surgical aspects of orofacial infection? Flashcards
How can infection spread?
Lymph or veins
what is the spread of infection influenced by?
Virulence
Host factors- susceptibility
what are the potential tissue spaces in which infection can spread defined by?
Fascial planes
What occurs when there is a dentoalveolar abcsess in regard to spread?
Suppuration at apex of tooth
- Exit of pus dictated by relationship of apex to cortical plate and thickness of bony cortical plate
- Pus tracks into tissue spaces dictated by muscle and fascial attachments
Where would the infection spread from upper incisors and why?
Thin cortical bone
infection can point into the nasal or labial spaces
where does swelling occur if there is an upper later incisor infection?
Palate
Where can pus point from the upper canines?
Labial sulcus or infraorbitally
Where does infection show when the upper maxillary molars have infection?
The buccal sulcus, this is due to the thin buccal cortical plate and high muscle attachment (buccinator)
where does infection track from the lower incisors?
The mentalis muscle attaches above the root apices so it spreads below the mentalid mm into the chin and submental space
where does infection spread form the mandibular molars?
Depends on relation to the mylohyiod muscle.
Above=sublingual space
Below= submanibular space
What is the spread of pericoronitis?
Buccal sulcus
Cheek space
Pterygomandibular space
Lateralpharyngeal space
Retropharyngeal space
Tonsillar fossa
Submasseteric space
label these fascial systems in the neck?
What is ludwigs angina?
infection within the sublingual and sub mandibular spaces bilaterally
• Thesespaces communicate around posterior margin of mylohyoid
floor of mouth swelling forces the tongue against the palate
riskingobstructionof the pharyngeal airway
LIFE THREATENING
How do you manage dental absesses?
- airway
- removal of source of infection, drainage
• Antibiotics
what is acute cellulitis?
Swelling of tissues, no suppuration
Usually confined to area around jaw
Severe systemic reaction, body failing to respond to the organism
Rapid spread through fascial planes
If body responds get suppuration Mixed infection, mainly oral anaerobes
what is Erysipelas?
An acute streptococcal infection of the deep dermis with
• lymphatic spread
Usually Streptococcus pyogenes, produces an exotoxin
The exotoxin produces the rash.
what are the signs and synptoms of cavernous sinus thrombosis?
Palpebral oedema
Pulsatile exophthalmos
Cyanosis
Proptosis
Fixed, dilated pupil
- Limited eye movement
- Spiking temperature
- Rigors
- Deteriorating sight
what is actinomycosis?
Chronic suppurative infection
• Rare
• Soft tissue swelling – angle of mandible,
- Multiple sinuses - fibrosis
- Trismus
- Gram +ve anaerobe
- Typically seen in tropical countries
When should you suspect actinomycosis? and what is the organism which causes it?
Suspect if persistent extra-oral sinus following removal of dental cause
Actinomyces israelii is the cause
pathogenic when tissue is devitalised andoxygen tension is reduced.
It may develop in the jaw or neck following an infection, trauma or surgery
How do you manage actinomycosis?
Abscess drained surgically
Removal of local cause
Prolonged course of antibacterial usually a penicillin
Repeated cultures
Actinomyces israelii (sometimes with Aggregatibacter
actinomycetemcomitans)
what is osteomyelitus?
Mandible>Maxilla
Severe, deep seated throbbing pain
Paraesthesia
Distension of periosteum
Sequestrae
what is this? what are the symptoms and precipitating factors and what is the microganism causing it?
Cancrum oris
Immunocompromised, malnourished
Poor oral hygiene
Necrotising gingivitis
Gross oedema
gangrenous slough Soft tissue and bone
Anaerobes esp Bacteroides, Treponema vincentii, Fusobacterium necrophorum
