infection in oral & maxillofacial region yu chuang-qi pandect

Infection inInfection inOral & Oral & Maxillofacial Maxillofacial RegionRegion

Yu Chuang-Yu Chuang-QiQi

PandectPandect

Infection--- inInfection--- inoral & maxillofacial regionoral & maxillofacial region

InfectionInfection ConceptionConception TraitTrait AnatomyAnatomy ArisingArising RouteRoute MutationMutation Influence factorsInfluence factors DiagnosisDiagnosis PrinciplesPrinciples TreatmentTreatment PrinciplesPrinciples

PandectPandect

Infection---conceptionInfection---conception

Infectious agent(bacteria)Infectious agent(bacteria) HostHost

Inflammatory reactionInflammatory reaction

Elimination the infectious pathogenElimination the infectious pathogen Repair tissue injury Repair tissue injury

Hypersensitivity Autoimmune diseaseHypersensitivity Autoimmune disease

Beneficial

Harmful

protective and defensive

Trait of anatomyTrait of anatomyTrait of anatomyTrait of anatomy

Oral and nasal cavityOral and nasal cavity

ToothTooth

SpaceSpace

Blood and Lymphoid systemBlood and Lymphoid system

BacteriaBacteria

Trait of anatomyTrait of anatomyTrait of anatomyTrait of anatomy

Oral and nasal cavityOral and nasal cavity

Maxillary sinus(Maxillary sinus( 上颌窦上颌窦 ))

Temperature + Moisture

(Beneficial)

Reproduction + Developing

Bacteria---Exist

Alveolar bone

Soft tissue

Fascial space

Alveolar bone

Soft tissue

Fascial space

Trait of anatomyTrait of anatomyTrait of anatomyTrait of anatomy

TootToot

hhCaries

Pulpitis

Apical infection

Caries

Pulpitis

Apical infection

Trait of anatomyTrait of anatomyTrait of anatomyTrait of anatomy

Fascial space(间隙 )---loose connective tissue

Among skin, maxillary and muscle

•Purulent--- spreading way

•Do not exist in healthy state

•Become filling during infection

Trait of anatomyTrait of anatomyTrait of anatomyTrait of anatomy

Blood and lymphoid system

Beneficial

Abundance Harmful

Blood and lymphoid system

Beneficial

Abundance Harmful

Dangerous triangle

•Lacking valves

•Cavernous sinus

Dangerous triangle

•Lacking valves

•Cavernous sinus

Cavernous sinus thrombosisCavernous sinus thrombosis

Encephalic infectionEncephalic infection

Trait of pathogenic Trait of pathogenic bacteriumbacterium

Trait of pathogenic Trait of pathogenic bacteriumbacterium

VariedVaried NumerousNumerous

Streptococcus hemolyticusStreptococcus hemolyticus

((溶血性链球菌溶血性链球菌 )) Staphylococcus aureusStaphylococcus aureus

((金黄色葡萄球菌金黄色葡萄球菌 )) Escherichia coliEscherichia coli

((大肠杆菌大肠杆菌 )) AnaerobeAnaerobe

((厌氧菌厌氧菌 ))

• Sterile

• Simple

• Complex

• Sterile

• Simple

• Complex

Flora(Flora( 菌菌丛丛 ))

Route of infectionRoute of infectionRoute of infectionRoute of infection

Odontogenic infectionOdontogenic infection

Adenogenous(Adenogenous( 腺源性腺源性 ) infection) infection

Traumatic infection Traumatic infection

Hematogenous(Hematogenous( 血源性血源性 ) infection) infection

Iatrogenic(Iatrogenic( 医源性医源性 ) infection) infection

Odontogenic infectionOdontogenic infectionOdontogenic infectionOdontogenic infection

• Periapical infection

• Pericoronitis(冠周炎 )

• Periapical infection

• Pericoronitis(冠周炎 )

Periapical infectionPeriapical infectionPeriapical infectionPeriapical infection

Acute-chronic

Periapical infection

Acute-chronic

Periapical infection

Fistular( 瘘 )Fistular( 瘘 )

Cellulitis

(蜂窝织炎 )

Cellulitis

(蜂窝织炎 )

Intraoral soft tissue abscess

(脓肿 )

Intraoral soft tissue abscess

(脓肿 )

Osteomyelitis

(骨髓炎 )

Osteomyelitis

(骨髓炎 )

Septicemia(败血症 )Septicemia(败血症 )

Deep fascial space infection

Deep fascial space infection

Ascending facial-cerebral infectionAscending facial-cerebral infection

Pathways of Periapical Pathways of Periapical infection infection

Pathways of Periapical Pathways of Periapical infection infection

Pericoronitis (Pericoronitis ( 冠周炎冠周炎 ))Pericoronitis (Pericoronitis ( 冠周炎冠周炎 ))

Lower third molar Lower third molar

Infection---ArisingInfection---ArisingInfection---ArisingInfection---Arising

Host--- defense systemHost--- defense system

Microbe---virulenceMicrobe---virulence

quantity quantity

Local circumstanceLocal circumstance

Balance ImbalanceBalance Imbalance

ScaleScale

MutationMutationMutationMutation

Influence factorsInfluence factors

Changing directionsChanging directions

Influence factorsInfluence factorsInfluence factorsInfluence factors

Host--- defense systemHost--- defense system

Microbe---virulenceMicrobe---virulence

quantity quantity

Treatment strategyTreatment strategy

Changing directionsChanging directionsChanging directionsChanging directions

Localization and recoveryLocalization and recovery

Acute chronicAcute chronic

DiffusionDiffusion

Blood system---Septicemia

lymphoid system---Lymphadenopathy

Blood system---Septicemia

lymphoid system---LymphadenopathyFrom submandible space infection to chest regionFrom submandible space infection to chest region

How to diagnose?How to diagnose?How to diagnose?How to diagnose?

