OS- spread of infection

Question 1

What does the spread of infection depend on?

Answer 1

Path of least resistance

Location of the perforation of infection compared to the muscles

Question 2

We have an infected maxillary.

The infection breaks through above the insertion of the buccinator.

What anterior areas will it spread to?

Answer 2

Into buccal space.

Or patatally- less likely as the palatal bone is more dense so a more resistant path- This is also more painful.

Question 3

We have an infected maxillary tooth. The infection spreads below the insertion of the buccinator. What anterior areas will it spread to?

Answer 3

It drains into the mouth via a draining sinus (there is a bad taste in the patient’s mouth)

Question 4

We have an infected mandibular tooth.

The infection perforates above the mylohyoid. What anterior areas will it spread to?

Answer 4

It spreads into the sublingual space producing a sublingual abscess.

Question 5

We have an infected mandibular tooth.

The infection perforates below the mylohyoid.

What anterior areas will it spread to?

Answer 5

It spreads into the submandibular space producing a submandibular abscess.

Question 6

Why is buccal spread of infection from a lower tooth less common than lingual spread?

Answer 6

Because the bone is thicker on the buccal- meaning there is a greater resistance to movement buccally.

Question 7

Identify and name the posterior spaces that the infection can spread to in the face?

What happens if infection spreads to these areas?

Answer 7

We get spasms of the muscles causing severe trismus.

Question 8

how does a facial infection spread back from the posterior spaces?

Answer 8

It spreads to:

1. Lateral pharyngeal space (important blood vessels are located here)
2. Retropharyngeal space
3. Prevertebral space.

Question 9

Identify these spaces

Answer 9

Question 10

Why are we worried about the spread of infection to the:

Lateral pharyngeal space, the prevertebral space and the retropharyngeal space?

Answer 10

These travel vertically so the infection can spread to the skull (putting pressure on the brain) or to the inferior sinus (putting pressure on the heart)

Question 11

What is the risk of the spread of infection to the infratemporal space?

Answer 11

The pterygoid venus plexus is located here so infection can spread to the cavernous sinus of the brain causing cavernous sinus thrombosis.

Question 12

An upper anterior tooth is infected. Typically, where will the infection spread?

Answer 12

Lips

Lower eyelid

Nasolabial region.

Question 13

Where could an upper lateral incisior also spread and why?

Answer 13

Palatally because the apex of the tooth is more palatally placed.

Question 14

An Upper premolar is infected, typically where would the infection spread?

Answer 14

Cheek

Infratemporal region

Palate

Maxillary antrum (rare)

Question 15

An upper molar is infected.

Typically, where would the infection spread?

Answer 15

Cheek

Infratemporal region

Maxillary antrum (rare)

Palate.

Question 16

Name the abscess pictured.

Answer 16

Palatal abscess

Question 17

Name the abscess pictured?

Answer 17

Labial/ intraoral abscess

Question 18

Name the abscess pictured

Answer 18

Buccal abscess

Question 19

There is infection in a lower anterior tooth. Where will this infection spread?

Answer 19

Mental and submental space.

Question 20

There is an infection in the lower premolar tooth. Where will this infection spread?

Answer 20

Buccal space

Submasseteric space

sublingual space

Submandibular space

Lateral pharyngeal space.

Question 21

There is an infection in the lower molar. Where will this infection spread?

Answer 21

Buccal space.

submandibular space

Submasseteric space

lateral pharyngeal space.

Sublingual space

Question 22

Name the abscess shown.

Answer 22

submental swellling.

Question 23

Identify the type of abscess

Answer 23

Submandibular

Question 24

Identify the type of swelling.

Answer 24

Buccal and submandibular

Question 25

What is the arrow pointing to?

Answer 25

Submandibular sinus tract to the skin.

Question 26

Where should be position our incision for exra-oral drainage and why ?

Answer 26

2 fingers breadths below the inferior border of the mandible to prevent damage to the marginal mandibular branch of the facial nerve.

Question 27

How can we drain out the abscess from the hole?

Answer 27

Using our fingers

Using the hilton technique- use an instrument (howarth’s elevator) to stretch open the hole and allow pus to drain out.

Question 28

What is this and what is it used for?

Answer 28

An extra-oral drain

This allows further drainage of the area.

We put a dressing on it and change the dressing.

We only remove the extra-oral drain when we go to change the dressing and it is still clean. Then we can suture up the incision.

Question 29

When would we not need to provide antibiotics for the infection?

Answer 29

If we have removed the cause, drained the infection AND the patient is systemically well.

Question 30

Identify this condition and discuss:

I/O signs

E/O signs

Systemic signs.

Answer 30

This is ludwings angina- bilateral cellulitis of the sublingual and submandibular spaces.

I/O

• raised tongue
• Difficulty breathing
• Difficulty swallowing
• Drooling.

E/O

• Diffuse redness and swelling in the submandibular region.

Systemic:

Increased temp. Increased HR. Increased respiratory rate. Increased WBC count.