Mgmnt of Complex orofacial infections

Question 1

Spread of odontogenic infections most commonly spreads via:

Answer 1

– Soft tissue/fascial spaces –

Question 2

Potential spaces between the fascia and underlying organs/tissues.

 In a healthy state, these spaces do not exist. However, these spaces  can be distended   
 by fluid or infective process. 
 
Thus infective process can spread from one area to the adjoining ones by disruption of  intervening fascial planes or around perforating blood vessels and nerves.

Answer 2

Fascial spaces

Question 3

What are the 3 primary spaces in maxilla?

Answer 3

Buccal
Canine
Infratemporal

Question 4

What are the 4 primary spaces in mandible?

Answer 4

Submental
Buccal
Submand
Sublingual

Question 5

The ___ lies btwn buccinator muscle and overlying skin and superficial fascia. This space can become involved via upper or lower molars

Answer 5

Buccal space

Question 6

Does buccal space carry infection from upper or lower molars?

Answer 6

Both

Question 7

Where is the sublingual space in regard to mylohyoid muscle?

Answer 7

Above mylohyoid

Question 8

Where is the sub mandibular space in relation to mylohyoid?

Answer 8

Below mylohyoid

Question 9

What teeth are more common to see sublingual infection with?

Answer 9

Mandibular premolars

Question 9

What teeth are more common to see sublingual infection with?

Answer 9

Mandibular premolars

Question 10

If you can’t palpate lower border of mand, what should you do?

Answer 10

Refer to hospital due to submandibular space infection

Question 11

this space lies btwn the mylohyoid muscle and skin and superficial fascia. Primarily 2nd and 3rd molars

Answer 11

Sub mand space

Question 12

Which I and D spaces in max and mand require extraoral drainage?

Answer 12

Sub mand, sub mental, temporal

Question 13

What are the 4 2ndary space infections?

Answer 13

Masticator
Pterygomandibular
Lateral pharyngeal
Retropharyngeal

Question 14

Any time an extra oral I&D, what should be done with the specimen?

Answer 14

Culture of the specimen

Question 15

Masticator Space Lateral Pharyngeal Space Retropharyngeal Space Danger Space
_________

Answer 15

MEDIASTINITIS

Question 16

Submandibular Space Submental Space Contralateral Submental Space Sublingual
Ludwigs Angina _______

Answer 16

AIRWAY OBSTRUCTION

Question 17

Canine Space Infraorbital Space Angular Vein ____

Answer 17

CAVERNOUS SINUS THROMBOSIS

Question 18

Indicates involvement of muscles of mastication, Difficult airway access

Answer 18

Trismus

Question 19

Indicates spread to the submandibular space

Answer 19

Inability to palpate inferior border of mandible

Question 20

Indicates ocular involvement

Answer 20

Visual changes

Question 21

Indicates advanced disease with systemic response

Answer 21

Malaise +/- Fever

Question 22

Indicates airway embarrassment

Answer 22

Shortness of breath

Question 23

Indicates oro-pharyngeal involvement

Answer 23

Difficulty in swallowing with secretions

Question 24

-It clearly delineates the position and size of the infection process as well as its relationship with the adjacent anatomic structures. -It is also useful to evaluate any changes to the patient’s upper airway(due to edema) as it occurs in more advanced infections of the head and neck. helps us to evaluate the extent of the complex oro-facial infection in the head and neck region. A rim enhancement around the area of infection is observed

Answer 24

CT w contrast

Question 25

is a fulminating, bilateral sublingual, submandibular, submental and cervical infection or cellulitis displacing the tongue with potential airway obstruction. Life-threatening condition Aetiology: Usually related to periapical abscess related to the lower molar teeth.

Answer 25

Ludwig's angina

Question 26

* Serious condition that is recognised by the appearance of marked oedema and congestion of the eyelids and conjunctiva as a result of impaired venous drainage. * This start as a unilateral and rapidly becoming bilateral.

Answer 26

Cavernous venous thrombosis

Question 27

Is Ludwig's angina or cavernous sinus thrombosis more common?

Answer 27

Ludwig's angina

Question 28

- Hematogenous spread of infection from the jaw to the cavernous sinus may occur anteriorly via the inferior or superior opthalmic vein or posteriorly via emissary veins from the pterygoid plexus. Direct extension through the opening in the cranial bones.

Answer 28

Cavernous sinus thrombosis

Question 29

– Ocular pain. – High fluctuating fever, chills, and sweating. – Periorbital and conjunctival oedema, starting unilaterally and progressing to bilateral as a result of thrombophlebitis. – Pulsating exophthalmos and retinal haemorrhage – Ophthalmoplegia, paralysis, dilated pupils and loss of corneal reflexes – Other cranial nerve involvement e.g. trigeminal nerve – Hospitalization. – Neurosurgical consultation. – Intensive antibiotic therapy. – Heparin to prevent extension of thrombosis.

Answer 29

Cavernous sinus thrombosis