Infection okkkkkkkk

Dento-alveolar
Infections
Dr/ Hamed Gad

Objectives
 Deferential diagnosis of pulpal and
periapical infection.
 Stages of periapical infection.
 Different types of fascial space infection.
 Management.
 Complications.

An infection involves the invasion and
proliferation of microbes or physical and chemical
factors, heat, and irradiation.
Inflammationis the localized reaction of
vascular and connective tissue of the body to an
irritant, resulting in the development of an
exudates rich in proteins and cells.

 So the inflammation is consider a
protective and aims to limiting or
eliminating the irritant with various
procedures while the mechanism of tissue
repair is triggered.

Type of irritant
1. Microbes,
2. physical
3. chemical factors,
4. heat,
5. irradiation.

Signs & symptom of inflammation
1. Redness.
2. Heat.
3. Swelling or edema.
4. Pain.
5. loss of function.

Stages of inflammation
1- vascular phase
2- Cellular phase
3- Reparative Phase

Bacteriology of oral cavity
 The oral cavity provide an optimum
environment for microorganisms.
1- Moisture
2-Warmth
3-Protected crypts

Progression of odontogenic infections
 Early infection is often initiated by high-virulence aerobic
organisms (commonly streptococci), which cause
cellulitis, followed by mixed aerobic and anaerobic
infections.
 As the infections become more chronic (abscess stage),
the anaerobic bacteria predominate, and eventually the
infection becomes exclusively anaerobic.
 So TTT------------

Microbiology of odontogenic infection
I- Aerobic bacteria
GRAM SRAIN TYPE
Gram postive cocci Streptococcus
Staphylococcus
Gram negative cocci Neisseria Spp
Gram postive rods Corynebacterium spp
Gram negative rods Haemophilus spp

I- Anaerobic bacteria
GRAM SRAIN TYPE
Gram postive cocci Pepto-Streptococcus
Gram negative cocci veillonella Spp
Gram postive rods Eubacterium spp
Lactobacillus
actinomyses
Gram negative rods Bacteroides
Fusobacterium

Streptococci favor spreading
of infection
 This due to:
1. it produce fibrinolysin enzyme
2. Low chemotactic effect on
leukocytes
3. It grow in chains

Staphylococcus favor localization
of infection
 This due to:
1. it produce coagulase enzyme
2. High chemotactic effect on
leukocytes
3. It grow in colonies

 Most odontogenic infections are the
result of bacteria, which normally
colonize the bacterial plaque, tongue,
saliva, and gingival sulcus.

 When caries is present,
Streptococcus mutans is the
predominant microorganism.

 When gingivitis is present, Gram-
negative anaerobic rods prevail,
(Bacteroides intermedius) being the
most common pathogen.

 When periodontitis is present,
Anaerobic Gram-negative microorganisms
prevail Bacteroides gingivalis) as the
most common pathogen.

 In suppurative odontogenic infections (e.g.,
periapical abscesses) or in infections of the deep
fascial spaces, there is usually polymicrobial flora,
with melaninogen Bacteroides, Fusobacterium
nucleatum, as well as the species
Peptostreptococcus, Actinomyces, and
Streptococcus as the most common microbes.

1. Diffuse,
2. reddened,
3. soft or hard
swelling.
Cellulitis

Abscess
 Focal accumulation
of pus.
 May have
spontaneous
drainage intraorally
or extraorally.

Etiology of odontogenic infections
1. Non-vital teeth
2. Pericoronitis (due to a semi-impacted
mandibular tooth)
3. Tooth extractions
4. Infected cysts.
5. Postoperative trauma
6. Infection as a result of local anesthesia.