Local Signs and Symptoms Local Signs and Symptoms

Systemical Signs and SymptomsSystemical Signs and Symptoms

Signs and Symptoms

Local Signs and Symptoms Local Signs and Symptoms Local Signs and Symptoms Local Signs and Symptoms

Pain Pain

Swelling Swelling

Surface erythema Surface erythema

Pus formation Pus formation

Limitation of motionLimitation of motion

LocallyLocally

Systemical Signs and Systemical Signs and SymptomsSymptoms

Systemical Signs and Systemical Signs and SymptomsSymptoms

Fever Fever

Lymphadenopathy Lymphadenopathy

Malaise Malaise

Toxic appearance Toxic appearance

Elevated white blood cell countElevated white blood cell count

How to treat?How to treat?How to treat?How to treat?

Acute stageAcute stage

Chronic stageChronic stage

Acute stageAcute stageAcute stageAcute stage

Host Host

Antibiotic therapyAntibiotic therapy

Surgical drainage and incisionSurgical drainage and incision

HostHostHostHost

Migration of white blood cellMigration of white blood cell

Production of antibodiesProduction of antibodies

Most important factor --- final outcomeMost important factor --- final outcome

The infections--- cured by the host, not by antibioticsThe infections--- cured by the host, not by antibiotics

Critical PrinciplesCritical Principles

Defense MechanismsDefense Mechanisms

Principles for choosing Principles for choosing appropriate antibioticappropriate antibiotic

Principles for choosing Principles for choosing appropriate antibioticappropriate antibiotic

causative organism(causative organism( 致病菌致病菌 ))

sensitivitysensitivity

specific, narrow-spectrum antibioticspecific, narrow-spectrum antibiotic

least toxic antibioticleast toxic antibiotic

drug history(success, allergic and toxic)drug history(success, allergic and toxic)

Antibiotic eraAntibiotic era

Principles of antibiotic Principles of antibiotic administrationadministration

Principles of antibiotic Principles of antibiotic administrationadministration

Proper doseProper dose

Proper time intervalProper time interval

Proper route of administration(oral, parenteral)Proper route of administration(oral, parenteral)

Combination antibiotic therapyCombination antibiotic therapy

Surgical drainage and Surgical drainage and incisionincision

Surgical drainage and Surgical drainage and incisionincision

How to judge the pus formation?How to judge the pus formation?

Purposes of surgical drainage and incisionPurposes of surgical drainage and incision

Principles of surgical drainage and incisionPrinciples of surgical drainage and incision

How to judge the pus How to judge the pus formation?formation?

How to judge the pus How to judge the pus formation?formation?

Three Three stagesstages

InoculationInoculation

CellulitisCellulitis

AbscessAbscess

Duration--- Duration--- >5 days>5 days

Palpation---FluctuantPalpation---Fluctuant

Appearance---ReddenedAppearance---Reddened

Needle aspirationNeedle aspiration

B-ultrasoundB-ultrasound

CT CT

CharacteristicCharacteristic

Fluctuant examinationFluctuant examinationFluctuant examinationFluctuant examination

Purposes of surgical drainage & Purposes of surgical drainage & incisionincision

Purposes of surgical drainage & Purposes of surgical drainage & incisionincision

Rid the body of toxic purulent materialRid the body of toxic purulent material

Decompress the tissuesDecompress the tissues

Allowing better perfusion of blood containing antibiotics Allowing better perfusion of blood containing antibiotics

and defensive elements and defensive elements

Increased oxygenation of the infected areaIncreased oxygenation of the infected area

Infection in masseteric Infection in masseteric spacespace

Infection in masseteric Infection in masseteric spacespace

Infection in multi-spaceInfection in multi-spaceInfection in multi-spaceInfection in multi-space

Ludwig’s anginaLudwig’s angina

Principles of surgical drainage Principles of surgical drainage & incision& incision

Principles of surgical drainage Principles of surgical drainage & incision& incision

Place the incision in an esthetically acceptablePlace the incision in an esthetically acceptable

Place the incision in a dependent position to Place the incision in a dependent position to

encourage drainage by gravityencourage drainage by gravity

Dissect bluntly through deeper tissues and explore all Dissect bluntly through deeper tissues and explore all

portions of the abscessportions of the abscess

Place a drain and stabilize it with suturesPlace a drain and stabilize it with sutures

Principles of surgical drainage Principles of surgical drainage & incision& incision

Principles of surgical drainage Principles of surgical drainage & incision& incision

Lesion tooth---Impacted toothLesion tooth---Impacted tooth

OsteomyelitisOsteomyelitis

Chronic stage Chronic stage Chronic stage Chronic stage

Surgical removal of the focus(Surgical removal of the focus( 病灶病灶 ))

ConclusionConclusionConclusionConclusion

The trait of Infection The trait of Infection

Odontogenic infectionOdontogenic infection

mutation of infectiousmutation of infectious

Diagnosis of the infectionDiagnosis of the infection

Diagnosis of the abscess formationDiagnosis of the abscess formation

The principles of the treatmentThe principles of the treatment

Infection in oral & maxillo-facial region

Thank youThank you