2. Pendahuluan
Infeksi pada daerah orofacial dan leher,
khususnya yang berasal dari
odontogenik, merupakan salah satu
penyakit yang umum pada manusia.
Infeksi ini tetap menjadi masalah besar;
cukup sering dihadapi
2
Malik, N.A. (2021) Textbook of oral and maxillofacial surgery. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
3. Etiologi
3
Malik, N.A. (2021) Textbook of oral and maxillofacial surgery. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
Infeksi Bakteri
• Infeksi odontogenik yang ditemui di daerah orofacial sebagian besar merupakan
infeksi bakteri
• Infeksi nonodontogenik:
• (i) Tonsil, dan (ii) Infeksi hidung yang lebih sering terjadi pada anak-anak, dan (iii)
Furunkel pada kulit di atasnya.
Infeksi Jamur
• Biasanya candidiasis biasanya dikenal dengan candidosis, monialisis atau thrush
• Candida biasanya berbentuk pseudohypae, yeast, dan chlamydospore
Infeksi virus
• Literatur tidak menunjukkan laporan yang cukup mengenai kondisi ini
5. Sekitar 60% dari
seluruh infeksi
odontogenik
disebabkan campuran
bakteri aerob dan
anaerob.
Hanya bakteri
anaerobik sekitar 35%
dan bakteri aerob
murni 5%. 5
Malik, N.A. (2021) Textbook of oral and maxillofacial surgery. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
6. 6
Malik, N.A. (2021) Textbook of oral and maxillofacial surgery. New Delhi, India: Jaypee Brothers Medical Publishers (P)
7. Faktor Penyebaran Infeksi
Malik, N.A. (2021) Textbook of oral and maxillofacial surgery. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
General Factors:
• Resistensi Host
• Virulensi mikroorganisme
• Pertahanan host
Local Factors:
• (i) Tempat sumber infeksi - rahang atas atau rahang bawah
• (ii) Titik keluarnya nanah dari tulang alveolar ke jaringan lunak di labial,
bukal atau Lingual, palatal
• (iii) Hambatan alami penyebaran nanah di jaringan sebagai lapisan fasia,
otot atau tulang rahang.
8. 8
Malik, N.A. (2021) Textbook of oral and maxillofacial surgery. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
9. • Menentukan keparahan
infeksi
• Menentukan lokasi
anatomis infeksi
• Evaluasi pertahanan
host
• Menentukan ruang
perawatan
• Implikasi anestesi
• Penanganan jalan nafas
Prinsip Manajemen Bedah
• 9
Malik, N.A. (2021) Textbook of oral and maxillofacial surgery. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
10. Manajemen Bedah
• 1
0
Malik, N.A. (2021) Textbook of oral and maxillofacial surgery. New Delhi, India: Jaypee Brothers Medical Publishers (P)
•Needle decompression
Surgical drainage
Ekstraksi gigi
Terapi medis suportif
11. Necrotizing Ulcerative Gingivitis (NUG)
• Etiologi
• Prevottela intermedia
• Fusobacterium nucleatum
• Klinis
• gingiva terang dan mudah berdarah
• nekrosis dan ulserasi pada
interdental dan margin gingiva
(crater like)
• Halitosis, bau amonia
13. Herpes Simplex Virus (HSV)
DNA virus
HSV tipe 1 (transmitted by contact with saliva
and is usually acquired in early childhood )
HSV tipe 2 (sexually transmitted and causes
lesions in the genital area)
Primary infection is often asymptomatic:
herpetic stomatitis/ primary herpetic
gingivostomatitis (PHG)/ gingivostomatitis
Recurrent Herpes labialis / herpes
simpleks sekunder/ herpes simpleks rekuren
•Lesi vesikobulosa, multipel, tepi kemerahan, batas jelas,
terdapat krusta, sakit.
Herpetic stomatitis/ primary herpetic
gingivostomatitis (PHG)/ gingivostomatitis
Herpes labialis / herpes simpleks
sekunder/ herpes simpleks rekuren
Glick, M. (2015). Burket's oral medicine. PMPH USA.
14. Varicella Zoster Virus
•Primary infection Varicella (Chicken Pox /cacar air)
Herpes virus (DNA)
Mainly a childhood disease
•5 years of age : infection rate 50%
•12 years of age : infection rate 90%
Tends to be more severe in adults
It may be fatal
•Neonates
•Immunocompromised persons
Malaise, fever, pharyngitis, rhinitis, itching or pruritic
rash
Glick, M. (2015). Burket's oral medicine. PMPH USA.
15. Herpes zoster (Shingles)
● Reactivation of varicella zoster virus
● Biasanya disertai Ramsay Hunt Syndrome (kelumpuhan
wajah unilateral & lepuh telinga) & Reye Syndrome
(demam tinggi, edema serebral, degenerasi hepar)
Glick, M. (2015). Burket's oral medicine. PMPH USA.
16. Coxackie Virus
Kelompok enterovirus
71 : EV 71 RNA virus
Gejala prodormal 1-2
hari
Makula kecil, merah
pada palatum, mukosa
bukal, gingiva, lidah
vesikel diameter 1-3
mm ulser
Ruam dan vesikel pada
tangan & kaki
Vesikel tidak gatal Self limiting disease Coxsackie virus : A & B
Infeksi primer HFMD
( Hand Foot and Mouth
Disease) / Flu
Singapura
Glick, M. (2015). Burket's oral medicine. PMPH USA.
