Infection Flashcards
(77 cards)
1
Q
What are fascial spaces?
A
Potential spaces between the layers of fascia filled with loose connective tissues and various anatomical structures like veins, arteries, glands, lymph nodes, etc.
2
Q
What are the primary maxillary spaces?
A
- Upper lip
- Canine
- Buccal
- Infratemporal spaces
3
Q
What are the primary mandibular spaces?
A
- Buccal
- Submental
- Submandibular
- Sublingual spaces
4
Q
What are secondary spaces related to infections?
A
- Masticatory spaces (Masseteric, pterygomandibular, infratemporal, temporal)
- Lateral pharyngeal
- Retropharyngeal
- Prevertebral spaces
- Parotid space
5
Q
What are the steps in the management of oro-facial infections?
A
- Determine the cause and severity of the infection
- Evaluate the host defense
- Decide on the setting of care
- Treat surgically (Incision and Drainage)
- Support medically
- Choose and prescribe antibiotics appropriately
- Evaluate patient frequently
6
Q
What is the anatomical location of an abscess at the base of the upper lip?
A
It is a vestibular abscess, at the base of the upper lip, on the oral side of the orbicularis oris muscle.
7
Q
What is the etiology of an abscess at the base of the upper lip?
A
Caused by infected root canals of maxillary anterior teeth.
8
Q
What are the clinical presentations of an abscess at the base of the upper lip?
A
- Swelling and protrusion of the upper lip
- Diffuse spreading and obliteration of the depth of the mucolabial fold
9
Q
What complications can arise from infections in the area of the upper lip?
A
Orbital cellulitis or cavernous sinus thrombophlebitis.
10
Q
How is an abscess at the base of the upper lip treated?
A
- Intraoral incision for drainage at the mucolabial fold
- Removal of the cause (RCT or extraction)
11
Q
Where is the canine fossa located?
A
Between the levator labii superioris and the levator anguli oris muscles.
12
Q
What is the etiology of a canine fossa abscess?
A
Infected root canals of maxillary canine or premolars.
13
Q
What are the clinical presentations of a canine fossa abscess?
A
- Painful edema localized in the infraorbital region
- Spreading towards the medial canthus of the eye, lower eyelid, and side of the nose
- Obliteration of the nasolabial and mucolabial folds
- Skin becomes taut and shiny due to suppuration
14
Q
How is a canine fossa abscess treated?
A
The incision for drainage is performed intraorally at the mucobuccal fold in the canine region.
15
Q
What is the etiology of a palatal abscess?
A
Infection usually originates from maxillary teeth whose roots lie close to it, like maxillary lateral incisors or palatal roots of molars.
16
Q
What are the clinical presentations of a palatal abscess?
A
A well-defined fluctuant swelling confined to one side of the palate, adjacent to the offending tooth.
17
Q
How is a palatal abscess treated?
A
Intraoral incision along the palatal mucoperiosteum down to the bone, done anteroposteriorly.
18
Q
What are the anatomical boundaries of the buccal space abscess?
A
- Superiorly: the zygomatic arch
- Inferiorly: the inferior border of the mandible
- Medially: buccinators muscle
- Laterally: covered by skin, superficial fascia
- Posteriorly: anterior border of the masseter
- Anteriorly: corner of the mouth
19
Q
What is the etiology of a buccal space abscess?
A
From infected root canals of posterior teeth of the maxilla and mandible.
20
Q
What are the clinical presentations of a buccal space abscess?
A
- Swelling of the cheek extending from the zygomatic arch to the inferior border of the mandible
- Skin appears taut and red, with or without fluctuation of the abscess
21
Q
How is a buccal space abscess treated?
A
Intraoral incision at the posterior region of the mouth, in an anteroposterior direction.
22
Q
What are the anatomical boundaries of the infratemporal abscess?
A
- Superiorly: infratemporal surface of greater wing of sphenoid bone
- Inferiorly: lateral pterygoid muscle
- Laterally: ramus of the mandible and temporalis muscle
- Medially: medial and lateral pterygoid muscles
- Posteriorly: parotid gland
- Anteriorly: infratemporal surface of maxilla
23
Q
What is the etiology of an infratemporal abscess?
A
- Infected buccal roots of maxillary molars
- Septic posterior superior alveolar nerve & inferior alveolar nerve block
- Ascending infection from pterygomandibular space
24
Q
What are the clinical presentations of an infratemporal abscess?
A
- Trismus and pain during mouth opening with lateral deviation towards the affected side
- Edema at the region anterior to the ear extending above the zygomatic arch
25
How is an infratemporal abscess treated?
* Intraoral incision at the depth of the mucobuccal fold, laterally to the maxillary third molar
* Extraoral incision on the skin in a superior direction
26
What are the anatomical boundaries of a submental abscess?
* Laterally: anterior belly of digastric muscle
* Superiorly: mylohyoid muscle
* Inferiorly: skin, superficial fascia, platysma, and deep cervical fascia
27
What is the etiology of a submental abscess?
