Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
and
spread of infection
SHASHI KANT CHAUDHARY
JR-I
Contents
Introduction
Pathway
of infection
Fascial
spaces
Fascial
space infection
Conclusion
References
Introduction
Etiology
Based on origin of the infection
Involvement
Incisor
Canine
Premolars
molars
Involvement
Incisor
Labial abscess
Below muscle submental space infection
Canine
Premolars
Vestibular abscess
Lingual perfortation may form sublingual space
infection
1st Molar
Vestibular abscess
Submandibular or sublingual if below the muscle
2nd
3rd
Submandibular or pterygomandibular or
submasseteric space infection
3
1
fistula
Septicemia
Acute
chronic
Ascending
facialcerebral
infection
Descending
facial
infection
periapical
infection
celluliti
s
Osteomyelitis
Classification
Based on the mode of involvement
Maxillary
Primary
space
Mandibular
Secondary
Anterovisceral (pretracheal)
Resolution
stage
Stages of
Infection
Characteristics
Inocluation
Cellulitis
Abscess
Duration
0-3 days
3-7 days
Over 5 days
Pain
Mild-moderate
Severe and
generalized
Size
small
Location
Diffuse
Diffuse
Circumscribed
Palpation
Hard, exquisitely
tender
Fluctant, tender
Appearance
Normal coloration
Reddened
Peripherally reddened
Skin quality
Normal
Thickened
Centrally undermined
Surface temperature
Slightly heated
Hot
Moderately headted
Loss of function
Minimal or none
Severe
Moderately severe
Tissue fluid
Edema
Serosanguineous,
flecks of pus
Pus
Level of malaise
Mild
Severe
Moderate-severe
Degree of seriousness
Mild
Severe
Moderate-severe
Predominant bacteria
Aerobic
mixed
Anaerobic
large
Small
Buccal space
Boundaries
Etiology
-may originate from infected root
canals of posterior teeth of the
maxilla and mandible
Clinical presentation
-Swelling of cheek which extends from
the zygomatic arch as far as the inferior
border of the mandible and from the
anterior border of ramus to the corner of
mouth
Treatment:
I)
II)
III) For
esthetic reason
Canine space
Boundaries:-
Clinical presentation
- edema localised in the infraorbital region
which spreads towards medial canthus
of eye, lower eyelid and side of nose as
far as the corner of mouth
-obliteration of nasolabial fold and
mucobuccal fold
Treatment:
-incision is placed intra orally at the mucobuccal folds
(parallel to alveolar bone) in the canine region
Infratemporal space
Boundaries
Etiology
-infected root canals of posterior teeth
of maxilla and mandible ,by way of
pterygomandibular space and may also be
the result of posterior superior alveolar
nerve block and inferior alveolar nerve
block
Clinical presentation:-
Treatment :
-incision is made intraorally at the depth of the
mucobuccal fold
-extraoral drainage is done through an incision at the
angle created by the junction of the frontal and temporal
processes of zygomatic bone
Masticator space
Massetric space
Boundaries:-
Surgical Treatment:-
Pterygomandibular space
Boundaries:-
Surgical treatment:-
Drainage by
Transoral approach
Temporal space
It is divided into
superficial
deep
&
temporal space
by belly of temporalis
Boundaries:-
Suprazygomatic incision
Sublingual space
Boundaries
Etiology
infection
Clinical presentation
Difficulty in speech
Surgical Treatment :
incision for drainage is performed intraorally, laterally and along
Whartons duct and lingual nerve
Submandibular space
Boundaries
Etiology
Usually
Clinical presentation:
Treatment:
- incision for drainage is performed on the skin approx. 1
cm beneath and parallel to inferior border of mandible
Contd
Submental space
Boundaries
Etiology:usually
Surgical Treatment:
-incision on the skin beneath the chin,in a horizontal
direction and parallel to the anterior border of chin
Lateral pharyngeal
Boundaries;-
Etiology :
Clinical Presentation
Deviation of uvula to contralateral side
Slight swelling at the angle of the mandible
Dysphasia
Dyspnea
Severe trismus
Surgical Treatment
Drainage by extra & intra oral approach
Peritonsillar space
Boundaries:
Laterally tonsil
1.
2.
3.
4.
5.
6.
Etiology
Secondary to pharyngotonsillitis
Clinical presentation
Deviation of the uvula to the contralateral side
Unilateral peritonsillar swelling
Malaise
Hot potato voice
Trismus
Dehydration or malnutrition
MANAGEMENT
Pretracheal space
Boundaries
Etiology
Thyroiditis
Clinical presentation
Mainly dysphagia
Hoarseness
Dyspnea
Airway obstruction
Surgical treatment
Fig.
1.Visceral fascia (surrounding thyroid gland, trachea, and esophagus);
2. posterior visceral space (or retropharyngeal space);
3. carotid sheath;
4. anterior visceral space;
5. danger space.
Retropharyngeal space
Boundaries
Etiology
Traumatic intubation
Clinical presentation
Odynophagia
Dysphasia
Neck swelling
Sailorrhea
Surgical Treatment:
Danger space
Boundaries
Etiology
Vertebral osteomyelitis
Clinical presentation
Leukocytosis
Dysphasia
Odynophagia
Surgical Treatment
Carotid sheath
Etiology:
Clinical presentation
Pain
Swelling
Trismus
Diagnosis
Gallium 67 scan
major complications
Orbital infections
Ludwigs angina
Necrotizing fascitis
Brain abscess
Mediastinitis
Peritonsillar abscess
Abdominal abscess
Ludwigs angina
-
Etiology
1.Dental
-primary dental infection
-post extraction phenomenon
2.Submandibular gland sialadenitis
3.Compound mandibular fracture
4.Oral soft tissue lacerations
5.Puncture wound of the floor of the mouth
6.Secondary infections of oral malignancies
Bacteriology
Aerobic
Streptococcus spp. : S. viridans, B - hemolytic
streptocci
Staphylococcus
Others include: Diptheroid, Klebsiella, Hemophillus
spp.
Anaerobic
Bacteroids: Oralis, Bivus, Fragilis
Peptostreptococcus
Fusobacterium
Lactobacillus
Clinical features
trismus
fever
dysphagia/odynophagia
airway obstruction
paucity of pus
Management
1.
Immediate hospitalization
3. Establish
treatment
Incision & drainage for individual spaces
Contd
Etiology
-infection of face can cause a septic thrombosis of the
cavernous sinus
-frunculosis and infected hair follicle in the nose are the
frequent causes
-extraction of maxillary anterior teeth in the presence of
acute infection and especially curettage of the sockets
under such circumstances
-usually staphylococcal infection
Diagnosis
-made in the presence of following six
features according to Eagleton:
1. a known site of infection
2. evidence of blood stream infection
3. early sign of venous obstruction in the retina,
conjnuctiva and eyelid
4. paresis of 3rd,4th and 6th cranial nerves resulting from
inflammatory edema
5. abscess formation in the neighbouring soft tissue
6. evidence of meningeal irritation
Treatment
Antibiotic therapy
Heparinization
-to prevent extension of thrombosis
Neurosurgical consultation
Mannitol
-reduces intracranial edema
Anticoagulants
-prevents venous thrombosis
Surgical drainage
Conclusion
References
Than
ks