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BDS4 Oral Surgery > TUT - Spreading infection > Flashcards

TUT - Spreading infection Flashcards

1
Q

What are signs of being systematically unwell?

A
  • lymphadenopathy
  • high temperature
  • sweating
  • palor
  • altered GCS
  • tachycardia
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2
Q

What is cellulitis?

A

Spreading infection between fascial planes

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3
Q

What is SIRS?

A

Systemic inflammatory response syndrome

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4
Q

What are the indicators of SIRS?

A
  • <36 or >38 temperature
  • > 90 bpm resting
  • > 20 breaths per minute
  • > 130/90 or >40 difference in normal blood pressure
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5
Q

What obs should you do prior to calling OMFS?

A
  • pulse
  • respiration rate
  • temperature
  • GCS - rough
  • oxygen saturation and blood pressure if available
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6
Q

How should you refer a patient with concerns of SIRS?

A
  • call OMFS with obs details via hospital switchboard (max-fac SHO)
  • give patient letter with details of obs, “discussed on phone” and printed x-rays if available
  • instruct patient to go direct to A&E
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7
Q

What structures should you be careful to avoid when incising the palate?

A
  • nasopalatine nerve
  • greater palatine nerve
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8
Q

What structures should you be careful to avoid when incising the buccal sulcus?

A

Mental nerve

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9
Q

How can you avoid incising the nerves in the palate?

A

Incise anteroposteriorly to go parallel with nerve

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10
Q

What part of the mouth should you avoid incising?

A

FOM

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11
Q

How should you incise a swelling?

A
  • incise the most fluctuant part
  • incise down to bone
  • do not close incision, allow drainage to continue
  • encourage rinsing immediately
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12
Q

What is pus?

A
  • collection of immune cells, body’s own product
  • inhibits healing
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13
Q

How is LA affected by infection?

A
  • infection causes low pH which leaves a lot of free ions
  • LA becomes positively charged by free ions which prevents passage through sodium channels and therefore cannot enter cells
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14
Q

What must you warn the patient of regarding LA and the swelling?

A

The LA may not take as well as usual but the patient should feel immediate relief after incision

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15
Q

Describe how infection spreads?

A
  • takes path of least resistance
  • buccal bone is usually thinner (except at 8, where lingual is thinner)
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16
Q

Describe the spread of infection in the lower arch in relation to the buccinator.

A
  • if inferior to buccinator attachment, infection moves to cheek and requires EO incision
  • if superior to buccinator attachment, infection moves to buccal sulcus
17
Q

Describe the spread of infection in the lower arch in relation to the mylohyoid.

A
  • if inferior to mylohyoid attachment, infection moves to submandibular space (posterior teeth)
  • if superior to mylohyoid attachment, infection moves to sublingual (FOM) space, eventually spreads to submandibular space (anterior teeth)
18
Q

Describe the spread of infection in the upper arch in relation to the buccinator.

A
  • if superior to buccinator attachment, infection moves to cheek and requires EO incision
  • if infection to buccinator attachment, infection moves to buccal sulcus
19
Q

Which teeth are likely to have infection spread to the palate?

A
  • upper molar if infection related to palatal root
  • upper premolar if infection related to palatal root
  • upper lateral as apex more palatal
20
Q

How does the spread of infection cause trismus?

A
  • acidic environment
  • swelling inhibits movement
21
Q

How are the pharyngeal spaces affected by spread of infection?

A
  • lateral pharyngeal space caves (unable to see clinically due to trismus)
  • retropharyngeal space compromises airway
22
Q

How can infection spread from a tooth to the wider body?

A
  • spread from masticatory spaces into pharyngeal spaces
  • spread upwards to base of skull or down into chest space and compress heart and lungs
23
Q

How do you manage a swelling?

A
  • RCT or XLA to gain primary drainage
  • incision of swelling if unable to gain primary drainage or swelling still present after RCT/XLA
  • antibiotics if spreading infection
24
Q

Why is culture used?

A

To give narrow spectrum antibiotics

25
Q

What is the benefit of an aspiration over a swab?

A

Not contaminated with oral microflora or oxygen exposure

BDS4 Oral Surgery (22 decks)

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