Management of Odontogenic Infections slides
Transcript of Management of Odontogenic Infections slides
![Page 1: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/1.jpg)
Management of Odontogenic Infections
David B. Ettinger MD,DMD
![Page 2: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/2.jpg)
![Page 3: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/3.jpg)
Stages of Infection
I. Cellulitis
II. Abscess
III. Sinus Tract/Fistula
![Page 4: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/4.jpg)
CELLULITIS
A painful swelling of the soft tissue
of the mouth and face resulting
from a diffuse spreading of
purulent exudate along the fascial
planes that separate the muscle
bundles.
![Page 5: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/5.jpg)
Abscess
Well defined borders
Pus accumulation in tissues
Fluctuant to palpation
![Page 6: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/6.jpg)
Cellulitis – “spreading” infection
Abscess – “localized” infection
![Page 7: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/7.jpg)
FISTULA
A drainage pathway or abnormal communication between two epithelium-lined surfaces due to destruction of the intervening tissue.
![Page 8: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/8.jpg)
Sinus Tract
Abscess ruptures to produce a draining sinus tract
![Page 9: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/9.jpg)
Management of Infection
Determine the severity of the infection
Evaluate the host defense
Decide on setting of care
Treat surgically
Support medically
Choose and prescribe antibiotics appropriately
Evaluate patient frequently
![Page 10: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/10.jpg)
Severity of Infection
Rate of progression
Potential for airway compromise or affecting vital organs
Anatomic location of infection
![Page 11: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/11.jpg)
HISTORY
Duration of infectious process.
Sequence of events and changes in symptoms or signs.
Antibiotics prescribed, dosages and responses.
Review of systems with emphasis on neuro-ophthalmologic and cardiopulmonary and immune systems.
Social history – exposure, travel, (fungal or parasitic infections), chemical dependency.
![Page 12: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/12.jpg)
SIGNS OF SEVERITY
Fever
Dehydration
Rapid progression of swelling
Trismus
Marked pain
Quality and/or location of swelling
Elevation of tongue
Difficulty with speech and swallowing
![Page 13: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/13.jpg)
Anatomic Location
Graded in severity by level to which the airway and vital structures are threatened Low
Buccal, Vestibular, Subperiosteal
Moderate Masticator space
Severe Lateral pharyngeal
Retropharyngeal
Danger Space
![Page 14: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/14.jpg)
What are the primary fascial spaces?
The spaces directly adjacent to the origin of the odontogenic infections. Infections spread from
the origin into these spaces, which are:
Vestibular Submental Canine Sublingual Buccal Submandibular
![Page 15: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/15.jpg)
Vestibular
![Page 16: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/16.jpg)
Buccal
Likely from
Upper Premolar
Upper molar
Lower molars
![Page 17: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/17.jpg)
CANINE SPACE
Superior to levator muscle attachment in canine fossa
Can lead to:
- orbital cellulitis
- carvernous sinus thrombosis
![Page 18: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/18.jpg)
“A unique aspect of the veins in the head and neck is their valveless nature”
Maxillofacial Infections
Selected Readings
OMFS Vol 2 No 1
![Page 19: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/19.jpg)
![Page 20: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/20.jpg)
CAVERNOUS SINUS THROMBOSIS
Cranial nerves III, IV, V, (opthalmic), VI
Internal carotid artery
![Page 21: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/21.jpg)
![Page 22: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/22.jpg)
SUBMENTAL SPACE
Anterior mandibular teeth
Deep to mentalis muscle
![Page 23: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/23.jpg)
Submental Space
Most likely caused by lower anterior teeth or mandibular sympysis fracture
![Page 24: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/24.jpg)
SUBLINGUAL SPACE
Presents in floor of mouth
Superior to mylohyoid
Drained intraorally parallel to Wharton’s duct
![Page 25: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/25.jpg)
Submandibular Space
Likely cause:
Lower molars
![Page 26: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/26.jpg)
SUBMANDIBULAR SPACE
Extra-oral presentation
Deep to mylohyoid
I & D through skin with blunt incision
![Page 27: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/27.jpg)
LUDWIG’S ANGINA
Bilateral sub-mandibular, sublingual, and sub-mental involvement
Rarely fluctuant
Often fatal
Requires early, aggressive intervention
![Page 28: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/28.jpg)
Department of Oral and Maxillofacial Surgery
Submental Submandibular
Submandibular
![Page 29: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/29.jpg)
![Page 30: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/30.jpg)
![Page 31: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/31.jpg)
What are the secondary fascial spaces?
