spread of infection Flashcards
origins
1) bacterial, viral, fungal
2) clinical signs
- swelling, color, pain!!!!
HCC
1) very important
2) get real good health history and physical exam
- is temp elevated
- complete blood count (hospital situation)
bacteremia
1) transient bacteria in bloodstream
septicemia
1 )chronic load of bacteria in blood stream
2) majorly ill, cause of death often
- antibiotic prophylaxis
antibiotic prophylaxis
to prevent a bacteremia from reaching a site of compromised circulation (artificial joint or heart valve)
cellulitis
1 )not localized infection, acute and spreading along fascial planes
2) life threatening
abcess
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)
spread dependent on
1) organism
2) physical health
3) management by practictioner
odontogenic infections
1) dental caries
2) gingivitis and periodontitis
3) local and regional infections from trauma
4) polymicrobial
- aerobic and anaerobic
- gram positive and negativei
infections follow the
1) path of least resistance
2) fascial planes!
modes of spread
1 )circulatory system
2) lymphatic system
3) fascial planes
venous pathways
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
intercranial involvement from infected maxillary molar
1 )can spread to the ear
2) what factors?
- spread through facial planesl
lymphatic pathways
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
superficial horizontal
1) head and neck junction
2) most likely drains to jugulodigastric node
- palpating into the submandibular to check the main points (for enlargement)
deep horizontal
1) surround cervical viscera
2) drain to jugulo-omohyoid node
deep vertical chain
1 )follows internal jugular vein
lymphatic drainage of the oral cavity
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
fascial spaces
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)
if infection gets through the facial planes
1) they move up and down the cylinders
potential fascial spaces
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)
spread of infection via fascial plane
1) follow fascial planes and fill potential fascial spaces
- space infections
2) know the boundaries and spatial relationships of fascial spaces
retropharyngeal space
- between buccopharyngeal and alar fascia
- between base of skull to upper thorax
danger space #4
- between alar and prevertebral
- base of skull to diapragm
masticator space infection
1) tend to localize and point
- tend to form drainage points EXTERNALLY
- anterior to masseter muscle
lateral pharyngeal space
1) inverted cone with base at skull and apex at hyoid bone
- medial: buccopharyngeal fascia
- lateral: parotidomasseteric fascia
- posterior: prevertebral fascia
retropharyngeal space boundaries
1) base of skull to upper mediastinum
- superior and inferior
2) posterior: alar fascia/danger space #4
3) anteriorly: lateral pharyngeal space
danger space #4
1) base of skull to diaphragm
2) posterior: prevertebral fascia
3) anterior: alar/retropharyngeal (buccopharyngeal) fascia
odontogenic infections
1) maxillary
- tend to drain superior and posterior
2) mandibular
- drain inferior and posterior
buccal space infection
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
canine space infection
1) muscular compartment between levator labii superioris and levator anguli oris
2) just below the eye
3) abscess type of infection
palatal space infection
1) palatal roots will drain out here
sublingual space infection
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
submental space infection
1) below the mentalis
2) thermal imaging is used for this
submandibular space infection
1) many teeth can cause infections
ludwig angina
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
not all swellings are infections
1) tumor
2) cyst
3) blocked gland
4) air emphysema
- crackles on palpation
- due to iatrogenic entry of air into fascial space
diagnosis requires
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
