Dr Shuja Presentation

8/2/2019 Dr Shuja Presentation

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ODONTOGENICINFECTIONS OF THE

MAXILLO FACIAL &

NECK REGION


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ETIOLOGY

1. Pulp disease.

2. Periodontal disease.

3. Secondarily infected cysts or odontomes.

4. Remaining root fragment.

5. Residual infection.

6. Pericoronal infection.


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Bacteriology

Aerobic 7% G +ve Cocci ( Strep, Staph) & G-ve cocci (Neisseria)

G +ve rods (Corny ) & G-ve rods

Anaerobic 33% G +ve Cocci ( Strep, Pseudo strep) & G-ve

cocci(veiollonela)

G +ve rods (Lacto, Actino ) & G-ve rods (Bacteriodes)

Mixed 60%


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TYPES

ACUTE

In the acute stage infection may remain intrabony or spread into soft tissues in

following clinical forms:1. Abscess:

1.Circumscribed collection of pus in a pathologicaltissue space.

2.Thick walled cavity containing pus.

3.Aerobes & anaerobes--- large accumulation ofpus--- pointing & drainage.


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AbscessAbscess


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2. Cellulitis:

1.This is spreading infection of loose CT.

1.It is a diffuse, erythematous, mucosal or cutaneous

infection.

2.It is result of streptococci & does not result in large

accumulation of pus.

3.Streptococci produce streptokinase, hyaluronidase.


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3.Fulminating infections:

1.Spread of infection in various primary spaces in the

orofacial region.

2.Here secondary spaces along the pathway of least

resistance are involved.

3.Spread of deep cervical spaces and beyond.


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Acute Peri Apical Abscess1

This is due to vascular dilatation, an exudate of

neutrophil leucocytes & oedema in the peri apical

region.

It is due to persistent irritation from chronic pulpor acute virulent infection, or less host

resistance.


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Etiology Acute Peri Apical Abscess

Infective necrosis of pulp

Caries.

Traumatic exposure.

Traumatic necrosis

Blow on teeth.Mechanical &

Chemical


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CLINICAL FEATURESAcute Peri Apical Abscess

1- History of previous pulpitis.

2- Carious or heavily filled tooth.

3- Tender and felt extruded in socket.

4- When pus has formed severethrobbing

pain5- sensitive to percussion.

6- Over lying gum may or may not be

swollen


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TREATMENTAcute Peri Apical Abscess

Antibiotics ,Analgesics & Drainage through

pulp chamber.

Extraction or endodontic treatment.


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Acute Dento Alveolar Abscess

When pus does not remain confined to the peri

apical region.

It perforates the cortex and comes to lie under

periosteum--- SUB PERIOSTEAL ABSCESS.

The perforating abscess come into the soft tissues

then called as ACUTE DENTOALVEOLAR ABSCESS


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CLINICAL FEATURESAcute Dento Alveolar Abscess

Pain depend on the stage of disease.

Sub mucosal swelling (Intra Oral).

Facial swelling (extra Oral).

Fluctuation may come after few days.

If untreated may point or burst producing adischarging sinus.


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Radiographic featuresAcute Dento Alveolar Abscess

Little informative in acute phase except

little widening of periodontal ligament.

But previous pathology if present will be

seen.


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Treatment

Acute Dento Alveolar Abscess

Same i.e. endo- or ext-.

Intra or extra oral drainage


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CHRONIC PERI APICAL

PERIODONTITIS1

When the irritation in the peri apicaltissues persists either due to, incomplete resolution

In complete treatment of acute periodontitis orpulpitis leading to necrotic pulp

a forgotten blow or massive fillings orunsuccessful R.C.T lead to chronic

periodontitis. This goes on painlessly and become

chronic


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Skin Sinus Due Chronic infectionSkin Sinus Due Chronic infection

from deciduous molarfrom deciduous molar


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FACIAL SPACE INFECTIONFACIAL SPACE INFECTION

Fascialined areas-- potential spaces thatdo not exist in healthy persons.

Filled by pus or exudation during infection.

Neurovascular structure - compartments.

Loose areolar CT------ Clefts


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Primary facial spacesPrimary facial spaces

Primary spaces are adjacent to tooth bearing

area & are directly involved by infection.

Primary maxillary spaces.

Canine Buccal

Infratemporal.

Primary mandibular spaces. Submental.

Buccal.

Submandibular.

Sublingual.


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Secondary spacesSecondary spaces

MASTICATORY SPACES

Masseteric.

Pterygomandibular.

Superficial & deep temporal.


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CERVICAL SPACES

Lateral pharyngeal

Retropharyngeal

Prevertebral


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High Risk Infections or LethalHigh Risk Infections or Lethal

complicationscomplications

Orbital & peri orbital cellulitis.

Cavernous sinus thrombosis

Ludwigs angina

Cervical cellulitis ( Lung Abscess &

Mediastinitis)


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Orbital & Periorbital cellulitisOrbital & Periorbital cellulitis


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Cavernous Sinus ThrombosisCavernous Sinus Thrombosis


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LUDWIG S ANGINALUDWIG S ANGINA


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Cervical CellulitisCervical Cellulitis


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Principles of managementPrinciples of management

Determine the severity of infection

Evaluate the state of patients host defensemechanism

Determine , whether treated by GDP or refer tospecialist

Appropriate antibiotic & their properadministration

Treat infection surgically

Diet & i-v fluids

Evaluate pts frequently


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Surgical ManagementSurgical Management


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