Spread of Infection

Question 1

In the maxilla, if infection spreads through the bone buccally, above the insertion of the buccinator, where will the infection end up?

Answer 1

in the buccal space

Question 2

In the maxilla, if infection spreads through the bone buccally, below the insertion of the buccinator, where will the infection end up?

Answer 2

Drains into the mouth

Question 3

In the maxilla, if infection spreads through the bone palatally, where will the infection end up?

Answer 3

In the palate = very painful

Question 4

In the maxilla, if infection spreads through the bone in an upwards direction, where will the infection end up?

Answer 4

in the maxillary sinus = leads to sinusitis

Question 5

why is it unlikely that dental infection would spread to the palate?

Answer 5

bone is more dense
- infection usually follows path of least resistance

Question 6

Dental infection from which teeth/roots are more likely to spread to the palate? (2)

Answer 6

commonly from palatal roots or lateral incisor (since root lies more palatally)

Question 7

In the mandible, if infection spreads through the bone lingually, above the insertion of the mylohyoid muscle, where will the infection end up?

Answer 7

sublingual space

Question 8

In the mandible, if infection spreads through the bone lingually, below the insertion of the mylohyoid muscle, where will the infection end up?

Answer 8

submandibular space

Question 9

In the mandible, if infection spreads through the bone buccally, above the insertion of the buccinator muscle, where will the infection end up?

Answer 9

drains into the mouth

Question 10

In the mandible, if infection spreads through the bone buccally, below the insertion of the buccinator muscle, where will the infection end up?

Answer 10

buccal space

Question 11

In the mandible, where does infection usually spread to in posterior teeth and why?

Answer 11

infection usually perforates lingually since the bone is thinner
(infection usually follows path of least resistance)

above mylohyoid = sublingual
below mylohyoid = submandibular

Question 12

In the mandible, where does infection usually spread to in anterior teeth and why?

Answer 12

infection can perforate the labial bone easier since its thinner

Question 13

What happens to the surrounding muscles when infection enters the masticatory spaces (posterior potential spaces)?

Answer 13

go into severe spasm and cause trismus

Question 14

list the masticatory spaces. (5)

Answer 14

• Superficial temporal space
• Deep temporal space
• Infratemporal space
• Pterygomandibular space
• Masseteric space

Question 15

If infection enters the masticatory potential spaces, where can it travel to next? (3)

Answer 15

• Lateral pharyngeal space
• Retropharyngeal space
• Prevertebral space

Question 16

Once infection reaches the posterior potential spaces including the Lateral pharyngeal space, the Retropharyngeal space and the Prevertebral space where can it spread to? (3)

Answer 16

the base of the skull
the superior mediastinum
the inferior mediastinum.

Question 17

Describe how mandibular infection causes cavernous sinus thrombosis. (3)

Answer 17

Infection can travel back into the lateral pharyngeal space

enter the infratemporal space where the pterygoid Venus plexus lies

and then the infection can travel to the cavernous sinus via the plexus.

Question 18

Describe how maxillary infection causes cavernous sinus thrombosis. (2)

Answer 18

Infection can travel up into the infraorbital space and enter the veins that lie within this space

the infection can be transported from the veins to the cavernous sinus.
(as the veins are valveless)

Question 19

Where can infection from anterior maxillary teeth spread to? (5)

Answer 19

• Lip
• Nasolabial region
• Lower eyelid

• Palate = usually from lateral incisors as since the roots ae more palatally placed
(less common)

• infraorbital space = from canine (long root)

Question 20

Where can infection from posterior maxillary premolars/molars spread to? (4)

Answer 20

• Cheek/buccal
• Infratemporal region
• Maxillary antrum (v rare)
• Palate (less common)

Question 21

Where can infection from anterior mandibular teeth spread to? (2)

Answer 21

• Mental space
• Submental space (commonly resolve themselves by bursting and draining via the face)

Question 22

Where can infection from posterior mandibular premolars/molars spread to? (5)

Answer 22

• Buccal space
• Submasseteric space
• Sublingual space
• Submandibular space
• Lateral pharyngeal space

Question 23

How do we manage infection? (3)

Answer 23

• Drainage – extra oral or intra oral incision

• Removal of source of infection – extraction or extirpation

Question 24

When is antibiotic therapy used In the management of infection? (2)

Answer 24

• Toxicity: are they systemically unwell? (SIRS – increased HR, respiratory rate, temperature and WCC)
• Medical history: are they immunocompromised?

Question 25

What is Ludwig’s angina?

Answer 25

Bilateral cellulitis (infection/swelling) of the sublingual and submandibular spaces (from dental infection)

• Swelling on both sides

Question 26

What are the extra-oral features of ludwigs angina? (2)

Answer 26

• Diffuse redness
• Bilateral swelling in submandibular region

Question 27

What are the intra-oral features of ludwigs angina? (4)

Answer 27

• Raised tongue: hot potato speach
• Difficulty breathing
• Difficulty swallowing
• Drooling

Question 28

What are the systemic features of ludwigs angina? (4)

Answer 28

• Increased HR
• Increased respiratory rate
• Increased temperature
• Increased WCC

(similar to SIRS of sepsis)