Fascial spaces that become involved following spread of infection from the
primary spaces.
The secondary spaces are:
Pterygomandibular Infratemporal Masseteric Lateral pharyngeal Superficial and deep temporal Retropharyngeal Prevertebral
![Page 32: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/32.jpg)
The hallmark of masticator space infection is: TRISMUS
![Page 33: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/33.jpg)
PHARYNGEAL SPACE INFECTIONS
Lateral pharyngeal
Retro-pharyngeal
(both can lead directly to
mediastinum)
![Page 34: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/34.jpg)
![Page 35: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/35.jpg)
![Page 36: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/36.jpg)
What factors influence the spread of odontogenic infection?
Thickness of bone adjacent to the offending tooth
Position of muscle attachment in relation to root tip
Virulence of the organism
Status of patient’s immune system
![Page 37: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/37.jpg)
INCISION AND DRAINAGE
The production of “laudable pus” by:
- mucosal incision
- extraction
- endodontic access
- periodontal curetage
![Page 38: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/38.jpg)
INCISION AND DRAINAGE
Incise in healthy skin
Incise in gravity-dependent, esthetic area – if possible
Explore entire abscess cavity
Non-absorbable drains
![Page 39: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/39.jpg)
PRINCIPLES IN THE USE OF DRAINS (II)
Drained wounds should be cleansed frequently.
Bacteria can migrate into a wound along the drain surface.
Latex Penrose drains are best used unmodified.
![Page 40: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/40.jpg)
![Page 41: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/41.jpg)
![Page 42: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/42.jpg)
![Page 43: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/43.jpg)
INDICATIONS FOR CULTURE
Nonresolving infection in spite of appropriate care
Atypical flora expected
= long term antibiotic treatment
= age extremes (<2 or >65)
= patients with malignancies
Infections with systemic involvement
Immunocompromised or myelosuppressed patients
![Page 44: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/44.jpg)
“the most important therapeutic action in the management of orofacial infections is the drainage of pus, and antibiotics are merely an adjunct…”
Pogrel, A; OMFS Clinics of
North America Feb 1993
![Page 45: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/45.jpg)
EMPIRIC THERAPY OF ODONTOGENIC INFECTIONS
Penicillin
Penicillin + metronidazole
PCN allergy clindamycin
![Page 46: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/46.jpg)
MANAGEMENT OF ODONTOGENIC INFECTIONS
1. Determine severity Assess history of onset and progression perform physical examination of area:
(1) Determine character and size
of swelling
(2) Establish presence of trismus
2. Evaluate host defenses Evaluate:
(1) Diseases that compromise
the host
(2) Medications that may
compromise the host
3. Perform surgery Remove the cause of infection
Drain pus
Relieve pressure
![Page 47: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/47.jpg)
MANAGEMENT OF ODONTOGENIC INFECTIONS
4. Select antibiotic
5. Follow up
Determine:
(1) Most likely causative organisms based on history
(2) Host defense status
(3) Allergy history
(4) Previous drug history
Prescribe drug property
(route,dose and dosage
interval, and duration)
Confirm treatment response
Evaluate for side effects and
secondary infections
![Page 48: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/48.jpg)
Follow-up
Patient should be monitored frequently
out-patient should return for f/u in 2-3 days
Patient should have decreased swelling, discharge, airway edema, malaise in 2-3 days
![Page 49: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/49.jpg)
Follow up
If no improvement consider:
Re-culture
Re-image
Repeat I and D
![Page 50: Management of Odontogenic Infections slides](https://reader034.fdocuments.in/reader034/viewer/2022051319/58802b7b1a28abdb4f8b4b96/html5/thumbnails/50.jpg)
Questions