Dento-alveolar
abscess
1- acute dento-
alveolar abscess
2- chronic dento-
alveolar abscess

acute dento-alveolar
abscess
 Acute dento-alveolar
abscess of early
stage
 Acute dento-alveolar
abscess of late stage

Acute dento-
alveolar abscess of
early stage

Acute dentoalveolar abscess of early
stage
 Clinical pictures:
 1- Extrusion of the tooth out of its
socket.
 2- Tenderness: on percussion of the
involved tooth
 3- sharp , shooting and throbbing pain
 4-lymphadinitis & General features

Treatment of Acute dento-alveolar
abscess of early stage
 Prophylactic antibiotics
 Surgical treatment: pulp
extirpation-extraction
 Anti-infalmmatory-
Analgesics
 Rest on the bed & high
protein diet

Indication of extraction of the tooth
in ADAA
1. Healthy patients
2. Deciduous tooth
3. More than grade II
mobility
4. Accessible tooth for
extraction
5. pain control

Fate of ADAA infection
1.Resolve of abscess
2.Develop to ADAA in
late stage
3.Chronic status

II
Acute dento-
alveolar abscess
in late stage

Spread of infection
 Though the lymph tissue
 Through the veins
 Through the tissue continuity

Factors governing the spread of
infection from early stage to late stage
1- Virulence and numbers of the invading
microorganisms
2- Host defense
3- Position of tooth in the alveolus
4- Relation of the root apices to the muscle
attachments
5- Organization of the cervical fascia

1- Virulence of the invading
microorganisms
Virulence means all characteristics of the
microbe that are injurious to the host
which include:
1. Degree of invasiveness
2. Bacterial toxins and enzymes

2- Host defense
1. Age of the patients
2. Medical status
3. Nutrition
4. Immuno-suppression diseases or
medication

3- Anatomical location of the tooth in the
alveolus

4- Relation of the root apices to the
muscle attachments

4- Relation of the root apices to
the muscle attachments

six possible 1ry spaces
locations:
1. vestibular abscess
2. buccal space
3. palatal abscess
4. sublingual space
5. submandibular space
6. maxillary sinus
According to roots position and muscles
attachment

5- Organization of the cervical fascia “facial spaces
“
The fascia are continuous layers of connective tissue consisting of
The superficial cervical fascia The
deep cervical fasciae

 The superficial cervical
fascia (tela subcutanae).
 It is a layer of loose C. T.
located directly beneath the
skin.
 Is a continuous sheet extend
from the head & neck into
the regions of the thorax,
shoulders & axillae.

superficial fascial layer enclose:
1. 1- Platysma
2- Muscles of Facial expression

The deep Cervical Fascia
 1- Superficial Layer
 2- Middle Layer
 3- Deep Layer

Fascial spaces
Fascial spaces are fascia-lined areas
that can be eroded or distended
by purulent exudates.

The danger space
Also called space 4 of
Grodinsky , it is the
potential space
between alar and
prevertebral fascia.
Its superior limit is
the skull base, and it
extends inferiorly
into the posterior
mediastinum.

Superficial layer
Middle layer
Deep layer

principles of management of
fascial space infection infections

Following factors should be taken into
consideration for management of odontogenic
infections
I
1. Determine the severity of infection.
2. Evaluate host defenses.
3. Indications for hospitalization.
II
4. Treat surgically.
5. Support medically.
6. Choose and prescribe antibiotic therapy.
7. Administer the antibiotic properly.
III
8. Evaluate the patient frequently.

infections
I
1. Determine the severity of infection.
2. Evaluate host defenses.
3. Indications for hospitalization.

infections
II
4. Treat surgically.
5. Support medically.
6. principle for antibiotic therapy.
7. Administer the antibiotic properly.

infections
III
8. Evaluate the patient frequently.

A- Determining the severity of
infection
1. Anatomic location.
2. Rate of progression.
3. Airway compromise.

B- Evaluate host defenses.
1. Age
2. Disease related
3. Defective immune system related
4. Drug related

C- indications for hospitalization
1. Temperature > 101°F (38.3°C)
2. Threat to the airway or vital structures
3. Infection in high severity anatomic spaces
4. Need for general anesthesia
5. Need for inpatient control of systemic disease

Objective of surgical drainage
1. Drain pus from tissue spaces
2. Relives tissue pressure.