17. Herpangina
Herpangina is
systemic infection,
common childhood
Fever and sore throat
usually last for 2 days
and are followed by
the appearance of
lesions in the
oropharynx
These are numerous
small vesicles 1-2 mm
in diameter, found
mostly on the pillar of
fauces, uvula, tonsils,
and palate
Glick, M. (2015). Burket's oral medicine. PMPH USA.
18. Infeksi HPV di Rongga Mulut
Focal epithelial hyperplasia (heck disease)
Oral squamous papilloma
Oral condyloma acuminata
Common warts (Verruca vulgaris)
Oral lichen planus
Oral leukoplakia
Oral squamous cell carcinoma
Little pinkish or whitish nodules
tongue, lips, palate and floor of
mouth can be sessile or
pedunculated. The surface contour is
usually cauliflower like HPV 6 & 11
Glick, M. (2015). Burket's oral medicine. PMPH USA.
20. Candidiasis
020
Candidiasis dikenal dengan Candidosis, moniliasis atau oral
thrush.
Disebabkan oleh yeast, biasanya disebabkan Candida
albicans
Species seperti C. Tropicalis, C. Parapsilosis, C. stellatoidea,
C. krusei, C. guilliermondii, C. dubliniensis, C. glabrata
Candida biasanya ditemukan di rongga mulut, Traktus
gastroinstestinal, dan vagina pada orang normal
Glick, Michael. Burket's oral medicine. PMPH USA, 2015.
21. Klasifikasi Oral Candidiasis
Primary Oral Candidiasis
• Acute Form
• Pseudomemebranous
• Erythematosus
• Chronic Forms
• Hyperplastic
• Nodular
• Plaque like
• Erythematosus
• Pseudomembranus
Candida Associated Lesion
• Denture stomatitis
• Angular cheilitis
• Median rhomboid glossitis
Secondary Oral Candidiasis
• Oral manifestations of systemic mucocutaneous candidiasis as a result of diseases such as thymic
aplasia and candidiasis endocrinopathy syndrome
26. Ps: Swelling at left cheek extended to left and right lower jaw, left temple and chin
region
S:
A 63 y.o male patient came with swelling at the cheek that extended to
the left lower jaw, left temple, chin, right lower jaw, floor of the mouth and
neck. ± 5 days prior to admission, the patient complained of toothache at left
upper tooth, but he didn’t seek treatment. ± 3 days prior to admission the
swelling occurred at cheek and the patient took 3 kinds of medicine by himself
(dexamethasone, ibuprofen and amoxicillin). ± 2 days prior to admission the
swelling extended to the left lower jaw, left temple, right lower jaw, floor of the
mouth and neck then he went to a general practitioner clinic in the Cipanas area
and referred to a dentist at the same clinic, the patient was given 3 kinds of
medicine (the patient forgot the name of the medicine) (antibiotics, painkillers,
anti-inflammation) but the swelling got bigger. ± 1 day prior to admission the
swelling got bigger, then the patient went to the Cipanas General Hospital and
performed infusion of electrolyte and injection of paracetamol. Then he went to
Hasan Sadikin Hospital Emergency Department for further treatment. History of
toothache (+) upper left tooth ± 5 days prior to admission. History to the dentist
(+) 2 days prior to admission and given premedication. Altered voice (+) hot
potato voice (+) hoarseness (-) painful swallowing (+) neck stiffness (+).
History of systemic disease (-) heart disease. History of taking regular drugs (+)
Amlodipine besilate 5 mg, Nitrokaf retard 2.5 mg, Candesartan, Cilexetil 16
mg, Isosorbide dinitrate 5 mg, Bisoprolol 1.25 mg.
27. Localized status :
Extra Oral :
• Asymmetrical face, swelling at left cheek, right and left lower
jaw, left temple and chin region with 10x6x5 cm in size, reddish
(+), febrile temperature (+), localized (+), fluctuation (+), pain
on palpation (+)
28. Intra Oral :
• Gingiva : Generalized hyperemia
• Floor of mouth : Swelling at floor of mouth region with 4x2x1
cm in size, reddish (+), febrile temperature (+),
localized (+), fluctuation (+), pain on
palpation (+)
• Tonsils : Difficult to assess
• Lips : Normal
• Vestibule : Normal
• Palate : Normal
• Buccal mucosa : Normal
• Tongue : Normal
29. 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
Odontogram
Mouth Opening : ± 1.5 cm
Calculus (+)
X
X
GP
X
32. Chest X – Ray
(Hasan Sadikin General Hospital, July 20th 2022)
Impression:
• Cardiomegaly with aortic atherosclerosis
• Bronchopneumonia at right lung
33. Neck Soft Tissue AP-Lateral X-Ray
(Hasan Sadikin General Hospital, July 20th 2022)
Impression :
• Swelling of soft tissue at bilateral submandible with radiolucent of
multiple air density within, suggestive of submandible abscess
• Air column still open
34. Neck Soft Tissue AP-Lateral X-Ray
(Hasan Sadikin General Hospital, July 24th 2022)
Impression :
• Mass soft tissue at submanbile region until bilateral neck that narrows
and pushed air column to the right at level C1-C5
35. A :
● Sepsis due to Phlegmon + Buccal, temple, neck and hemithorax
abscess due to gangrene radices of tooth 28 + Chronic apical
periodontitis due to gangrene radices of teeth 16,34 and gangrene
pulp of tooth 26
● Inflammatory anemia with MODS AKI, suspected DIC
● Thrombocytopenia due to DIC dd/ drug
● DM type 2 with DKD regulation neuropathy
● AKI dd/ AKI superimposed CKD due to DKD
● Hypertensive heart diseases, coronary artery disease ischemic
anterior/anteroseptal
