odontogenic infections (4)
DESCRIPTION
TRANSCRIPT
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ODONTOGENIC INFECTIONS
Prepared by:Dr. Rea Corpuz
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(1) Cellulitis
(2) Ludwig’s Angina
(3) Cavernous Sinus Thrombosis
(4) Osteomyelitis
Odontogenic Infections
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if abscess is NOT able to establish drainage through the surface of skin or into oral cavity
may spread diffusely through facial planes of soft tissue
acute + edematous spread of acute inflammatory process
(1) Cellulitis
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two dangerous forms:
Ludwig’s Angina
Cavernous Sinus Thrombosis
(1) Cellulitis
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named after German physician who described the seriousness of disorder in 1836
Angina comes from Latin word angere
strangle
(2) Ludwig’s Angina
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70% of cases, develop from spread of an acute infection from lower molar teeth
prevalence in patients who are immunocompromised secondary to disorders such as:
diabetes mellitus organ transplantation acquired immunodeficiency syndrome (AIDS) aplastic anemia
(2) Ludwig’s Angina
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Clinical Features
massive swelling on neck
often extends close to clavicle
involvement of sublingual space results in
• elevation Woody Tongue• posterior enlargement can compromise• protrusion of tongue airway
(2) Ludwig’s Angina
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(2) Ludwig’s Angina
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Clinical Features
involvement of submandibular space results in
• enlargement• tenderness of neck above level of hyoid bone Bull Neck• pain in neck + floor of mouth• restricted neck movement
(2) Ludwig’s Angina
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Clinical Features
involvement of submandibular space results in
• dysphagia• dysphonia• dysarthria• drooling• sore throat
(2) Ludwig’s Angina
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Clinical Features
involvement of lateral pharyngeal space
• respiratory obstruction secondary to laryngeal edema
• tachypnea• dyspnea• tachycardia• patient needs to maintain erect position
(2) Ludwig’s Angina
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Treatment & Prognosis
centers around 4 activities
• maintenance of airway• incision + drainage• antibiotic therapy• elimination of original focus
of inflammation
(2) Ludwig’s Angina
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Treatment & Prognosis
initial observation many clinicians administer
• systemic corticosteroid medications such as intravenous (IV) dexamethasone
attempt to reduce cellulitis
(2) Ludwig’s Angina
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Treatment & Prognosis
if signs or symptoms of impending airway obstruction:
• fiber-optic nasotracheal intubation
• tracheostomy
• cricothyroidotomy
(2) Ludwig’s Angina
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Treatment & Prognosis
if signs or symptoms of impending airway obstruction:
• cricothyroidotomy
sometimes performed instead of tracheostomy
perceived lower risk of spreading infection to mediastinum
(2) Ludwig’s Angina
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Treatment & Prognosis
• cricothyroidotomy
(2) Ludwig’s Angina
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Treatment & Prognosis
high dose of penicillin penicillin-
Clindamycin OR sensitive Choramphenicol patients
anitbiotic medication is adjusted according to patient’s response + culture result from aspirates of fluid from enlargement
(2) Ludwig’s Angina
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Treatment & Prognosis
if infection remains:
diffuse surgical intervention indurated is at discretion of clinician brawny + often governed by patient’s
response to noninvasive therapy
(2) Ludwig’s Angina
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Treatment & Prognosis
complications:
• Pericarditis• Pneumonia• Mediastinitis• Sepsis• Empyema• Respiratory Obstruction
(2) Ludwig’s Angina
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edematous periorbital enlargement
with involvement of eyelids + conjunctiva
(3) Cavernous Sinus Thrombosis
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in cases, involving canine space
swelling along lateral border of nose
may extend up to medial aspect of eye + periorbital area
protrusion + fixation of eyeball
(3) Cavernous Sinus Thrombosis
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in cases, involving canine space
induration + swelling of adjacent forehead + nose
pupil dilation lacrimation may also photophobia occur loss of vision
(3) Cavernous Sinus Thrombosis
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in cases, involving canine space
pain over eye + along distribution of:
• opthalmic Trigeminal • maxillary branches Nerve
(3) Cavernous Sinus Thrombosis
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Treatment & Prognosis
surgical drainage + high-dose antibiotic medication similar to those administered for patient’s with Ludwig’s Angina
(3) Cavernous Sinus Thrombosis
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an acute or chronic inflammatory process in extends
medullary spaces OR away from cortical surfaces of bone initial site of
involvement
(4) Osteomyelitis
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caused by bacterial infections
result in expanding lytic destruction of involved bone
with suppuration sequestra formation
