unlike the other two

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3
Q

maxillary abscess spread upwards causes

A

sinusitis

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4
Q

muscle which impact maxillary spread of infection

A

buccinator

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5
Q

muscles which impacts mandibular spread of infection

A

mylohyoid and buccinator

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6
Q

mandibular abscess which breaks above the inseriton of mylohyoid

A

into sublingual space - sublingual abscess

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7
Q

mandibular abscess which breaks below the mylohyoid insertion

A

submandibular space = submandubular abscess

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8
Q

buccal spread of mandibular infection

A

possible but less common than lingual spread as bone thick on buccal posterior

but if anterior abscess more likely as bone thinner in labial region

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9
Q

lower abscess infection perforate above the insertion of buccinator

A

drain as pus into oral cavity

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10
Q

lower abscess perforate below insertion of buccinator

A

enter buccal space - swelling

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11
Q

importance of mylohyoid in lower infection spread

A

mylohyoid muscle insertion determines where infection can spread to in mandible

  • Attaches to mylohyoid line
    • sublingual spread above
    • submandibular spread below

Depends on which tooth

  • premolar - sublingual
  • 7- submandibular

Mylohyoid Not continuous

  • Open at back so infection from sublingual space can spread to submandibular and vice versa
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12
Q

if infection spread back from jaw can spread into

A

posterior potential spaces

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13
Q

posterior potential spaces areas

A

pterygoid plates region

many muscle and bones – lots of spaces, healthy individual filled with alveolar connective tissue quite flat

infection can spread into them as easy due to little resistance and then can progress to more when penetrate one

spaces are quite explanatory

  • pterygomandibular space – bound by mandible and two pterygoids
  • superficial temporal on outside of temporalis muscle compared to deep temporal space
  • infratemporal space
  • masserteric space

all spaces communicate with each other

  • infection spread in – muscle spasm, trismus
  • all the spaces can be referred to as masticatory spaces*
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14
Q

if posterior potential spaces infected

A

can cause muscle spasm and trismus

they are all interconnected

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15
Q

masticatory spaces a.k.a

A

posterior potential spaces

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16
Q

pterygomandibular space

A

bound by mandible and 2 pterygoids

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17
Q

superficial temporal space

A

outside of temporalis muscle

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18
Q

deep temporal space

A

inside of temporalis muscle

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19
Q

masseteric space

A

between masseter and madnibular ramus

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20
Q

infratemporal spasce

A

above lateral pterygoid muscle below deep temporal space and sphenoid bone

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21
Q

infection spread deeper after posterior spaces into

A

lateral pharyngeal space

retrophargneal space

prevertebral space

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22
Q

plane for this disection

A

coronal

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23
Q

plane for this disection

A

sagittal

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24
Q

what is in the lateral pharyngeal space

A

holds imp vessels and nerves

if able to open mouth , can see pharyngeal wall being pushed in, bulge

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25
Q

after invading the lateral pharyngeal, retropharyngeal and prevertebral space

where can infection spread

A

into infection of chest

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26
Q

plane here

A

lateral

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27
Q

spread from retropharyngeal space

A

up into skull

down into superior mediastinum

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28
Q

prevertebral space spread

A

up into skull

down into inferior mediastinum

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29
Q

spread into chest spaces impact

A

cause cardiac tamponade as infection can add pressure to heart

or abscess in brain

rare but serious

30
Q

cavernous sinus thrombosis

A

infection spread to brain

both lower and upper tooth infection can spread through venous connections to brain – complex but serious

31
Q

lower tooth infection spread to cavernous sinus

A

Infection from lower tooth can spread into lateral pharyngeal space

into infratemporal space,

goes into pterygoid venous plexus – communicates with brain and veins are valve less so blood can flow in both directions meaning infection can spread in both direction

32
Q

upper tooth infection spread into cavernous sinus

A

Infection from upper tooth – spread into infraorbital space

angular and infraorbital veins there (valve less) then into brain

33
Q

intial spread of infection for upper anterior teeth

A

lip

nasolabial region

lower eyelid

34
Q

intial spread of infection for upper lateral incisor

A

(palatally placed root)

palate - less common

35
Q

intial spread of infection for upper premolars and molars

A

cheek

infra-temporal region

maxillary antrum (very rare)

palate (less common)

36
Q

what is this

A

palatl abascess

very painful, tissue strech

likely due to grossly carious lateral incisor

37
Q

what is this

A

intraoral labial abscess

spread buccally below insertion of muscles

38
Q

what is this

A

buccal/infraorbital spread

spread buccal above insertion of muscles, parial closure of eye

swelling of infraorbital and buccal space - linked

39
Q

what is this

A

infraoribital spread

tend to lose nasolabial fold when infraorbital space invaded due to skin stretching

likely canine source of abscess for pure infraorbital spread as higher apex

40
Q

what is this

A

Nasolabial fold unaffected, relatively mild – not red yet but is swollen

41
Q

what is this

A

buccal space infraorbital spread

nasolabial fold is unaffected in this case

42
Q

likely way for upper tooth abscess infection to spread

A

Can spread further but tend to go up into brain

Unusual for uppers to spread lower

  • unless get into buccal space and then spread into lateral pharyngeal via pterygomandibular space (lowers tend to spread down quickly, less so for anteriors)
43
Q

initial spread of infection for lower anterior

A

mental and submental space (tend to stick there)

could spread back into sublingual and submandiular space (not often)

