Spread of Infection Flashcards

(44 cards)

1
Q

Where can a maxillary abscess spread to

A
  • buccal space (if above buccinator)
  • draining sinus (if below buccinator)
  • into maxillary sinus (unusual)
  • palatal route (painful)
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2
Q

Where can a mandibular abscess spread to?

A
  • lingually to give sublingual abscess (above mylohyoid)
  • lingually into submandibular space (below mylohyoid)
  • buccally below buccinator
  • buccally above buccinator
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3
Q

What determines where an infection spreads on the lower jaw

A
  1. The mylohyoid muscle attachement
    i.e. above muscle = lingually into sublingual space; below muscle = submandibular space
  2. Tooth anatomy
    - 33 = sublingual, 37 = submandibular

Also, muscle is open at the back so infection in sublingual space could spread into submandibular space and vice versa

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4
Q

What are the different (masticatory) posterior potential spaces infection can spread to

A
  • superficial temporal space
  • deep temporal space
  • infratemporal space
  • masseteric space
  • pterygomandibular space
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5
Q

what happens to the muscles of mastication when infection gets into the spaces around the mandible

A

they spasm (trismus)

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6
Q

after spreading to masticatory spaces, where can infection then spread

A
  1. lateral pharygeal space (first)
  2. retropharyngeal space
  3. prevertable space
    then even further…
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7
Q

after infection goes through the retropharyngeal and prevertable spaces, where can it then go

A
  • up into the brain
  • down into the mediastinum
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8
Q

what infection could result if infection reaches the brain

A

cavernous sinus thrombosis

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9
Q

where do infections tend to spread from the upper anterior teeth

A
  • lip
  • nasiolabial region
  • lower eyelid
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10
Q

Where do infections tend to spread from the upper lateral incisor

A

palate

because the apex of its root is more palatally placed

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11
Q

where do infections tend to spread from upper premolars and molars

A
  • cheek
  • infra-temporal region
  • maxillary antrum
  • palate
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12
Q

What is the diagnosis for this and where is this infection most likely spreading

A

Intraoral (labial) abscess
Draining into mouth so spreading below buccinator

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13
Q

Where is this patients infection spreading

A

Buccal but above muscle insertions
- swellings in cheek, infraorbital region and buccal
- partial closure of eye

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14
Q

how would you describe this spread of infection

A

mainly infra orbital, not buccal yet nb nasiolabial fold gone (nose deformed)

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15
Q

how would you describe this spread of infection

A

mainly buccal spread, more mild

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16
Q

how would you describe this spread of infection

A

buccal and infraorbital spread (nasio labial fold still here in this case)

nb unusual for upper infections to spread back but can happen

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17
Q

Where do lower anterior teeth infections spread

A

mental and submental space

often stay there but can spread to sublingual and submandibular spaces

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18
Q

where can lower premolars and molar infections spread

A
  • buccal space
  • submasseteric space
  • sublingual space
  • submandibular space
  • lateral pharyngeal space
19
Q

How would you describe this spread of infection

A

submental spread
- tend to be self liimiting and eventually burst and drain through skin

pure submandibular spread?

20
Q

What is this and how did it happen

A

Submental sinus tract to skin
- has burst and formed a chronic sinus which is draining EO
- once infection removed will have to do plastic surgery to get rid of scar

21
Q

What would you call this spread of infection and what would the clinical appearance be

A

Submandibular spread

  • won’t be able to feel lower border of the mandible
  • could spread to other side or more worryingly backwards into submassateric space, pterygomandibular space, lateral pterygoid space
  • check systemic symptoms
  • need to incise and drain as well as extract tooth
22
Q

What spread of infection is this

A

buccal and submandibular spread
- now cannot feel lower border of mandible
- check systemic symptoms

23
Q

What view of a radiograph is this

A

lateral oblique radiograph

24
Q

What is the arrow pointing at

A

submandibular sinus tract to skin

25
Describe the management of abscesses
1. Establishment of drainage (EO via incise, IO via tooth/incise) 2. Removal of source of infection (immediate or delayed) 3. Antibiotic therapy (depends on toxicity/desirability/ MHx)
26
what can make the removal of the source of infection challenging
hard to anaesthetise patient with severe infection
27
What systemic symptoms do you need to look out for
SIRS
28
What does SIRS stand for
Systemic Inflammatory Response Syndrome
29
What symptoms make up SIRS
- increased temperature - increased heart rate - increased respiratory rate - increased white blood cells | first 3 can check in dental chair
30
what do you do if you suspect someone has SIRS
- give antibiotics - refer to hospital
31
when carrying out submandibular drainage, what nerve do you have to consider and how do you avoid it
Facial nerve (marginal mandibular branch) go at least 2 fingers below inferior border of mandible | marginal mandibular crosses over border of mandible
32
what technique is used to drain EO
hilton technique (anything with 2 ends which can be opened e.g. scissors) | put in the opening closed and then open them to remove pus/blood
33
what needs to be placed following submandibular drainage
placement of an EO drain for a few days
34
what is this
extra-oral sinus
35
describe this swelling
buccal space spread
36
What radiographic view is this
lateral oblique
37
What type of infection spread is this
submandibular space spread | quite low down in this case
38
What do you call bilateral cellulitis of the sublingual and submandibular spaces
Ludwig's Angina
39
what is ludwig's angina
- bilateral cellulitis of the sublingual and submandibular spaces - will show signs of SIRS
40
Features of Ludwig's angina
IO - raised tongue - difficulty breathing - difficulty swallowing - drooling EO - diffuse redness and swelling bilaterally in submandibular region Systemically - increased heart rate, respiratory rate, temperature and white cell count (SIRS)
41
What would you do if you thought someone had ludwig's angina
urgent referal to maxfax | very urgent
42
What does NEWS2 stand for and what is it
National Early Warning Score - used in emergency medicine to observe patients
43
What are the different scores in NEWS2
0 - normal 1 2 3 - most unwell
44
How is consciousness measured
A - Alert C - confusion V - responds to verbal commands P - responds to pain U - completely unresponsive