(4) Osteomyelitis
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patients of all ages can be affected
strong male predominance
most cases involves mandible
(4) Osteomyelitis
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Acute Supporative Osteomyelitis
Chronic Suppporative Osteomyelitis
(4) Osteomyelitis
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acute inflammatory process spreads through medullary spaces of bone
insufficient time has passed for body to react to presence of inflammatory infiltrate
(4) Osteomyelitis (Acute Supporative Osteomyelitis)
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Clinical Features
symptoms of acute inflammatory process less than1 month in duration
fever
leukocytosis
(4) Osteomyelitis (Acute Supporative Osteomyelitis)
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Clinical Features
lymphadenopathy
soft tissue swelling of affected area
on occasion, paresthesia of lower lip
(4) Osteomyelitis (Acute Supporative Osteomyelitis)
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Histopathologic Features
biopsy material from patients
• liquid content• lack of soft tissue component• consist predominantly of necrotic bone
(4) Osteomyelitis (Acute Supporative Osteomyelitis)
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Histopathologic Features
necrotic bone
• loss of osteocytes• peripheral resorption• bacterial colonization• acute inflammatory infiltrate
consists of polymorphonuclear leukocytes
(4) Osteomyelitis (Acute Supporative Osteomyelitis)
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Radiographic Features
ill- defined radioluscency
periosteal new bone formation may be seen
• response to subperiosteal spread of infection
• proliferations more common in young patients
(4) Osteomyelitis (Acute Supporative Osteomyelitis)
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Radiographic Features
periosteal new bone formation may be seen
• single-layered radioopaque line
• separated from normal cortex by an intervening radiolucent band
(4) Osteomyelitis (Acute Supporative Osteomyelitis)
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Radiographic Features
on occasion, exfoliation of fragments of necrotic bone
fragment of necrotic bone that has separated from adjacent vital bone is teremed sequestrum
(4) Osteomyelitis (Acute Supporative Osteomyelitis)
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Radiographic Features
on occasion, fragments of necrotic bone may become surrounded by new vital bone, known as involucrum
(4) Osteomyelitis (Acute Supporative Osteomyelitis)
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Treatment
if obvious abscess formation,
• antibiotics penicillin clindamycin cephalexin cefotaxime gentamicin
• drainage
(4) Osteomyelitis (Acute Supporative Osteomyelitis)
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defensive response leads to production of granulation tissue
subsequent forms dense scar tissue
• attempt to wall off infected area
(4) Osteomyelitis (Chronic Supporative Osteomyelitis)
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(4) Osteomyelitis (Chronic Supporative Osteomyelitis)
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subsequent forms dense scar tissue
• encircled dead space acts as reservoir for bacteria
• antibiotic medications have great difficulty reaching the site
(4) Osteomyelitis (Chronic Supporative Osteomyelitis)
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Clinical Features
if acute osteomyelitis is not resolved expeditiously
entrenchment of chronic osteomyelitis occurs
sometimes may arise without previous acute episode
(4) Osteomyelitis (Chronic Supporative Osteomyelitis)
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Clinical Features
swelling pain sinus formation purulent discharge sequestrum formation tooth loss pathologic fracture
(4) Osteomyelitis (Chronic Supporative Osteomyelitis)
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Clinical Features
may experience acute exacerbations or periods of decreased pain associated with chronic smoldering progression
(4) Osteomyelitis (Chronic Supporative Osteomyelitis)
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Histophathologic Features
biopsy material from patient
• soft tissue component• consists of chronically or subacutely inflammed connective tissue filling the intertrabecular areas of bone• scattered sequestra + pockets of abscess formation
(4) Osteomyelitis (Chronic Supporative Osteomyelitis)
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Radiographic Features
patchy ragged ill-defined radiolucency
• often contains central radiopaque sequestra
(4) Osteomyelitis (Chronic Supporative Osteomyelitis)
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Radiographic Features
(4) Osteomyelitis (Chronic Supporative Osteomyelitis)
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Treatment
difficult to manage medically
• pockets of dead bone• organisms are protected from antibiotic drugs
due to surrounding wall of fibrous connective tissue
(4) Osteomyelitis (Chronic Supporative Osteomyelitis)
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Treatment
surgical intervention is mandatory
antibiotic medications are similar to those used in acute form
• but must be given intravenously in high doses
(4) Osteomyelitis (Chronic Supporative Osteomyelitis)
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References:References: BooksBooks
Neville, et. al: Oral and Maxillofacial PathologyNeville, et. al: Oral and Maxillofacial Pathology 33rdrd Edition Edition
• (pages 138-144) (pages 138-144)