Originates in the mandibular anterior teeth or spread of infection from other spaces.
28
What are the clinical presentations of a submental abscess?
Indurated and painful submental swelling which may fluctuate or spread.
29
How is a submental abscess treated?
Extraoral incision on the skin beneath the chin, in a horizontal direction.
30
What are the anatomical boundaries of a sublingual abscess?
* Superiorly: mucosa of the floor of the mouth
* Inferiorly: mylohyoid muscle
* Anteriorly and Laterally: inner surface of the body of the mandible
* Medially: hyoglossus, genioglossus, and geniohyoid muscles
* Posteriorly: hyoid bone
31
What is the etiology of a sublingual abscess?
Infected mandibular anterior teeth, premolars, and first molar.
32
What are the clinical presentations of a sublingual abscess?
Swelling of the mucosa of the floor of the mouth, elevating the tongue, causing airway obstruction.
33
How is a sublingual abscess treated?
* Intraoral incision near the lingual cortical plate
* Extraoral incision when both submental and sublingual spaces contain pus
34
What are the anatomical boundaries of a submandibular abscess?
* Superiorly: mylohyoid muscle
* Medially: anterior belly of digastric
* Laterally: medial surface of the mandible
* Inferiorly: superficial layer of deep cervical fascia
35
What is the etiology of a submandibular abscess?
Infection from mandibular second and third molars or spread from sublingual or submental spaces.
36
What are the clinical presentations of a submandibular abscess?
* Moderate painful swelling at the submandibular area
* Indurated and redness of the skin
* Moderate trismus
37
How is a submandibular abscess treated?
Extraoral skin incision approximately 1 cm beneath and parallel to the inferior border of the mandible.
38
What are the secondary potential fascial spaces?
* Masticatory spaces
* Infra-temporal abscess
* Temporal abscess
* Submasseteric abscess
* Pterygomandibular abscess
39
What are the anatomical boundaries of the temporal abscess?
* Lateral: temporal fascia
* Medial: temporalis muscle
40
What is the etiology of a temporal abscess?
Caused by the spread of infection from the infratemporal space.
41
What are the clinical presentations of a temporal abscess?
* Painful edema of the temporal region
* Trismus
42
How is a temporal abscess treated?
Extraoral incision for drainage at the margin of the scalp hair, approximately 3 cm above the zygomatic arch.
43
Where is the submasseteric abscess located?
Between the masseter muscle and the lateral surface of the ramus of the mandible.
44
What is the etiology of a submasseteric abscess?
Infection originates in the mandibular third molars (pericoronitis).
45
What are the clinical presentations of a submasseteric abscess?
* Firm edema painful to pressure in the masseter region
* Severe trismus
* Intraoral edema present at the retromolar area
46
How is a submasseteric abscess treated?
* Intraoral incision from the coronoid process along the anterior border of the ramus
* Extraoral skin incision beneath the angle of the mandible.
47
What are the anatomical boundaries of a pterygomandibular abscess?
* Laterally: medial surface of the ramus of the mandible
* Medially: medial pterygoid muscle
* Superiorly: lateral pterygoid muscle
* Anteriorly: pterygomandibular raphe
* Posteriorly: parotid gland
48
What is the anatomic location of the pterygomandibular space?
Bounded laterally by the medial surface of the ramus of the mandible, medially by the medial pterygoid muscle, superiorly by the lateral pterygoid muscle, anteriorly by the pterygomandibular raphe, and posteriorly by the parotid gland.
49
What are the contents of the pterygomandibular abscess?
* The mandibular neurovascular bundle
* Lingual nerve
* Part of the buccal fat pad
50
What is a common etiology of a pterygomandibular abscess?
Pericoronitis related to mandibular third molars and septic inferior alveolar nerve block.
51
What are the clinical presentations of a pterygomandibular abscess?
* Severe trismus
* Slight extraoral edema beneath the angle of the mandible
* Edema of the soft palate of the affected side
* Displacement of the uvula and lateral pharyngeal wall
* Difficulty in swallowing
52
Describe the treatment for a pterygomandibular abscess.
Incision for drainage is performed on the mucosa of the oral cavity along the medial and anterior aspect of the ramus, 1.5 cm long and 3–4 mm deep. An extraoral approach is advised in case of severe trismus.
53
What is the anatomic location of the parotid space abscess?
Between the splitting of the superficial layer of deep cervical fascia surrounding the parotid gland, and lies posterior to the masticatory space.
54
What is a common etiology of a parotid space abscess?
Infection originating from odontogenic migratory infections of the lateral pharyngeal and submandibular spaces.
55
What are the clinical presentations of a parotid space abscess?
