Spread of infection Flashcards
Spread of infection
Where does the infection spread through?
- The infection spreads through the cancellous bone until it encounters a cortical plate
- If this cortical plate is thin , the infection erodes through the bone and enters the surrounding soft tissues .
Cure of infection
- Treatment of the necrotic pulp by standard endodontic therapy or extraction of the tooth should resolve the infection
- Antibiotics alone may arrest but do not cure the infection because the infection is likely to recur when antibiotic therapy has ended without treatment of the underlying dental cause.
Low severity infections
- Low severity infections, such as those involving the vestibular and subcutaneous spaces have low potential of threatening the airway or vital structures .
- Usually these infections can be treated on an outpatient basis .
Moderate severity
Moderate severity infections have the potential to hinder access to the airway , making endotracheal intubation difficult .
- For example, masticator space infections cause trismus , due to inflammation in the muscles of mastication .
- Perimandibular infections can elevate the tongue and cause swelling of the epiglottis hindering intubation .
High severity infections
have the potential to directly compress or deviate the airway , or to damage vital structures such as the brain and the heart.
The fourth step is to determine the setting of care:
The fourth step is to determine the setting of care: inpatient or outpatient.
- The indications for hospitalization of the patient with head and neck infection are listed as below
The fifth step in the treatment of severe odontogenic infections is
The fifth step in the treatment of severe odontogenic infections is to perform the appropriate surgery .
The surgical goals in head and neck infections are to
- secure the airway,
- to establish dependent drainage and
- to remove the cause of infection, such as a carious tooth.
Incision and drainage
- Incision and drainage decreases the bacterial load
- In addition, the dead space of the abscess cavity is collapsed , enhancing vascular flow to the region , by reducing the pressure exerted by the expanding abscess cavity against surrounding tissue.
Removal of the cause of infection
Removal of the cause of infection also reduces the load of necrotic tissue and eliminates the substrate for continued bacterial growth and invasion of surrounding tissues , especially in infections, such as odontogenic infections, osteomyelitis and osteonecrosis.
Failure of improvement
hospital discharge
FASCIAL SPACES OF THE FACE
- Orofacial infection can spread superiorly to the skull base and inferiorly to the diaphragm .
- Infection generally spreads through the path of least resistance in subcutaneous connective tissues and along fascial planes with separation of the layers of fascia.
- Purulent exudates including pus and gas , tend to collect at specific locations forming a space (termed fascial space).
- Fascial spaces commonly form in loose connective tissue between muscles or skin and bone and have real and potential paths to communicate with other spaces .
Sublingual space infection
The sublingual space is defined superiorly by the the mucosa in the floor of the mouth and inferiorly by the mylohyoid muscles . Anterior and lateral borders are the lingual surface of mandibular bone .
- The sublingual space contains the sublingual gland, submandibular duct lingual nerve, and sublingual artery and vein.
Infection of the sublingual space produces
Submandibular space infection
Submandibular space infection
Drainage is generally achieved by
Submental space infection
Ludwig’s angina
Buccal space infections
Canine space infections
