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Management of odontogenic Infection Flashcards

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1
Q

diagram about infection

- ven diagram encompesses - just keep in mind..

A

infection in middle with

  1. patient health
  2. anatomical factors
  3. microbial factor
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2
Q

etiology of odontogenic

A

pulpal

periodontal

peri-coronal
- subset of the periodontal like in3rd molars

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3
Q

abscess

A

localized collection of pus due to the breadown of infected tissue involved

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4
Q

cellulitits

A

diffuse inflammatory characterized by extensive hard swelling, induration and erythema

MORE DIFFUSE than than an abscess

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5
Q

pt. presents stressed and discomfort on lower left

now difficulty swallowing and a lot of swelling

trismus
convexity

A

pterygoid space infection secondary to the pericoronitis

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6
Q

10-11 year old boy with swelling around inferior of eye

firm swelling closer to maxilla and soft swelling near the infraorbital region

hit with hockey stick around maxillary incisors

A

canine space infection

NO INFECTION IN EYE – palpating lymphatic space - built up pressure from apical abscess / cellulitis

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7
Q

microbiology of odontogenic infection

A

higher % of ANAEROBIC involved than aerobes

many are POLYMICROBIAL

prominent aneerobes are
- bacteriocides, peptostreptococus , actinomyces, (the general microbial that we see in the mouth)

Aerobe = treptococcus

so management – not really doing the culture and specifying the treatment
- make assumption that we need polymicrobial

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8
Q

spread of infection usually through

A
  1. direct extension
  2. hematogenous – bacteremia
  3. lymphatic - lymphadenopathy
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9
Q

anatomical considerations for DIRECT extension for vestibular abscess

A

APEX of teeth are housed within the normal structure

most likely peri-apical infections break out to the buccal side into vestibule

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10
Q

peri-apoical infections usually break out

A

towards the buccal

  • remember that posteiror mandibular molars are close to mylohyoid line and can break out into the submandibular space
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11
Q

palpate swelling for abscess

A

balloon - feel like the fluid

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12
Q

palpate cellulitis

A

no give – more like a baseball not as fluctuant

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13
Q

basal bone and alveolar bone in relation to the molars

A

alveolar bone is more lingual in this location of the molars

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14
Q

mylohyoid line and implication with apex of teeth (posterior lower molars) breakout of infection

A

break out into the SUBMANDIBULAR SPACE –

the first and second molar is very close to this mylohyoid line

the molars are situated more over the mylohyoid line above alveolar bone than the basal bone

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15
Q

most likely teeth to break out into the vestibule

A

the maxillary teeth

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16
Q

so typical alveolar abscess breaks out

A

toward buccal into the vestibule

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17
Q

mandibular molars will break out

A

submandibular space

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18
Q

posteiror molar that broke out buccally was from?

A

the furcation - not a peri-apical

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19
Q

mandibular anterior / incisor region - anatomic considerations for direct break out

A

mandibular incisors – spread into the MENTALIS SPACE

- since this muscle attaches relatively high – may break out into this space versus the oral cavity

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20
Q

direct FACIAL spaces to consider

A
  1. buccal
  2. pterygomandibular
  3. masseteric
  4. submandibular
  5. sublingual
  6. canine space
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21
Q