D- Treat surgically
 Extirpation of the necrotic tooth pulp
 Soft tissue incision

Incision for temporal
Submandibular,
Submental,
Incision for retropharyngeal, lateral
pharyngeal spaces
Incision for retropharyngeal,
lateral pharyngeal spaces,carotid
sheath

E-Support medically.
1. Hydration
2. Nutrition
3. Control of fever

principle for antibiotic therapy
1. Identification of causative organism
2. Determination of antibiotic sensitivity
3. Use of narrow spectrum antibiotic
4. Use of least toxic antibiotic
5. Patient drug history
6. Use of bactericidal rather than bacteriostatic antibiotic
7. Cost of antibiotic

Odontogenic infections caused
by:
1. mixed flora 70%
2. aerobic flora 5%
3. anaerobic flora 25%

determination of antibiotic
culture sensitivity indications:
1. If patient has received treatment for 3 days
without improvement
2. Post operative wound infection
3. Recurrent infection
4. Chronic specific and none specific
infection

USE OF NARROW SPECTRUM
ANTIBIOTICS
When a broad spectrum antibiotic is used, many
different bacteria, present in body are exposed to
antibiotic.
However if narrow spectrum antibiotic is used fewer
organisms have opportunity to become resistant
as they are not even partially sensitive

USE OF LEAST TOXIC ANTIBIOTIC
Antibiotics are used to kill bacteria but some antibiotics may injure
human cells. At times these drugs may be used but in most of
situations, less toxic drugs that are equally effective may be
used. Treatment with less toxic drug may be prolonged. Hence,
clinician should continuously monitor for signs of toxicity &
instruct patient to look for & report them as well

Use of bactericidal rather than
bacteriostatic antibiotic
Advantages of bactericidal antibiotics are:
1. Less reliance on host resistance
2. Killing of bacteria by antibiotic itself
3. Greater flexibility with dosage
intervals
4. Faster results than bacteriostatic

BACTERICIDAL
ANTIBIOTICS
BACTERIOSTATI
C ANTIBIOTICS
Penicillins Tetracyclines
Cephalosporins Arithromycin
Aminoglycosides Clarithromycin
Vancomycin Azithromycin
Fluoroquinolones Clindamycin
Metronidazole Sulfa
Imipenem

COST OF DRUG
It is difficult to place price tag on health, but
surgeon should consider the cost of antibiotic
prescribed.
In some situations more expensive drug may be
drug of choice.
But in some situations there is substantial
difference in the antibiotics of equal efficacy.

Principles of antibiotic
administration
1. Proper dosage
2. Proper time interval
3. Consistency in route of administration
4. Combination antibiotic therapy

PROPER DOSAGE
- The goal of any drug therapy should be to prescribe /
administer sufficient amounts to achieve the desired
therapeutic effect but not enough to cause injury to the
host.
- For therapeutic purposes the peak concentration of the
antibiotic at the site of infection should be 3-4 times the
MIC.

PROPER DOSAGE
Sufficient antibiotic must be given to reach
therapeutic levels, because subtherapeutic levels
may mask the infection and suppress the clinical
manifestations without actually killing the
bacteria.
Subtherapeutic doses may cause the recurrence of
infection once the drug is discontinued.

