TUT - Spreading infection Flashcards
What are signs of being systematically unwell?
- lymphadenopathy
- high temperature
- sweating
- palor
- altered GCS
- tachycardia
What is cellulitis?
Spreading infection between fascial planes
What is SIRS?
Systemic inflammatory response syndrome
What are the indicators of SIRS?
- <36 or >38 temperature
- > 90 bpm resting
- > 20 breaths per minute
- > 130/90 or >40 difference in normal blood pressure
What obs should you do prior to calling OMFS?
- blood pressure
- pulse
- respiration rate
- temperature
- GCS - rough
- oxygen saturation if available
How should you refer a patient with concerns of SIRS?
- call OMFS with obs details via hospital switchboard (max-fac SHO)
- give patient letter with details of obs, “discussed on phone” adn printed x-rays in available
- instruct patient to go direct to A&E
What structures should you be careful to avoid when incising the palate?
- nasopalatine nerve
- greater palatine nerve
What structures should you be careful to avoid when incising the buccal sulcus?
Mental nerve
How can you avoid incising the nerves in the palate?
Incise anteroposteriorly to go parallel with nerve
What part of the mouth should you avoid incising?
FOM
How should you incise a swelling?
- incise the most fluctuant part
- incise down to bone
- do not close incision, allow drainage to continue
- encourage rinsing immediately
What is pus?
- collection of immune cells, body’s own product
- inhibits healing
How is LA affected by infection?
- infection causes low pH which leaves a lot of free ions
- LA becomes positively charged by free ions which prevents passage through sodium channels and therefore cannot enter cells
What must you warn the patient of regarding LA and the swelling?
The LA may not take as well as usual but the patient should feel immediate relief after incision
Describe how infection spreads?
- takes path of least resistance
- buccal bone is usually thinner (except at 8, where lingual is thinner)
Describe the spread of infection in the lower arch in relation to the buccinator.
- if inferior to buccinator attachment, infection moves to cheek and requires EO incision
- if superior to buccinator attachment, infection moves to buccal sulcus
Describe the spread of infection in the lower arch in relation to the mylohyoid.
- if inferior to mylohyoid attachment, infection moves to submandibular space (posterior teeth)
- if superior to mylohyoid attachment, infection moves to sublingual (FOM) space, eventually spreads to submandibular space (anterior teeth)
Describe the spread of infection in the upper arch in relation to the buccinator.
- if superior to buccinator attachment, infection moves to cheek and requires EO incision
- if infection to buccinator attachment, infection moves to buccal sulcus
Which teeth are likely to have infection spread to the palate?
- upper molar if infection related to palatal root
- upper premolar if infection related to palatal root
- upper lateral as apex more palatal
How does the spread of infection cause trismus?
- acidic environment
- swelling inhibits movement
How are the pharyngeal spaces affected by spread of infection?
- lateral pharyngeal space caves (unable to see clinically due to trismus)
- retropharyngeal space compromises airway
How can infect spread from a tooth to the wider body?
- spread into masticatory spaces
- spread into pharyngeal spaces
- spread upwards to base of skull or down into chest space and compress heart and lungs
How do you manage a swelling?
- RCT or XLA to gain primary drainage
- incision of swelling if unable to gain primary drainage or swelling still present after RCT/XLA
- antibiotics if spreading infection
Why is culture used?
To give narrow spectrum antibiotics
What is the benefit of an aspiration over a swab?
Not contaminated with oral microflora or oxygen exposure
