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    Odontogenic Infection Ettinger

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    Bunga Erlita Rosalia
    1) Odontogenic infections are classified into 3 stages: cellulitis (diffuse spreading infection), abscess (localized pus accumulation), and sinus tract/fistula (abnormal drainage pathway between surfaces). 2) Cellulitis and abscesses spread from primary fascial spaces near the infection origin into secondary spaces, potentially compromising vital structures. 3) Management involves determining severity, evaluating host defenses, surgically draining pus and removing the cause, prescribing antibiotics, and frequent follow-up to monitor for resolution or need for additional treatment.

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    Odontogenic Infection Ettinger

    Uploaded by

    Bunga Erlita Rosalia
    167 views50 pages
    1) Odontogenic infections are classified into 3 stages: cellulitis (diffuse spreading infection), abscess (localized pus accumulation), and sinus tract/fistula (abnormal drainage pathway between surfaces). 2) Cellulitis and abscesses spread from primary fascial spaces near the infection origin into secondary spaces, potentially compromising vital structures. 3) Management involves determining severity, evaluating host defenses, surgically draining pus and removing the cause, prescribing antibiotics, and frequent follow-up to monitor for resolution or need for additional treatment.

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    Odontogenic INfection

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    1) Odontogenic infections are classified into 3 stages: cellulitis (diffuse spreading infection), abscess (localized pus accumulation), and sinus tract/fistula (abnormal drainage pathway between surfaces). 2) Cellulitis and abscesses spread from primary fascial spaces near the infection origin into secondary spaces, potentially compromising vital structures. 3) Management involves determining severity, evaluating host defenses, surgically draining pus and removing the cause, prescribing antibiotics, and frequent follow-up to monitor for resolution or need for additional treatment.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    167 views50 pages

    Odontogenic Infection Ettinger

    Uploaded by

    Bunga Erlita Rosalia
    1) Odontogenic infections are classified into 3 stages: cellulitis (diffuse spreading infection), abscess (localized pus accumulation), and sinus tract/fistula (abnormal drainage pathway between surfaces). 2) Cellulitis and abscesses spread from primary fascial spaces near the infection origin into secondary spaces, potentially compromising vital structures. 3) Management involves determining severity, evaluating host defenses, surgically draining pus and removing the cause, prescribing antibiotics, and frequent follow-up to monitor for resolution or need for additional treatment.

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    Management of Odontogenic Infections

    David B. Ettinger MD,DMD

    Stages of Infection

    I. Cellulitis II. Abscess III. Sinus Tract/Fistula

    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.

    Abscess
    Well defined borders Pus accumulation in tissues Fluctuant to palpation

    Cellulitis spreading infection Abscess localized infection

    FISTULA
    A drainage pathway or abnormal communication between two epithelium-lined surfaces due to destruction of the intervening tissue.

    Sinus Tract

    Abscess ruptures to produce a draining sinus tract

    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

    Severity of Infection
    Rate of progression Potential for airway compromise or affecting vital organs Anatomic location of infection

    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.

    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

    Anatomic Location

    Graded in severity by level to which the airway and vital structures are threatened
    Low

    Buccal, Vestibular, Subperiosteal Masticator space

    Moderate

    Severe

    Lateral pharyngeal Retropharyngeal Danger Space

    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 Canine Buccal Submental Sublingual Submandibular

    Vestibular

    Buccal

    Likely from
    Upper

    Premolar Upper molar Lower molars

    CANINE SPACE

    Superior to levator muscle attachment in canine fossa Can lead to:


    - orbital cellulitis - carvernous sinus thrombosis

    A unique aspect of the veins in the head and neck is their valveless nature
    Maxillofacial Infections Selected Readings OMFS Vol 2 No 1

    CAVERNOUS SINUS THROMBOSIS


    Cranial nerves III, IV, V, (opthalmic), VI Internal carotid artery

    SUBMENTAL SPACE
    Anterior mandibular teeth Deep to mentalis muscle

    Submental Space

    Most likely caused by lower anterior teeth or mandibular sympysis fracture

    SUBLINGUAL SPACE

    Presents in floor of mouth Superior to mylohyoid Drained intraorally parallel to Whartons duct

    Submandibular Space

    Likely cause:
    Lower

    molars

    SUBMANDIBULAR SPACE
    Extra-oral presentation Deep to mylohyoid I & D through skin with blunt incision

    LUDWIGS ANGINA

    Bilateral submandibular, sublingual, and sub-mental involvement Rarely fluctuant Often fatal Requires early, aggressive intervention

    Submandibular

    Submandibular

    Submental

    Department of Oral and Maxillofacial Surgery

    What are the secondary fascial spaces?


    Fascial spaces that become involved following spread of infection from the primary spaces.
    The secondary spaces are:
    Pterygomandibular Masseteric Superficial and deep temporal Infratemporal Lateral pharyngeal Retropharyngeal Prevertebral

    The hallmark of masticator space infection is: TRISMUS

    PHARYNGEAL SPACE INFECTIONS


    Lateral pharyngeal Retro-pharyngeal

    (both can lead directly to mediastinum)

    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 patients immune system

    INCISION AND DRAINAGE


    The production of laudable pus by: - mucosal incision - extraction - endodontic access - periodontal curetage

    INCISION AND DRAINAGE


    Incise in healthy skin Incise in gravity-dependent, esthetic area if possible Explore entire abscess cavity Non-absorbable drains

    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.

    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

    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

    EMPIRIC THERAPY OF ODONTOGENIC INFECTIONS


    Penicillin Penicillin + metronidazole PCN allergy clindamycin

    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

    MANAGEMENT OF ODONTOGENIC INFECTIONS


    4. Select antibiotic 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

    5. Follow up

    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

    Follow up

    If no improvement consider:
    Re-culture Re-image Repeat

    I and D

    Questions

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