SPREAD OF INFECTION Flashcards
List types of odontogenic infection
caries
periapical periodontitis
periodontitis
pericoronitis
osteomyelitis
maxillary sinusitis
describe cellulitis
diffuse inflammation of soft tissues
spreads through tissue spaces along fascial planes
fatal complication with periorbital oedema
cavernous sinus thrombosis
potential spread of infection from mandible leading to mediastinitis
laryngeal inlet - asphyxia
pretracheal fascia
prevertebral fascia
retropharyngeal space
bilateral involvement and oedema of the submandibular/ submental/ sublingual/ para and retro pharyngeal spaces
ludwigs angina
sign of cavernous sinus thrombosis?
difficulty of movement of eyes
build up of pressure leading to proptosis of eye
life-threatening organ dysfunction caused by dysregulated host response to infection
sepsis
signs of sepsis
slurred speech
extreme shivering
passed no urine in a day
severe breathlessness
illness
skin mortalling/ discolor/ cyanosis
how to differentiate a rash and septic rash
doesn’t blanch with pressure
sepsis ABCDE
temp >38 or <36
HR >90
resp rate >20
WCC >12 or <4
BP systolic <100
sepsis management
take blood cultures prior to antibiotics
take serum lactate >2mmol/l
give O2
give empirical IV antibiotics
give IV fluids
monitor urine output
management of odontogenic infection
- eliminate cause of infection
- provide path of least resistance
- analgesics (paracetamol, ibuprofen)
- review after 48-72 hours
co-codamol preparation
800mg codeine
500mg paracetamol
what is a sinus?
chronic infection - usually asymptomatic
where do sinuses present?
apex of tooth
an extraoral discharge resulting from infection?
orocutaneous fistula
orocutaneous fistula tx?
extirpate pulp/ xLA
excise fistula
feature of a orocutaneous fistula?
epithelial lined
what can a buccal space infection present as?
facial swelling which doesn’t proceed above zygomatic arch
can spread periorbitally
buccal space infection management in primary care
eliminate source of infection - most likely molar (max/man)
extirpate pulp/ xLA
where may canine roots pass through?
muscles of facial expression
clinical presentation of canine space?
infraorbital swelling
obliteration of nasolabial fold
clinical presentation of infratemporal space infection
severe trismus
bulging of temporalis
cavernous sinus thrombosis
what muscles does the infratemporal space lay between
temporalis
pterygoid
presentation of submandibular space infection
firm swelling in SM region
trismus
signs of acute inflammation
presentation of sublingual space infection
little extraorally
IO swelling FOM
can you incise and drain SM space in primary care?
no
can you incise and drain SL space in primary care?
yes
what does SL space infection suggest?
root is closer to sublingual plate and short rooted - apex above mylohyoid
what does SM space infection suggest?
long root and close to inferior border of mandible - under mylohyoid muscle into SM space
what teeth normally cause submental space infection?
lower incisors
clinical presentation of submental space infection
firm swelling under chin
discomfort on swallowing
cause of submental space infection
lower incisors with long roots that contact the inferior border/ lingual plate of the mandible
3 spaces that communicate from head to chest, leading to mediastinitis
prevertibral
retropharyngeal
lateral pharyngeal
why doesn’t an infected area/ abscess not have a good blood supply?
the pus/ inflammation compresses the vessels
how may a periapical collection of pus be drained?
through access cavity - creating path of least resistance - then place temp dressing
what blade is used to incise abscess?
number 11
when would you do blunt dissection?
when there is loculated pus
what is used for blunt dissection?
artery forcep or scissors
what are general measures post drainage?
adequate fluid intake
rest
diet
what analgesics can be taken after incision and drainage?
paracetamol
ibuprofen
cocodamol
indication for antibiotics
systemic involvement
significant cellulitis
compromised host defences
involvement of fascial spaces
antibiotic of choice for most abscesses (anaerobic)
metronidazole
what antibiotics may you combine in severe infections
metronidazole and penV
when to refer?
rapid progression
difficulty breathing
difficulty swallowing
fascial tissue involvement
temp >39 degrees
severe trismus
compromised host defences
infection not responding to tx
what sites may you use LA for drainage?
buccal/ labial sulcus
palate
SL space - buccal and parallel to sublingual fold
Ludwig’s angina oral symptoms
rapid, board like swelling of FOM, elevation of tongue, dysphagia, dysarthria, trismus
why is ludwig’s an anesthetic emergency?
compression of airway
what is the technique of drainage performed under LA?
Bilateral Hiltons drainage
