Management of Odontogenic Infection Flashcards Preview

Oral Surgery Final > Management of Odontogenic Infection > Flashcards

Flashcards in Management of Odontogenic Infection Deck (30):
1

Pathiobiology of Odontogenic Infection

Initiated by aerobic bacteria and perpetuated by anaerobic bacteria

2

Aerobic Phase

1. Cellulitis
2. Abscess
3. Fistula

Doesn't always progress to the next stage but may become severe stage

3

Cellulitis

Primarily streptococcus

Early - Mild, soft/red, easily treated

Advanced - diffuse, hard, life threatening, hard to treat

4

Abscess

Primarily filled with anaerobes

Pus filled cavity

5

Propagation of Odontogenic Infection - Determination of spread

Determination of spread = muscle attachments, bone thickness, root angulation

6

Primary Space Infection

Immediately adjacent to where tooth is

Vestibular
Canine
Buccal
Sublingual
Submental
Submandibular

7

Spread of Maxillary Infection

Usually goes through facial bone rather than palatal.

Roots of anterior teeth usually below muscles = vestibular infection

Roots of posterior teeth above muscles = buccal space infection

8

Spread of Mandibular Infection

Thin labial bone anterior

Thin lingual bone posterior

Mylohyoid muscles - roots of 2nd and 3rd molars are below (submandibular) and the rest are above (sublingual)

9

Submental Space Infection

Not odontogenic source typically

10

Ludwig's angina

Bilateral submandibular, sublingual and submental space cellulitis

Life threatening

11

Secondary spaces

Masticator space (masseteric, superficial/deep temporal, infratemporal, pterygomandibular) of infections = trismus

12

Pterygomandibular Space Infection (secondary space)

Trismus is hallmark
Direct spread from submandibular or sublingual infection or needle track infection

13

Lateral Pharyngeal Space

Vascular necrosis and hemorrhage

Direct airway impingement

Spreads to superior mediastinum or to inferior mediastinum = danger space

14

Rapid/Severe Fascial Space Involvement risk factors

High speed hand piece for extractions

Non-sterile water/air

Vented into wound

15

Rapid/Severe Fascial Space Involvement Presentation

Rapidly involves multiple spaces including distant

May have crepitance on palpation or air on radiograph

16

Principles of therapy of odontogenic infections

Determine Severity!
Evaluate host defenses
Refer
Treat surgically
Support medically
Antiobiotics
Re-evaluate frequently

17

Factors to Consider

Rate of progression!
Quality and Quantity of swelling
Location of swelling
Trismus
Systemic Involvement
Airway

18

Location of swelling

Primary Space
Secondary Space - admission advised
Neck space - admission advised

Use CT scan

19

Trismus

Indicates secondary space involvement

Important when evaluating referral or admission

20

Trismus measurements

<15 mm = refer/consider admission
<10 mm = admission advised

35 mm normal

21

Systemic Issues w/ odontogenic Infections

Temperature >101 degrees

General malaise

22

Lab Tests

WBC count not good measure of severity of odontogenic infection (Elevated early and remains high)

Temperature is most correlative

23

Airway

Any compromise is serious

Dysphagia, odynophagia, dyspnea, drooling, posturing

24

Surgical Goals

Remove source of infection!
Drain pus
Release tension to improve circulation (cellulitis)

25

Medical Management

Fluids, analgesics, nutrition, antibiotics

26

Antiobiotic Therapy

Empiric Therapy
Narrow spectrum
Least toxic
Bactericidal
Cost?

27

Mild Infection Antiobiotic

PCN VK
or
Amoxicillin!!

28

Moderate Infection

Amoxicillin plus metronidazole

29

PCN Allergy

Clindamycin

3rd line - Clarithromycin

30

Reasons for Failure

Bad surgery = source remains or all spaces not explored or inadequate drainage

Unrecognized immune suppression
Foreign body

Antibiotic Problem