buccal facial space - genreal

A

superficial to the buccinator muscle
- roots of teeth insert above usually

more in children into buccal space infection

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22
Q

lower third molars can spread directly into what facial space

A

pterygomandibular space

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23
Q

pterygomandibular space infectin symptoms may present with

A

difficulty swallowing and opening
- muscle is inflammed

may not present with swelling – more convex

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24
Q

space lateral to the body of the mandible is

A

submasseteric space

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25
submasseteric space potential symptoms
swelling externally may be trismus but not really airway problems
26
impacted 3rd molar that is placed more buccally could have more tendency to go towards ____ space as compared to _____ space even though this space is more common
may go towards the submasseteric space vs the pterygomandibular space (more likely) probably wont feel a fluctuant swelling
27
apical abscess on the mandibular molars likely spread to
submandibular space probably wont feel fluctuance at first
28
sublingual space infectino - general
NOT common lower anterior and pre molar peri-apical disease more likely to spread out towards the vestibular space - more simple vestibular abscesses so think about other things if lingual floor swelling -- like stone / trauma / of the salivary gland
29
canine space
in the infraorbital area or canine fossa more likely in children -- apex could be above the insertion of the muscles
30
masticatino and swallowing not involved in
canine space / infraorbital area
31
SECONDARY fascial spaces
1. peritonsilar 2. lateral pharyngeal 3. retropharyngela 4. temporal 5. infratemporal 6. parotid
32
massive swelling in tonsilar area - but no teeth involved
peritonsilar space infection and rule out maxillary molars pathology
33
behind the pterygoid space?
lateral pharyngeal retropharyngeal space
34
lateral pharyngeal space
can coincide with the pterygoid space infection
35
just medial to the lateral pharyngeal space
retropharyngeal space --so could spread here too
36
spread of infection from pterygoid to ___ space
lateral pharyngeal space
37
spread of infection to the temporalis space likely from
submasseteric space AND pterygomandibular space superficial to or deep to the ZYGOMATIC ARCH A
38
swelling at location of zygomatic arch
temporalis space infection likely from submasseteric space or pterygomandibular space
39
lymphatic spread | - general outline
consider chain posterior to sternocleidomastoid and anterior to it submandibular submental into anterior cervical
40
most of the area of head and neck drain into
submandibular / submental
41
submnetal node drainage primary
mid lower lip chin tip of tongue lower incisor and ginginva
42
submental node drainage secondary
submandibular and superior deep cervical nodes
43
submandibular node drainage
just about everything else upper and lower jaw (BESIDES INCISORS) LIPS - EXCEPT MID LOWER anterior nasal cavity anterior palate body of tongue
44
secondary drainage for submandibular node drainage
deep cervical nodes
45
lower incisor lymph drain?
to the SUBMENTAL
46
tip of tongue lymph drains
to the SUBMENTAL
47
SUBMANDIBULAR LYMPHADONPATHY from maxillary?
yes-- drains all maxillary
48
primary drainage of the deep cervical node
base of tongue posterior palate sublingual region
49
secondary drainage of the deep cervical node
submental, submandibular and accessory nodes
50
drainage of tongue
tip = submental body = submandibualr base = deep cervical
51
drainage of the tongue
can cross over - so variable
52
T/F antibiotics are essential in the treatment of odontogenic infections
FALSE -- are NOT
53
essentials in treatment of odontogenic infections
1. eliminate the source of the infection | 2. establishment of drainage
54
fistula drainage?
if fistula present -- drainage has already been established -- manifest as pain swelling off and on drainage off and on re-establish drainage
55
treatment for fistula
endo tx patient already has established drainage and may be off and on so treat the source of infection
56
pt has bump of granulation tissue | tx?
put gutta percha point and take x-ray to confirm which tooth it is associated with and perform endo tx
57
incision and drainage use noramally - general
modality of tx WITH FLUCTUANT SWELLING If rock hard -- probably not
58
incision with
15 blade into abscess cavity just at the surface! then can follow up with a more blunt instrument to chase it - but NO sharp disection to establish drainage
59
if establish drainage then decompresses / heals then comes back?
consider leaving something in the space for drainage - latex rubber drain and suture to keep drainage
60
remove drain after?
usually 48 hours - if really deep could be left longer now treat the tooth usually after drainage has been established
61
peri-coronal infection - most likely from
tends to be almost exclusively with impacted 3rd molars gets better and worse recurrent swelling
62
symptoms of pericorintis | rx too?
temporalis muscle could be involved can see loss of bone radigrpahically as well
63
initial tx of peri-corinitis
antibiotics rinses perio-probe to lift tissue not take tooth out -- traumatic extraction want to get rid of acute infection first
64
if peri-coronitis and hurts mostly when closes down? what to do
remember do not want to extract the acutely infected tooth take upper third molar out -- may be supra-erupted and traumitizing the lower
65
antibiotic dose for penicillin V
500 q4-6h
66
antibiotic dose for erythromycin
250 q6h
67
antibiotic dose for doxycycline
100 q12h x 2 then 50 q12
68
antibiotic dose for keflex
500 q 6hrs - like penicillin V
69
antibiotic dose for metronidazole
250 q8h
70
antibiotic dose for clindamycin
150 q6 hr
71
antibiotic dose for amaxicillin
500 Q8HR
72
complications of odontogenic infectinos
1. airway obstruciton 2. mediastinitis 3. osteomyletitis 4. sinusitis 5. cavernous sinus thrombosis 6. endocarditis 7. systemic sepsis
73
osteomyelitis usually seen with
pt. that is not as healthy
74
a bilateral sublingual and submandibualr space cellulitis
LUDWIG'S ANGINA
75
Ludwig's angina is?
a bilateral submandibualr and sublingual space cellulitis needs to have all 4 spaces involved struggles to breathe and keep mouth closed
76
radiation patient?
antibiotic tx probably necesary
77
evident cloudiness in one of the sinuses?
potential sign of root fragment displacment in into the sinus
78
if cavernous sinus infection?
probably from midface odontogenic if occurs but dont rule out lower face infection
79
dx of cavernous sinus infection
muscle and a lot of nerves and muscles there ecchymosis of eyes
80
eagleston's criteria for
cavernous sinus thrombosis
81
eagleston's criteria for cavernous sinus thrombosis
1. site of infection 2. evidence of bloos stream invasion (liek presence of fever) 3. venous obstruction of retina conjunctiva, eyelid 4. paresisi of nerves 3, 4, 6 5. abscess formation in adjacent soft tissue 6. evidence of meningeal irritiation
82
pt with cavernous sinus thrombosis close their eye?
YES -- facial (VII) nerve closes eye droopy eyelid - b/c patient cant open

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