3. (1) Cellulitis
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
5. (2) Ludwig’s Angina
named after German physician
who described the seriousness
of disorder in 1836
Angina comes from Latin
word angere
strangle
6. (2) Ludwig’s Angina
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
7. (2) Ludwig’s Angina
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
9. (2) Ludwig’s Angina
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
10. (2) Ludwig’s Angina
Clinical Features
involvement of submandibular
space results in
• dysphagia
• dysphonia
• dysarthria
• drooling
• sore throat
11. (2) Ludwig’s Angina
Clinical Features
involvement of lateral
pharyngeal space
• respiratory obstruction
secondary to laryngeal edema
• tachypnea
• dyspnea
• tachycardia
• patient needs to maintain erect position
12. (2) Ludwig’s Angina
Treatment & Prognosis
centers around 4 activities
• maintenance of airway
• incision + drainage
• antibiotic therapy
• elimination of original focus
of inflammation
13. (2) Ludwig’s Angina
Treatment & Prognosis
initial observation many
clinicians administer
• systemic corticosteroid
medications such as
intravenous (IV)
dexamethasone
attempt to reduce
cellulitis
14. (2) Ludwig’s Angina
Treatment & Prognosis
if signs or symptoms of
impending airway obstruction:
• fiber-optic nasotracheal
intubation
• tracheostomy
• cricothyroidotomy
15. (2) Ludwig’s Angina
Treatment & Prognosis
if signs or symptoms of
impending airway obstruction:
• cricothyroidotomy
sometimes performed
instead of tracheostomy
perceived lower risk of
spreading infection to mediastinum
17. (2) Ludwig’s Angina
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
18. (2) Ludwig’s Angina
Treatment & Prognosis
if infection remains:
diffuse surgical intervention
indurated is at discretion of clinician
brawny + often governed by patient’s
response to noninvasive therapy
20. (3) Cavernous Sinus
Thrombosis
edematous periorbital
enlargement
with involvement of eyelids +
conjunctiva
21. (3) Cavernous Sinus
Thrombosis
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
22. (3) Cavernous Sinus
Thrombosis
in cases, involving canine
space
induration + swelling
of adjacent forehead
+ nose
pupil dilation
lacrimation may also
photophobia occur
loss of vision
23. (3) Cavernous Sinus
Thrombosis
in cases, involving canine
space
pain over eye +
along distribution of:
• opthalmic Trigeminal
• maxillary branches Nerve
24. (3) Cavernous Sinus
Thrombosis
Treatment & Prognosis
surgical drainage +
high-dose antibiotic
medication similar to
those administered for
patient’s with Ludwig’s
Angina
25. (4) Osteomyelitis
an acute or chronic
inflammatory process in
extends
medullary spaces OR away from
cortical surfaces of bone initial site of
involvement
26. (4) Osteomyelitis
caused by bacterial infections
result in expanding lytic
destruction of involved bone
with suppuration
sequestra formation
27. (4) Osteomyelitis
patients of all ages can
be affected
strong male predominance
most cases involves mandible
29. (4) Osteomyelitis
(Acute Supporative Osteomyelitis)
acute inflammatory process
spreads through medullary
spaces of bone
insufficient time has passed for
body to react to presence of
inflammatory infiltrate
30. (4) Osteomyelitis
(Acute Supporative Osteomyelitis)
Clinical Features
symptoms of acute
inflammatory process
less than1 month in
duration
fever
leukocytosis
31. (4) Osteomyelitis
(Acute Supporative Osteomyelitis)
Clinical Features
lymphadenopathy
soft tissue swelling of
affected area
on occasion, paresthesia
of lower lip
32. (4) Osteomyelitis
(Acute Supporative Osteomyelitis)
Histopathologic Features
biopsy material from
patients
• liquid content
• lack of soft tissue component
• consist predominantly of
necrotic bone
33. (4) Osteomyelitis
(Acute Supporative Osteomyelitis)
Histopathologic Features
necrotic bone
• loss of osteocytes
• peripheral resorption
• bacterial colonization
• acute inflammatory infiltrate
consists of polymorphonuclear
leukocytes
34. (4) Osteomyelitis
(Acute Supporative Osteomyelitis)
Radiographic Features
ill- defined radioluscency
periosteal new bone
formation may be seen
• response to subperiosteal
spread of infection
• proliferations more common
in young patients
35. (4) Osteomyelitis
(Acute Supporative Osteomyelitis)
Radiographic Features
periosteal new bone
formation may be seen
• single-layered radioopaque
line
• separated from normal cortex
by an intervening radiolucent
band
36. (4) Osteomyelitis
(Acute Supporative Osteomyelitis)
Radiographic Features
on occasion, exfoliation
of fragments of necrotic
bone
fragment of necrotic bone
that has separated from
adjacent vital bone is
teremed sequestrum
37. (4) Osteomyelitis
(Acute Supporative Osteomyelitis)
Radiographic Features
on occasion, fragments
of necrotic bone may become
surrounded by new vital
bone, known as involucrum
39. (4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
defensive response leads
to production of granulation
tissue
subsequent forms dense
scar tissue
• attempt to wall off
infected area
41. (4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
subsequent forms dense
scar tissue
• encircled dead space
acts as reservoir for
bacteria
• antibiotic medications
have great difficulty
reaching the site
42. (4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
Clinical Features
if acute osteomyelitis
is not resolved expeditiously
entrenchment of chronic
osteomyelitis occurs
sometimes may arise without
previous acute episode
44. (4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
Clinical Features
may experience acute exacerbations
or periods of decreased pain
associated with chronic
smoldering progression
45. (4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
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
46. (4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
Radiographic Features
patchy
ragged
ill-defined radiolucency
• often contains central
radiopaque sequestra
47. (4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
Radiographic Features
48. (4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
Treatment
difficult to manage medically
• pockets of dead bone
• organisms are protected
from antibiotic drugs
due to surrounding
wall of fibrous connective
tissue
49. (4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
Treatment
surgical intervention is
mandatory
antibiotic medications are
similar to those used in
acute form
• but must be given
intravenously in high doses
