Spread of Infection Flashcards
Where can maxillary tooth infection spread to?
Draining palatal sinus (very painful, less common due to thick palatal bone)
Draining buccal sinus - below buccinator insertion
Into maxillary sinus - sinusitis
Into buccal space, superior to insertion of buccinator - swelling of cheek
Where a mandibular tooth infection can spread to?
- Drain buccally and perforate above buccinator muscle – draining buccal sinus
- Drain buccally and perforate below buccinator muscle and drain into buccal space
- Perforate above the mylohyoid muscles (sublingual abscess ion sublingual space)
- Perforated below the mylohyoid insertion – submandibular abscess
Label this diagram.
What type of section is this?
- Cross sectional of ramus of the mandible (coronal section)
- Infection spreads into path of less resistance and can spread to any of these spaces
Label this diagram. What is its importance to spread of infection?
- If infection spreads from one of the posterior spaces i.e. masseteric space, it can proceed to spread to
- first the lateral pharyngeal space
- second to the retropharyngeal space (behind the pharynx)
- third to prevertebral space
concerning
This diagram shows the mylohyoid line which is where the mylohyoid muscle attaches to. What is the relevance of mylohyoid line in terms of infection?
- Where the infection starts from gives a indication as to where it will spread
- I.e infection from a premolar that spreads lingually will end up in sublingual space (infront of the mylohyoid )
- infection from the apex of 7 that spreads lingually will go into submandibular space (behind mylohyoid )
- Mylohyoid muscle is loosely attached at the side therefore infection from submandibular region can spread into sublingual and vice versa
Why is the
- Masseteric space
- Deep temporal space
- Infratemporal space
- Pterygomandibular space
- Superficial temporal space
Called that particular space?
- Pterygomandibular space because bound by mandible and lateral and medial pterygoid muscle
- Infratemporal space because in the infratemporal fossa region
- Deep temporal space because deep to temporalis muscle
- Superficial temporal space because superficial to temporalis muscle
- Masseteric space because between masseteric muscle and mandible
What can be a presenting symptom the pt will have if there is infection in any of the posterior spaces i.e. masseteric , deep temporal etc..?
- pt will present with trismus as infection has caused spasming of the muscles associated with the space
- i.e. if infection in masseteric space then spasming of the masseter muscle
If a pt has an infection in their lateral pharyngeal space what can they present with?
- Limited mouth opening
- Can see the pharyngeal wall being bulged out
Describe what is going on in this image, how does it relate to spread of infection?
- If infection continues to spread and ends up in either prevertebral space or retropharyngeal space
- This can continue to spread and either spread into the base of the skull or into the mediastinum
- if spreads into mediastinum this can cause cardiac tamponade (life threatening)
Label this diagram. What is the importance of this diagram in regard to spread of dental infection?
- Posterior infection spread to infratemporal space can spread into pterygoid venus plexus which communicates with the brain
- Can spread through emissary veins and spread into cavernous sinus - can cause cavernous sinus thrombosis
- Maxillary infection can spread through inferior ophthalmic vein and into cavernous sinus
What is cavernous sinus thrombosis?
- Blood clot in the cavernous sinus
- Can be lifethreatening
Where commonly does infection of upper anterior teeth spread to?
- Lip
- Nasiolabial region
- Lower eyelid
Where commonly does infection of the upper lateral incisor spread to?
- Palate (less common)
Where commonly does infection of upper premolars and molars spread to?
- Cheek
- Infratemporal region
- Maxillary antrum (very rare)
- Palate (less common)
Why type of abscess does this image show? What is the most probable cause?
- Palatal abscess
- Due to grossly carious 21 but could be other
What type of abscess does this image show?
- Buccal abscess (labial) between 21 and 22
- Gone below the insertion of the muscles so drains into the mouth
What type of abscess does this image show?
- Buccal / infraorbital spread
- Infection gone above the muscles to give swelling of outer face
- Tend to lose nasiolabial fold with these swellings
Why type of swelling is this? What tooth is most likely to cause these swelling and why?
- Infraorbital
- Canine due to its long root so therefore drains higher up into infraorbital space
Most commonly where does infection of lower anteriors spread to?
- Mental and submental space
Where most commonly does infection of lower premolars and molars spread to?
- Buccal space
- Submasseteric space
- Sublingual space
- Submandibular space
- Lateral pharyngeal space
What type of spread of infection are these two images showing?
- Submental spread
- Left with a scar due to the fact these swelling usually burst and drain via the face if left untreated (called a submental sinus tract extraorally)
What type of swelling does this image show?
- Submandibular space spread of infection
What type of spread does this image show?
- Buccal / submandibular spread
What is the surgical management of large presenting abscess’?
- Establish drainage via
- XLA
- Pulp extirpation
- Extra oral incision
- Removal of source of drainage either that visit or another visit
- Consider antibiotics only when systemically involved or when local measure do not work
What are the signs of a systemically unwell pt?
- SIRS (Systemic inflammatory response syndrome)
- Raised temp, HR, White cell count, BP
What nerve do you need to be careful of when performing extra-oral incision in submandibular swelling?
- Marginal mandibular branch which innervates the mentalis so will affect smiling
- Always go two finger breadths below the inferior border of mandible to not incise it
What technique can be used for drainage of large submandibular abscess?
- Hilton technique
- Use finger to pop it
- Then place a drain sutured in for a few days to allow drainage until complete
What is Ludwigs Angina?
- Bilateral cellulitis of the sublingual and submandibular spaces
What are intraoral / extraoral and systemical features of Ludwig’s Angina?
Intraoral
- Raised tongue
- Difficulty breathing
- Difficulty swallowing
- Drooling
Extraoral
- Diffuse redness and swelling bilaterally in submandibular region
Systemically
- Increased HR
- Increased resp rate
- Increased temp
- Increased white cell count
What are the boundaries of submandibular space?
Laterally - mandible below mylohyoid line
Medially - mylohyoid muscle
Inferiorly - deep cervical fascia and overlying platysma and skin
