Spread of Infection Flashcards
Where can a maxillary abscess spread to
- buccal space (if above buccinator)
- draining sinus (if below buccinator)
- into maxillary sinus (unusual)
- palatal route (painful)
Where can a mandibular abscess spread to?
- lingually to give sublingual abscess (above mylohyoid)
- lingually into submandibular space (below mylohyoid)
- buccally below buccinator
- buccally above buccinator
What determines where an infection spreads on the lower jaw
- The mylohyoid muscle attachement
i.e. above muscle = lingually into sublingual space; below muscle = submandibular space - Tooth anatomy
- 33 = sublingual, 37 = submandibular
Also, muscle is open at the back so infection in sublingual space could spread into submandibular space and vice versa
What are the different (masticatory) posterior potential spaces infection can spread to
- superficial temporal space
- deep temporal space
- infratemporal space
- masseteric space
- pterygomandibular space
what happens to the muscles of mastication when infection gets into the spaces around the mandible
they spasm (trismus)
after spreading to masticatory spaces, where can infection then spread
- lateral pharygeal space (first)
- retropharyngeal space
- prevertable space
then even further…
after infection goes through the retropharyngeal and prevertable spaces, where can it then go
- up into the brain
- down into the mediastinum
what infection could result if infection reaches the brain
cavernous sinus thrombosis
where do infections tend to spread from the upper anterior teeth
- lip
- nasiolabial region
- lower eyelid
Where do infections tend to spread from the upper lateral incisor
palate
because the apex of its root is more palatally placed
where do infections tend to spread from upper premolars and molars
- cheek
- infra-temporal region
- maxillary antrum
- palate
What is the diagnosis for this and where is this infection most likely spreading
Intraoral (labial) abscess
Draining into mouth so spreading below buccinator
Where is this patients infection spreading
Buccal but above muscle insertions
- swellings in cheek, infraorbital region and buccal
- partial closure of eye
how would you describe this spread of infection
mainly infra orbital, not buccal yet nb nasiolabial fold gone (nose deformed)
how would you describe this spread of infection
mainly buccal spread, more mild
how would you describe this spread of infection
buccal and infraorbital spread (nasio labial fold still here in this case)
nb unusual for upper infections to spread back but can happen
Where do lower anterior teeth infections spread
mental and submental space
often stay there but can spread to sublingual and submandibular spaces
where can lower premolars and molar infections spread
- buccal space
- submasseteric space
- sublingual space
- submandibular space
- lateral pharyngeal space
How would you describe this spread of infection
submental spread
- tend to be self liimiting and eventually burst and drain through skin
pure submandibular spread?
What is this and how did it happen
Submental sinus tract to skin
- has burst and formed a chronic sinus which is draining EO
- once infection removed will have to do plastic surgery to get rid of scar
What would you call this spread of infection and what would the clinical appearance be
Submandibular spread
- won’t be able to feel lower border of the mandible
- could spread to other side or more worryingly backwards into submassateric space, pterygomandibular space, lateral pterygoid space
- check systemic symptoms
- need to incise and drain as well as extract tooth
What spread of infection is this
buccal and submandibular spread
- now cannot feel lower border of mandible
- check systemic symptoms
What view of a radiograph is this
lateral oblique radiograph
What is the arrow pointing at
submandibular sinus tract to skin
Describe the management of abscesses
- Establishment of drainage (EO via incise, IO via tooth/incise)
- Removal of source of infection (immediate or delayed)
- Antibiotic therapy (depends on toxicity/desirability/ MHx)
what can make the removal of the source of infection challenging
hard to anaesthetise patient with severe infection
What systemic symptoms do you need to look out for
SIRS
What does SIRS stand for
Systemic Inflammatory Response Syndrome
What symptoms make up SIRS
- increased temperature
- increased heart rate
- increased respiratory rate
- increased white blood cells
first 3 can check in dental chair
what do you do if you suspect someone has SIRS
- give antibiotics
- refer to hospital
when carrying out submandibular drainage, what nerve do you have to consider and how do you avoid it
Facial nerve (marginal mandibular branch)
go at least 2 fingers below inferior border of mandible
marginal mandibular crosses over border of mandible
what technique is used to drain EO
hilton technique (anything with 2 ends which can be opened e.g. scissors)
put in the opening closed and then open them to remove pus/blood
what needs to be placed following submandibular drainage
placement of an EO drain for a few days
what is this
extra-oral sinus
describe this swelling
buccal space spread
What radiographic view is this
lateral oblique
What type of infection spread is this
submandibular space spread
quite low down in this case
What do you call bilateral cellulitis of the sublingual and submandibular spaces
Ludwig’s Angina
what is ludwig’s angina
- bilateral cellulitis of the sublingual and submandibular spaces
- will show signs of SIRS
Features of Ludwig’s angina
IO
- raised tongue
- difficulty breathing
- difficulty swallowing
- drooling
EO
- diffuse redness and swelling bilaterally in submandibular region
Systemically
- increased heart rate, respiratory rate, temperature and white cell count (SIRS)
What would you do if you thought someone had ludwig’s angina
urgent referal to maxfax
very urgent
What does NEWS2 stand for and what is it
National Early Warning Score
- used in emergency medicine to observe patients
What are the different scores in NEWS2
0 - normal
1
2
3 - most unwell
How is consciousness measured
A - Alert
C - confusion
V - responds to verbal commands
P - responds to pain
U - completely unresponsive