DRUG T1/2(hr) USUALADULT
DODAGE
PEDIATRIC
DOSAGE
Penicillin G 0.5 600,000-1,200,000
U 4hrly
100,000U/Kg/day
in 3 doses
Penicillin V 1.0 500mg qid 50mg/Kg/d in 3-4
D
Amoxycillin 1.0 250-500mg tds 25mg/Kg/d in 3 D
Ampicillin 0.7 250-500mg qid 100mg/kg/d in 4 D
Oxacillin 0.5 500-1000mg 6hrly 50-100mg/Kg/d 4
D
Dicloxacillin 0.5 250-500mg qid 12.5-50mg/Kg/d 4
D
Cefotaxim 0.7 1-2g 8-12hrly
Cephalexin 0.7 500-1000mg qid 25-50mg/Kg/d 4D
Metronidazole 8 400mg tds 30-40mg/Kg/d
Clindamycin 4 150-450mg 6hrly 10-20mg/Kg/d 3-
4D

PROPER TIME INTERVAL
Each antibiotic has established plasma
half life (t1/2), during which half of the
absorbed dose is excreted.

As most of the antibiotics are eliminated
by kidneys, in patients with pre
existing renal diseases longer interval
between doses is maintained.

indications of combination therapy
1. When it is necessary to increase the antibacterial spectrum
in the patient with life threatening sepsis of unknown
cause.
2. When increased bactericidal effect against a specific
organism is desired
3. In prevention of rapid emergence of resistant bacteria.
4. Empiric treatment of certain odontogenic infections

 Penicillin
 it is considered an antibiotic of choice for the treatment of
odontogenic infections.
 Penicillin inhibits synthesis of the cell wall.
 The semisynthetic derivatives(amoxicillin-ampicillen) is
effective against aerobic Gram-positive rods and
anaerobic Gram-positive and -negative cocci. as well as
anaerobic G –ve rods and relatively effective against
aerobic Gram-negative rods.

The recommended dose administration is 500–1000
mg every 6–8 h for ampicillin, and 500 mg every 8
h for amoxicillin.

combinations of semisynthetic penicillins with various 􀁂-
lactamase inhibitors
1. Ampicillin with sulbactam
2. Amoxicillin with clavulanic acid,
They may be administered orally, and the recommended
doses are 375–750 mg every 12 h for ampicillin/sulbactam,
and 625 mg every 8 h for amoxicillin/ clavulanic acid.

It is worth noting that penicillins are not
contraindicated during pregnancy, and are
classed as relatively safe drugs (category B
according to the FDA categorization1)
 The most common and most serious adverse
reactions to penicillins are hypersensitivity
reactions 3–5% of the population).

Cephalosporins
The mechanism of action of cephalosporins, regardless of generation, is
the same as that of penicillin. As far as antimicrobial effectiveness is
concerned, orally administered first-generation cephalosporins
(cefalexin and cefadroxil) are not advantageous compared to
penicillin or ampicillin, while orally administered second-generation
cephalosporins (cefaclor, cefatrizine, loracarbef, cefprozil and
cefuroxime) are characterized by resistance to 􀁂-lactamases, which
neutralize ampicillin, and may be used as alternative drugs if there is
no response to penicillin.

Cephalosporins are considered relatively safe
drugs during pregnancy (category B
according to FDA categorization) and their
dose needs to be decreased only in case of
advanced renal failure.

Macrolides
Their antimicrobial spectrum includes Gram-positive aerobic and
anaerobic cocci of the mouth, while Gram-negative aerobes and
anaerobes are resistant.
As such, they are a good alternative solution for treatment of odontogenic
infections without complications of mild and intermediate severity in
patients allergic to lactams.
Erythromycin and azithromycin are considered relatively safe drugs for
pregnant patients (category B according to FDA categorization

Clindamycin
effectiveness against the most frequent pathogens in
odontogenic infections, such as Gram-positive
aerobic and anaerobic cocci and Gram negative
anaerobic rods.
Clindamycin is not effective against Gram-negative
aerobic rods.
The recommended dose for oral administration is 300
mg every 8 h, which does not need to be adjusted
even in end-stage renal failure.

