SPREAD OF INFECTION

Question 1

List types of odontogenic infection

Answer 1

caries
periapical periodontitis
periodontitis
pericoronitis
osteomyelitis
maxillary sinusitis

Question 2

describe cellulitis

Answer 2

diffuse inflammation of soft tissues
spreads through tissue spaces along fascial planes

Question 3

fatal complication with periorbital oedema

Answer 3

cavernous sinus thrombosis

Question 4

potential spread of infection from mandible leading to mediastinitis

Answer 4

laryngeal inlet - asphyxia
pretracheal fascia
prevertebral fascia
retropharyngeal space

Question 5

bilateral involvement and oedema of the submandibular/ submental/ sublingual/ para and retro pharyngeal spaces

Answer 5

ludwigs angina

Question 6

sign of cavernous sinus thrombosis?

Answer 6

difficulty of movement of eyes
build up of pressure leading to proptosis of eye

Question 7

life-threatening organ dysfunction caused by dysregulated host response to infection

Answer 7

sepsis

Question 8

signs of sepsis

Answer 8

slurred speech
extreme shivering
passed no urine in a day
severe breathlessness
illness
skin mortalling/ discolor/ cyanosis

Question 9

how to differentiate a rash and septic rash

Answer 9

doesn’t blanch with pressure

Question 10

sepsis ABCDE

Answer 10

temp >38 or <36
HR >90
resp rate >20
WCC >12 or <4
BP systolic <100

Question 11

sepsis management

Answer 11

take blood cultures prior to antibiotics
take serum lactate >2mmol/l
give O2
give empirical IV antibiotics
give IV fluids
monitor urine output

Question 12

management of odontogenic infection

Answer 12

• eliminate cause of infection
• provide path of least resistance
• analgesics (paracetamol, ibuprofen)
• review after 48-72 hours

Question 13

co-codamol preparation

Answer 13

800mg codeine
500mg paracetamol

Question 14

what is a sinus?

Answer 14

chronic infection - usually asymptomatic

Question 15

where do sinuses present?

Answer 15

apex of tooth

Question 16

an extraoral discharge resulting from infection?

Answer 16

orocutaneous fistula

Question 17

orocutaneous fistula tx?

Answer 17

extirpate pulp/ xLA
excise fistula

Question 18

feature of a orocutaneous fistula?

Answer 18

epithelial lined

Question 19

what can a buccal space infection present as?

Answer 19

facial swelling which doesn’t proceed above zygomatic arch
can spread periorbitally

Question 20

buccal space infection management in primary care

Answer 20

eliminate source of infection - most likely molar (max/man)
extirpate pulp/ xLA

Question 21

where may canine roots pass through?

Answer 21

muscles of facial expression

Question 22

clinical presentation of canine space?

Answer 22

infraorbital swelling
obliteration of nasolabial fold

Question 23

clinical presentation of infratemporal space infection

Answer 23

severe trismus
bulging of temporalis
cavernous sinus thrombosis

Question 24

what muscles does the infratemporal space lay between

Answer 24

temporalis
pterygoid

Question 25

presentation of submandibular space infection

Answer 25

firm swelling in SM region trismus signs of acute inflammation

Question 26

presentation of sublingual space infection

Answer 26

little extraorally IO swelling FOM

Question 27

can you incise and drain SM space in primary care?

Answer 27

no

Question 28

can you incise and drain SL space in primary care?

Answer 28

yes

Question 29

what does SL space infection suggest?

Answer 29

root is closer to sublingual plate and short rooted - apex above mylohyoid

Question 30

what does SM space infection suggest?

Answer 30

long root and close to inferior border of mandible - under mylohyoid muscle into SM space

Question 31

what teeth normally cause submental space infection?

Answer 31

lower incisors

Question 32

clinical presentation of submental space infection

Answer 32

firm swelling under chin discomfort on swallowing

Question 33

cause of submental space infection

Answer 33

lower incisors with long roots that contact the inferior border/ lingual plate of the mandible

Question 34

3 spaces that communicate from head to chest, leading to mediastinitis

Answer 34

prevertibral retropharyngeal lateral pharyngeal

Question 35

why doesn't an infected area/ abscess not have a good blood supply?

Answer 35

the pus/ inflammation compresses the vessels

Question 36

how may a periapical collection of pus be drained?

Answer 36

through access cavity - creating path of least resistance - then place temp dressing

Question 37

what blade is used to incise abscess?

Answer 37

number 11

Question 38

when would you do blunt dissection?

Answer 38

when there is loculated pus

Question 39

what is used for blunt dissection?

Answer 39

artery forcep or scissors

Question 40

what are general measures post drainage?

Answer 40

adequate fluid intake rest diet

Question 41

what analgesics can be taken after incision and drainage?

Answer 41

paracetamol ibuprofen cocodamol

Question 42

indication for antibiotics

Answer 42

systemic involvement significant cellulitis compromised host defences involvement of fascial spaces

Question 43

antibiotic of choice for most abscesses (anaerobic)

Answer 43

metronidazole

Question 44

what antibiotics may you combine in severe infections

Answer 44

metronidazole and penV

Question 45

when to refer?

Answer 45

rapid progression difficulty breathing difficulty swallowing fascial tissue involvement temp >39 degrees severe trismus compromised host defences infection not responding to tx

Question 46

what sites may you use LA for drainage?

Answer 46

buccal/ labial sulcus palate SL space - buccal and parallel to sublingual fold

Question 47

Ludwig's angina oral symptoms

Answer 47

rapid, board like swelling of FOM, elevation of tongue, dysphagia, dysarthria, trismus

Question 48

why is ludwig's an anesthetic emergency?

Answer 48

compression of airway

Question 49

what is the technique of drainage performed under LA?

Answer 49

Bilateral Hiltons drainage