44
Q

inital spread of infection for lower premolars and molars

A
  • Buccal Space (1st)
  • Submasseteric Space
  • Sublingual Space (1st)
  • Submandibular Space (1sT)
  • Lateral Pharyngeal Space
45
Q

what is this

A

submental sinus track to skin

Chronic sinus formation

Once cause removed, need to do plastic surgery to get rid of scar

Pt often don’t think teeth is source of issue – go to doctor/dermatologist who incise and it keeps recurring as infections cause still present

cause - grossly carious lower anteriors

46
Q

what is this

A

submental spread

tends to be self limiting

burst and drain through skin

47
Q

what is this

A

submandibular space spread

red

starting to obliterate the inferior border of mandiblar

could spread to other side or worringly backwards into submasserteric space or ptergomanidublar space and then lateral pharyngeal space

48
Q

what is this

A

buccal and submandibular space spread

cannot see border of mandible - concern, likely systemically unwell

49
Q

what is this

A

submandibular sinus tract to skin

submandibular spread which burst through skin

drained but now has scar - can be tx once cause removed (here unerupted premolar)

50
Q

management of spread of infection from abscess done under

A

LA if pt comfortable if not GA

51
Q

3 principles of managament of spread of infection from abscess

A

establish drainage

removal of source of infection

antibiotic therapy? (not routine)

52
Q

estrablishment of drainage can be

A

extra oral

or

intra oral

53
Q

removal of source of infection

how

A

Tooth itself

  • Extirpate the pulp
  • Extract

Ideally on the day, but could be too painful so need to revisit (delayed removal of source)

54
Q

antibiotic therapy dependent on

A

many factors - not routine

  • Toxicity
  • Desirability
  • Medical history
55
Q

no indication for antibiotics when

A

if able to remove source of infection and obtain proper drainage from all location and pt systemically well

56
Q

indication for antiobiotcs

A

if unable to establish proper drainage for all areas or pt systemically unwell

57
Q

what to look for when trying to detect if systemic infection

A

SIRS scores

58
Q

SIRS stands for

A

Systemic Inflammatory Response Syndrome

59
Q

4 element of SIRS scores

A
  • Raised temperature
  • Raised heart rate
  • Raised respiratory rate
  • Raised white cell count
60
Q

if pt has any of the 4 SIRS scores

A

need IB AB urgently - get to hospital for management

61
Q

e.g management here

A

Extra-oral incision and drainage – submandibular region,

  • be careful of facial nerve marginal mandibular branch (goes down beyond mandible border and comes back up to corner of mouth)
    • standard rule is to go at least 2 finger breadths below inferior border of the mandible

drain after making incision

  • Hold finger in the incision to stimulate flow
  • Hilton Technique
    • Use two ended instrument that can be opened (like scissors, tweezers), close it and place it in the incision and open it to stretch the tissues to allow pus to drain

Serosanguinous combination – blood and pus

Try and get as much as you can

Placement of extra-oral drain to get the last of the infection, held in place by non-resorbable sutures (prolene) for a few days (sterile surgical tubing) with dressing over

  • checked periodically and if dirty still draining, when clean on checked likely ready for drain to be removed
62
Q

what is this

A

buccal space spread

63
Q

what is this

A

submandibualr space spread

lower down than usual

64
Q

what is this

A

Extra oral sinus

Unusual – draining sinus tend to be lower tooth not upper

65
Q

ludwig’s angina

A

Bilateral cellulitis of the sublingual and submandibular spaces (as a result of dental infection)

66
Q

e.g. dental cause of ludwig’s angina

A

lower molar infection spreads to sublingual space then submandibular space on that side,

crosses over and spread into the other two sublingual and submandibular spaces.

Then large swelling under neck with raised tongue (due to infection underneath).

Serious – compromise airway and difficulty swallowing – urgent tx needed, likely also systemically unwell

67
Q

intraoral features of ludwigs angina

A
  • Raised tongue
  • Difficulty breathing
  • Difficulty swallowing
  • Drooling
68
Q

extra oral features of ludwig’s angina

A
  • Diffuse redness and swelling bilaterally in submandibular region
69
Q

systemic features of ludwig’s angina

A
  • Increased heart rate
  • Increased respiratory rate
  • Increased temperature
  • Increased white cell count

  • If low HR/resp/ temp – worrying, going into shock*
  • Check pt when in the chair with infection – one raised, worried send to max fax*
70
Q

National Early Warning Score

A

NEWS

used in emergency med, higher score more unwell pt

3 are SIRS scores which can check in chair

71
Q

ACVPU

A

A = Alert

C = Confusion

V = Responds to verbal commands

P = Responds to pain

U = Completely unresponsive

used to asses pt

BDS4 CDS Oral Surgery (19 decks)

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