The most serious and common side-effect of clindamycin is
antibiotic-associated diarrhea (0.3–21%) and an even more
severe diarrheal state, pseudomembranous colitis (1.9–10%).
Clindamycin belongs to category B according to the FDA
categorization for pregnancy and has been extensively used
during pregnancy. Even so, there are no controlled studies
concerning its safety in humans.

metronidazole
Mainly metronidazole and ornidazole belong to the group of
nitroimidazole drugs, whose mechanism of action has not
been fully clarified even today.
They are drugs with rapid bactericidal action principally
against Gram-negative anaerobes, a slightly more
restricted bactericidal action against Gram-positive
anaerobes (microaerophilic
The usual dose for oral administration is 500 mg every 8 h for
metronidazole, and 500 mg every 12 h for ornidazole.

Pregnancy is not a contraindication for
administration (category B of FDA
categorization), but nitroimidazoles must be
avoided during the first trimester, while the
dose must be decreased to half the normal
dose only in cases of severe renal failure.

I- Aerobic bacteria
GRAM SRAIN TYPE
Gram postive cocci Streptococcus
Staphylococcus
Macrolides
Clindamycin
Gram negative cocci Neisseria Spp PENICILLEN------
Gram postive rods Corynebacterium spp
PENICILLEN
Gram negative rods Haemophilus spp
PENICILLEN
Clindamycin

I- Anaerobic bacteria
GRAM SRAIN TYPE
Gram postive cocci Pepto-Streptococcus
Macrolides
Clindamycin
Gram negative cocci veillonella Spp
Gram postive rods Eubacterium spp
Lactobacillus
Actinomyses PENICILLEN
Gram negative rods Bacteroides
Fusobacterium
PENICILLEN
metronidazole

Antibiotic Therapy
 Removal of the cause, drainage, and
supportive care more important than
antibiotic therapy.
 Infections are cured by the patient’s
defenses, not antibiotics.

Antibiotic therapy
 Oral infections are typically polymicrobial.
 Antibiotic effectiveness dependent upon adequate
tissue (not serum) concentration for an
appropriate amount of time.
 Antibiotics should be prescribed for at least one
week

Antibiotic therapy
 Penicillin (bacteriocidal) drug of choice for treatment of
odontogenic infections (5% incident of allergy).
 Clindamycin (batericiodal) 1st line after penicillin; effective
against anaerobes; stop taking at first sign of diarrhea.
 Cephalosporin (slightly broader spectrum and bacteriocidal);
cautious use in penicillin-allergic patients → cross-sensitivity; if
history of anaphylaxis to penicillin, do not use.

Antibiotic therapy
 Erythromycin (bacteriostatic) good 2nd line drug
after penicillin; use enteric-coated to reduce GI upset.
 Metronidazole (bacteriocidal) excellent against
anaerobes only.
 Augmentin (amoxicillin + clavulanic acid) kills
penicillinase-producing bacteria that interferes with
amoxicillin; expensive.

H- EVALUATE THE PATIENT
FREQUENTLY
1. Subjective sense of feeling better
2. Objective signs of improvement
3. Review culture & sensitivity reports
4. Reevaluate host responses if
necessary

 Abscess of Base of
Upper Lip
 Etiology. It is usually caused by
infected root canals of maxillary
anterior teeth.
 Clinical Presentation.
 swelling and protrusion of the
upper lip,
 diffuse spreading and obliteration
of the depth of the mucolabial fold

Treatment
• incision for drainage:
• is made at the mucolabial fold parallel to
the alveolar process.
•A hemostat is then inserted inside the
cavity, which reaches bone, aiming for the
apex of the responsible tooth, facilitating
the evacuation of pus.
•A rubber drain is placed until the clinical
symptoms of the infection subside .

•Canine Space infection
•Clinical Presentation.
This is characterized :
edema localized in the infraorbital region,
• obliteration of the nasolabial fold and
somewhat of the mucolabial fold.
•the skin becomes taut and shiny due to
suppuration, while its color is reddish

Submental Abscess
Etiology.
- mandibular anterior
teeth
- - spread of infection
from other anatomic
spaces (mental,
sublingual,

Submental Abscess
Clinical Presentation.
- indurated and painful
submental edema,
which later may
fluctuate or may even
spread as far as the
hyoid bone.

