3. 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
5. named after German physician
who described the seriousness
of disorder in 1836
Angina comes from Latin
word angere
strangle
(2) Ludwig’s Angina
6. 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
7. 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
9. 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
10. Clinical Features
involvement of submandibular
space results in
• dysphagia
• dysphonia
• dysarthria
• drooling
• sore throat
(2) Ludwig’s Angina
11. 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
12. Treatment & Prognosis
centers around 4 activities
• maintenance of airway
• incision + drainage
• antibiotic therapy
• elimination of original focus
of inflammation
(2) Ludwig’s Angina
13. Treatment & Prognosis
initial observation many
clinicians administer
• systemic corticosteroid
medications such as
intravenous (IV)
dexamethasone
attempt to reduce
cellulitis
(2) Ludwig’s Angina
14. Treatment & Prognosis
if signs or symptoms of
impending airway obstruction:
• fiber-optic nasotracheal
intubation
• tracheostomy
• cricothyroidotomy
(2) Ludwig’s Angina
15. 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
17. 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
18. 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
21. 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
22. 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
23. in cases, involving canine
space
pain over eye +
along distribution of:
• opthalmic Trigeminal
• maxillary branches Nerve
(3) Cavernous Sinus
Thrombosis
24. Treatment & Prognosis
surgical drainage +
high-dose antibiotic
medication similar to
those administered for
patient’s with Ludwig’s
Angina
(3) Cavernous Sinus
Thrombosis
25. an acute or chronic
inflammatory process in
extends
medullary spaces OR away from
cortical surfaces of bone initial site of
involvement
(4) Osteomyelitis
26. caused by bacterial infections
result in expanding lytic
destruction of involved bone
with suppuration
sequestra formation
(4) Osteomyelitis
27. patients of all ages can
be affected
strong male predominance
most cases involves mandible
(4) Osteomyelitis
29. 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)
30. Clinical Features
symptoms of acute
inflammatory process
less than1 month in
duration
fever
leukocytosis
(4) Osteomyelitis
(Acute Supporative Osteomyelitis)
31. Clinical Features
lymphadenopathy
soft tissue swelling of
affected area
on occasion, paresthesia
of lower lip
(4) Osteomyelitis
(Acute Supporative Osteomyelitis)
32. Histopathologic Features
biopsy material from
patients
• liquid content
• lack of soft tissue component
• consist predominantly of
necrotic bone
(4) Osteomyelitis
(Acute Supporative Osteomyelitis)
33. Histopathologic Features
necrotic bone
• loss of osteocytes
• peripheral resorption
• bacterial colonization
• acute inflammatory infiltrate
consists of polymorphonuclear
leukocytes
(4) Osteomyelitis
(Acute Supporative Osteomyelitis)
34. 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)
35. 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)
36. 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)
37. Radiographic Features
on occasion, fragments
of necrotic bone may become
surrounded by new vital
bone, known as involucrum
(4) Osteomyelitis
(Acute Supporative Osteomyelitis)
39. defensive response leads
to production of granulation
tissue
subsequent forms dense
scar tissue
• attempt to wall off
infected area
(4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
41. 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)
42. 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)
44. Clinical Features
may experience acute exacerbations
or periods of decreased pain
associated with chronic
smoldering progression
(4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
45. 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)
46. Radiographic Features
patchy
ragged
ill-defined radiolucency
• often contains central
radiopaque sequestra
(4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
48. 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)
49. 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)