* Edema of the retromandibular and parotid region
* Everted ear lobe
* Difficulty in swallowing
* Pain during chewing radiating to the ear and temporal region
* Redness of the skin and subcutaneous fluctuation
* Purulent exudate from the papilla of the parotid duct after pressure
56
What is the treatment for a parotid space abscess?
Extraoral incision posterior to the angle of the mandible, extending from the inferior aspect of the lobule of the ear to just above the mandible.
57
What are the anatomic boundaries of the lateral pharyngeal abscess?
* Superior: Base of the skull
* Inferior: Hyoid bone
* Anterior: Pterygomandibular raphe
* Posterior: Carotid sheath, Stylohyoid, Styloglossus, and Stylopharyngeus
* Medial: Superior constrictor of Pharynx and Retropharyngeal space
* Lateral: Medial pterygoid muscle, Deep lobe of the parotid gland
58
What are the contents of the lateral pharyngeal abscess?
* Internal carotid artery
* Internal jugular vein with respective lymph nodes
* Glossopharyngeal nerve
* Hypoglossal nerve
* Vagus nerve
* Accessory nerve
59
What is a common etiology of a lateral pharyngeal abscess?
Infected third molar and spread of infection from the submandibular and pterygomandibular spaces.
60
What are the clinical presentations of a lateral pharyngeal abscess?
* Extraoral edema at the lateral region of the neck
* Displacement of the pharyngeal wall, tonsil, and uvula towards the midline
* Pain radiating to the ear
* Trismus
* Difficulty in swallowing (dysphagia)
61
Describe the treatment for a lateral pharyngeal abscess.
Drainage is performed extraorally with an incision 2 cm long, inferior to or posterior to the posterior part of the body of the mandible. Intraoral drainage is difficult and risky.
62
What are the anatomic boundaries of the retropharyngeal abscess?
* Posterior to the soft tissue of the posterior wall of the pharynx
* Anteriorly by the superior pharyngeal constrictor muscle and associated fascia
* Posteriorly by the alar fascia
* Superiorly by the base of the skull
* Inferiorly by the posterior mediastinum
63
What is a common etiology of a retropharyngeal abscess?
Infections of this space originate in the lateral pharyngeal space.
64
What are the clinical presentations of a retropharyngeal abscess?
* Symptoms similar to lateral pharyngeal abscess
* Greater difficulty in swallowing
* Stiff neck
* Sore throat
* Dysphagia
65
What are the complications of a retropharyngeal abscess?
* Obstruction of the upper respiratory tract
* Rupture of the abscess and aspiration of pus into the lungs
* Spread of infection into the mediastinum
66
What are the supportive therapy measures for orofacial infections?
* Adequate control of systemic diseases
* Administration of antibiotics
* Hydration
* Maintain adequate nutritional status
* Analgesics
* Bed rest
* Application of heat
* Frequent wound irrigation and dressing changes
67
What are the complications of orofacial infection related to the lower jaw?
* Ludwig‘s angina
* Descending deep cellulitis of the neck
* Carotid sheath invasion
68
What are the complications of orofacial infection related to the upper jaw?
* Intracranial complications
* Cavernous sinus thrombosis
* Brain abscess
* Dural meningitis
* Osteomyelitis of the skull
* Retrobulbar cellulitis with possibility of blindness
69
What characterizes Ludwig's Angina?
Acute cellular infection characterized by bilateral involvement of the submandibular, sublingual, and submental spaces.
70
What are the common etiologies of Ludwig's Angina?
* Dental infection from lower 7 & 8
* Iatrogenic causes from contaminated needles
* Traumatic injuries to orofacial region
* Osteomyelitis of the mandible
* Submandibular and sublingual sialadenitis
71
What are the two types of Ludwig's Angina?
* Septic non-suppurative type
* Septic suppurative type
72
What are the signs and symptoms of Ludwig's Angina?
* Rapidly developing brawny hard swelling of the floor of the mouth
* Firm, painful diffuse swelling with no evidence of localization
* Elevated and protruded tongue
* Edema of the glottis
* Constitutional symptoms: fever, rapid pulse, malaise, excessive salivation
73
What are general supportive measures for Ludwig's Angina treatment?
* Early diagnosis
* Maintenance of patent airway
* Intense and prolonged antibiotic therapy
* Extraction of offending teeth
* Surgical drainage or decompression
74
What antibiotics are used in the treatment of Ludwig's Angina?
IV penicillin in combination with metronidazole or clindamycin.
75
What surgical procedure is performed in Ludwig's Angina for respiratory difficulties?
Tracheostomy.
76
What is the incision technique for drainage in Ludwig's Angina?
2 cm long incision 2 cm below the chin in the midline through skin, subcutaneous tissue, and platysma muscle.
77
What postoperative care is recommended for Ludwig's Angina?
* Hot application
* Irrigation by fenestrated drain every 24-48 hours
* Complete drainage in 7-10 days
* IV fluid intake until able to swallow
* Soft and fluid diet with high caloric content
* Continuation of antibiotics until recovery