Sublingual Abscess
There are two sublingual spaces
above the mylohyoid muscle, to
the right and left of the midline.
These spaces are divided by
dense fascia. Abscesses formed in
these spaces are known as
sublingual abscesses.
.

Etiology.
 the mandibular anterior teeth, premolars and the first
molar, whose apices are found above the attachment of
the mylohyoid muscle.
 Also, infection may spread to this space from other
bordering spaces with which it communicates
(submandibular, submental, lateral pharyngeal).

 Treatment. I&D
 intraoral incision, laterally, and
along Wharton’s duct and the
lingual nerve.
 In order to locate the pus, a
hemostat is used to explore the
space inferiorly, in an
anteroposterior direction and
beneath the gland.
 After drainage is complete, a
rubber drain is placed.

Etiology. Infection of this space may
originate from
the mandibular second and third
molars, if their apices are found
beneath the attachment of the
mylohyoid muscle. It may also be
the result of spread of infection
from the sublingual or submental
spaces.
Sub-mandibular Abscess

 Clinical Presentation. The infection
presents asmoderate
 swelling at the submandibular area,
which spreads, creating greater edema
that is indurated and redness of the
overlying skin.
 Also, the angle of the mandible is
obliterated, while pain during palpation
and moderate trismus due to
involvement of the medial pterygoid
muscle are observed as well.

A hemostat is inserted into the cavity of the
abscess to explore the space and an
attempt is made to communicate with
the infected spaces.
Blunt dissection must be performed along
the medial surface of the mandibular
bone also, because pus is often located in
this area as well. After drainage, a
rubber drain is placed.

- Masticator space infection
a- Submasseteric Abscess
Etiology. Infection of this space
originates in the mandibular
third molars (pericoronitis)

Pathway of spread from masseteric
space infection

 Clinical Presentation. It is
characterized by a firm
 edema that is painful to pressure in the
region of the masseter muscle.
 Severe trismus and an inability to
palpate the angle of the mandible are
observed.
 Intraorally, there is edema present at
the retromolar area and at the anterior
border of the ramus.
 This abscess rarely fluctuates, while it
may present generalized symptoms.

Treatment.
Treatment of this abscess is basically intraorally.
with an incision that begins at the coronoid process and runs
along the anterior border of the ramus towards the
mucobuccal fold, approximately as far as the second molar.
Extraorally on the skin, beneath the angle of the mandible . In
both cases, a hemostat is inserted, which proceeds as far as
the center of suppuration and until it comes into contact with
bone.
Because access is distant from the purulent accumulation, often
it is difficult to drain the area well, resulting in frequent

Masticator space infection
b- Temporal Abscess
Anatomic Location.
A-The superficial temporal space is
bounded laterally by the temporal
fascia and medially by the
temporalis muscle
B- the deep temporal space is found
between the medial surface of the
temporalis muscle and the temporal
bone

Temporal Space infection
Clinical Presentation. It is
characterized by painful edema of
the temporal fascia, trismus (the
temporalis and medial pterygoid
muscles are involved), and pain
during palpation of the edema.

 Etiology. Infection of the temporal space is
caused by the spread of infection from the
infratemporal space, with which it
communicates.

 Treatment. The incision for drainage is
performed horizontally, at the margin of
the scalp hair and approximately 3 cm
above the zygomatic arch. It then
continues carefully between the two
layers of the temporal fascia as far as the
temporalis muscle. A curved hemostat is
used to drain the abscess.

 Masticator space infection
 C- Pterygomandibular Space
An abscess of this space is caused mainly by infection of
mandibular third molars or the result of an inferior
alveolar nerve block, if the penetration site of the needle
is infected (pericoronitis).
 Clinical Presentation.
 Severe trismus and slight extraoral edema beneath the
angle of the mandible are observed.
 Intraorally, edema of the soft palate of the affected side
is present, as is displacement of the uvula and lateral
pharyngeal wall, while there is difficulty in swallowing.

