spread of infection

Question 1

what two muscles attachments are particularly relevant when looking at spread of infection from mandibular teeth

Answer 1

mylohyoid (lingual)
buccinator (buccal)

Question 2

with regards to the mylohyoid muscle, when would an infection spread sublingual and submandibular

Answer 2

an infection from a mandibular tooth would spread sublingual if the infection perforates bone above the mylohyoid muscle
it would spread submandibular if perforated bone below mylohyoid attachment

Question 3

with regards to buccinator, where would mandibular infection spread

Answer 3

if perforates bone above buccinator muscle, will drain into mouth (vestibular space)
if perforates below buccinator will develop into a buccal face swelling

Question 4

is it more likely for a mandibular infection to spread lingually or buccally and why

Answer 4

bucally until 7/8 where its more likely to go lingual

Question 5

why does tooth position alter likelihood of infection spreading sublingual or submandibular

Answer 5

mylohyoid insertion is along mylohyoid line which is not continuous anteriorly and moves superiorly as it progresses posteriorly

Therefore more likely a premolar infection spreading lingually will go sublingual whereas a 3rd molar infection spreading lingually will more likely go submandibular

Question 6

spread of infection in what direction has the potential to cause trismus

Answer 6

posterior spread

Question 7

name 3 spaces an infection that has spread posteriorly may spread into

Answer 7

pterygomandibular space
masseteric space
superficial temporal space
infratemporal space
deep temporal space

Question 8

what are the 5 masticatory spaces a posteriorly spreading infection may enter

Answer 8

pterygomandibular
infratemporal
deep temporal
superficial temporal
masseteric

Question 9

after the masticatory space where would a posteriorly spreading infection go next

Answer 9

lateral pharyngeal space then retropharyngeal space and prevertebral space

Very dangerous! lots of important structures in this region

Question 10

what tooth is most likely to experience infraorbital spread

Answer 10

canine due to high apex of root

Question 11

what swelling may see loss of nasolabial fold

Answer 11

infraorbital

Question 12

what are the 4 signs of systemic infection (SIRS)

Answer 12

raised HR (>90bpm)
raised respiratory rate (>20/min)
temperature (<36 or >38)
raised WCC (<4000mm3 or >12000mm3)

Question 13

spread to where means palapation of lower border of mandible may be compromised

Answer 13

submandibular

Question 14

what are the 3 aims of managing a dental infection

Answer 14

1. establish drainage - intra or extra oral
2. remove source of infection - extraction, extirpation
3. antibiotics - case dependent

Question 15

what is the Hilton technique

Answer 15

method of drainage
instrument with 2 ends inserted closed then opened to spread tissues once in e.g scissors

Question 16

ludwigs angina

Answer 16

bilateral submandibular and sublingual swelling
Can cause tongue to raise risking airway
Requires urgent treatment , patients will also be systemically unwell

Question 17

clinical features of ludwigs angina

Answer 17

raised tongue, difficult breathing, difficult swallowing, drooling, diffuse swelling and redness bilaterally in submandibular and sublingual area