spread of infection

Question 1

origins

Answer 1

1) bacterial, viral, fungal
2) clinical signs
- swelling, color, pain!!!!

Question 2

HCC

Answer 2

1) very important
2) get real good health history and physical exam
- is temp elevated
- complete blood count (hospital situation)

Question 3

bacteremia

Answer 3

1) transient bacteria in bloodstream

Question 4

septicemia

Answer 4

1 )chronic load of bacteria in blood stream
2) majorly ill, cause of death often
- antibiotic prophylaxis

Question 5

antibiotic prophylaxis

Answer 5

to prevent a bacteremia from reaching a site of compromised circulation (artificial joint or heart valve)

Question 6

cellulitis

Answer 6

1 )not localized infection, acute and spreading along fascial planes
2) life threatening

Question 7

abcess

Answer 7

1 )localized infection, walled off
2) pus, suppuration
3) incision and drainage
- tooth extraction
- RCT
- antibiotics poor effect on it (no blood supply to it)

Question 8

spread dependent on

Answer 8

1) organism
2) physical health
3) management by practictioner

Question 9

odontogenic infections

Answer 9

1) dental caries
2) gingivitis and periodontitis
3) local and regional infections from trauma
4) polymicrobial
- aerobic and anaerobic
- gram positive and negativei

Question 10

infections follow the

Answer 10

1) path of least resistance
2) fascial planes!

Question 11

modes of spread

Answer 11

1 )circulatory system
2) lymphatic system
3) fascial planes

Question 12

venous pathways

Answer 12

1) infections entering the venous system of he face have no valves
2) can flow anywhere (gravity)
3) can get int pterygoid venous plexus to the ITF
- could lead to cavernous sinus infection

Question 13

intercranial involvement from infected maxillary molar

Answer 13

1 )can spread to the ear
2) what factors?
- spread through facial planesl

Question 14

lymphatic pathways

Answer 14

1) two rings
2) superficial horizontal ring
- at head and neck junction
3) deep horizontal ring
- surrounds cervical viscera
4) deep vertical chain
- follows internal jugular vein
- connect the two rings bilaterally

Question 15

superficial horizontal

Answer 15

1) head and neck junction
2) most likely drains to jugulodigastric node
- palpating into the submandibular to check the main points (for enlargement)

Question 16

deep horizontal

Answer 16

1) surround cervical viscera
2) drain to jugulo-omohyoid node

Question 17

deep vertical chain

Answer 17

1 )follows internal jugular vein

Question 18

lymphatic drainage of the oral cavity

Answer 18

1) midline structures such as the tongue and floor of the mouth drain bilaterally
- wide and aggressive spread of oral infections and carcinomas
- most drain to submandibular node

Question 19

fascial spaces

Answer 19

1) deep cervical fascia
- prevertebral
- alar fascia anteriorly between transverse processes
2) pre-tracheal (visceral) fascia
3) investing fascia (outer layer)
4) carotid sheath (contributed to by the others)

Question 20

if infection gets through the facial planes

Answer 20

1) they move up and down the cylinders

Question 21

potential fascial spaces

Answer 21

1) masticator space
- temporal space
- infratemporal space
2) lateral pharyngeal space
3) retropharyngeal (retrovisceral space)
4) danger space #4
5) carotid space

• lots of space to go posteriorly! (difficulty swallowing or breathing)

Question 22

spread of infection via fascial plane

Answer 22

1) follow fascial planes and fill potential fascial spaces
- space infections
2) know the boundaries and spatial relationships of fascial spaces

Question 23

retropharyngeal space

Answer 23

• between buccopharyngeal and alar fascia
• between base of skull to upper thorax

Question 24

danger space #4

Answer 24

• between alar and prevertebral
• base of skull to diapragm

Question 25

masticator space infection

Answer 25

1) tend to localize and point
- tend to form drainage points EXTERNALLY
- anterior to masseter muscle

Question 26

lateral pharyngeal space

Answer 26

1) inverted cone with base at skull and apex at hyoid bone
- medial: buccopharyngeal fascia
- lateral: parotidomasseteric fascia
- posterior: prevertebral fascia

Question 27

retropharyngeal space boundaries

Answer 27

1) base of skull to upper mediastinum
- superior and inferior
2) posterior: alar fascia/danger space #4
3) anteriorly: lateral pharyngeal space

Question 28

danger space #4

Answer 28

1) base of skull to diaphragm
2) posterior: prevertebral fascia
3) anterior: alar/retropharyngeal (buccopharyngeal) fascia

Question 29

odontogenic infections

Answer 29

1) maxillary
- tend to drain superior and posterior
2) mandibular
- drain inferior and posterior

Question 30

buccal space infection

Answer 30

1) vestibular
- a pimple may drain into buccal vestibule
- large swellings localized to that area
- make a horizontal incision through the muscle and drain

2) perialveolar spaces
- buccal space
a) medial: buccinator
b) lateral: skin
c) anterior: labial muscles
d) posterior: pterygomandibular raphe

Question 31

canine space infection

Answer 31

1) muscular compartment between levator labii superioris and levator anguli oris
2) just below the eye
3) abscess type of infection

Question 32

palatal space infection

Answer 32

1) palatal roots will drain out here

Question 33

sublingual space infection

Answer 33

1) apices of the mandibular tooth above the mylohyoid
- sublingual space drainage
- typically mandibular bicuspids
2) if below
- submandibular space drainage
- typically mandibular molars
–
1) the sublingual fold can swell

Question 34

submental space infection

Answer 34

1) below the mentalis
2) thermal imaging is used for this

Question 35

submandibular space infection

Answer 35

1) many teeth can cause infections

Question 36

ludwig angina

Answer 36

1) bilateral swelling of the sublingual space that spreads bilaterally
- to submandibular and submental spaces
2) may spread bilaterally too
3) most common cause
- infected mandibular 3rd molar extraction site
4) tongue elevated, swollen, and LITERALLY FILLS THE MOUTH
- very aggressive infection

Question 37

not all swellings are infections

Answer 37

1) tumor
2) cyst
3) blocked gland
4) air emphysema
- crackles on palpation
- due to iatrogenic entry of air into fascial space

Question 38

diagnosis requires

Answer 38

1) history of infection
2) review medical and dental history
2) physical exam
4) anatomy and virulence of infection
5) differential and definitive diagnosis
6) treatment risks, benefits and options
7) inform and get consent