Right pterygomandibular
space abscess. Note the
swelling of the anterior
tonsillar pillar and the
deviation of the
edematous uvula to the
opposite side.

Treatment.
The abscess is drained, permitting
the evacuation of pus along the
shaft of the instrument.

 Lateral Pharyngeal
Abscess


Lateral Pharyngeal (parapharyngeal)
Space
• Contents :
• Int. carotid a.
•Int. jugular v.
•Deep cervical lymph
nodes
•Nerve IX, X, XI, XII
•Sympathetic chain

Left lateral pharyngeal space
abscess. Note the swelling just
anterior to the sternocleidomastoid
muscle above the level of the hyoid
bone and the deviation of the head
toward the right shoulder, in an
attempt to place the upper airway
directly over the deviated trachea

Incision for temporal &
submassetric space
Submandibular, submasseteric,
pterygomandibular
Submental,
Sublingual
lateral pharyngeal spaces
lateral pharyngeal

Upper Canine
 Canine space Buccal space
Pterygomandibular space
Submandibular space
Lateral pharyngeal space
Retropharyngeal space
Superior mediastinum

Upper Molars
 Buccal space infratmporal
space
Temporal space
Ptergomandibular space
Submandibular space Lateral
pharyngeal space

Lower premolars
Sublingual space
Submandibular space
Superior mediastinum

Lower 1st +2nd molars
Buccal space Pterygomandibular
space
Submandibular space molar

Lower 3 rd molar
Pterygomandibular space
Submandibular space Lateral
pharyngeal space
Retropharyngeal space Superior
mediastinum

 Complications of odontogenic
infections

1- Ludwig's angina
Ludwig's angina is
bilateral, brawny,
induration of the
submandibular,
sublingual, and
submental spaces.

Ludwig’s angina with bilateral involvement
of sublingual and submandibular spaces

 The principles of treatment of
Ludwig's angina are early diagnosis,
surgical intervention, and definitive
airway management.
 After securing an airway, surgical
drainage of each individual space
should begin even before fluctuance
becomes palpable externally.

Clinical Presentation. The middle
third of the tongue is elevated
towards the palate, while the
anterior portion projects out
of the mouth.The posterior
portion displaces the
edematous epiglottis
posteriorly, resulting in
obstruction of the airway.

The incisions must be bilateral,
extraoral, parallel, and medial to the
inferior border of the mandible, at
the premolar and molar region , and
intraoral, parallel to the ducts of the
submandibular glands.

2- Cavernous sinus thrombosis
It is an uncommon but potentially lethal
extension of odontogenic infection.
An orofacial infection can reach the
cavernous sinus through two routes: an
anterior route via the angular and inferior
ophthalmic veins, and a posterior route via
the transverse facial vein and the pterygoid

. Cavernous sinus thrombosis
The first clinical signs of cavernous sinus
thrombosis include vascular congestion in
periorbital, scleral, and retinal veins.
Other clinical signs include periorbital edema,
proptosis, thrombosis of the retinal vein, ptosis,
dilated pupils, absent corneal reflex, and
supraorbital sensory deficits.

3- Cervicofacial necrotizing
fasciitis?
 Cervicofacial necrotizing fasciitis is a very aggressive
infection of the skin and superficial fascia of the head and
neck and is commonly seen in diabetic and
immunocompromised patients.
 It carries a mortality rate of 30%-50% from sepsis of the
dead tissue in the affected area.

Necrotizing
fasciitis. Large
granulating skin
defect
extending from
the inferior
border of the
mandible to the
clavicle, 2
weeks
After
débridement.

Infection okkkkkkkk

More Related Content

What's hot

Similar to Infection okkkkkkkk

Recently uploaded

Infection okkkkkkkk

Editor's Notes