(1) The document discusses various odontogenic infections including cellulitis, Ludwig's angina, cavernous sinus thrombosis, and osteomyelitis. (2) Ludwig's angina is a serious bacterial infection that causes massive swelling of the neck and floor of the mouth. It develops from a dental infection and can compromise the airway. (3) Treatment for these infections involves drainage of abscesses, high-dose antibiotics, and potentially surgical intervention to maintain the airway if it becomes obstructed.

1. ODONTOGENIC
INFECTIONS
Prepared by:
Dr. Rea Corpuz

2. Odontogenic Infections
 (1) Cellulitis
 (2) Ludwig’s Angina
 (3) Cavernous Sinus Thrombosis
 (4) Osteomyelitis

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

4. (1) Cellulitis
 two dangerous forms:
 Ludwig’s Angina
 Cavernous Sinus Thrombosis

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

8. (2) Ludwig’s Angina

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

16. (2) Ludwig’s Angina
 Treatment & Prognosis
• cricothyroidotomy

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

19. (2) Ludwig’s Angina
 Treatment & Prognosis
 complications:
• Pericarditis
• Pneumonia
• Mediastinitis
• Sepsis
• Empyema
• Respiratory Obstruction

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

28. (4) Osteomyelitis
 Acute Supporative
Osteomyelitis
 Chronic Suppporative
Osteomyelitis

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

38. (4) Osteomyelitis
(Acute Supporative Osteomyelitis)
 Treatment
 if obvious abscess formation,
• antibiotics
 penicillin
 clindamycin
 cephalexin
 cefotaxime
 gentamicin
• drainage

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

40. (4) Osteomyelitis
(Chronic Supporative Osteomyelitis)

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

43. (4) Osteomyelitis
(Chronic Supporative Osteomyelitis)
 Clinical Features
 swelling
 pain
 sinus formation
 purulent discharge
 sequestrum formation
 tooth loss
 pathologic fracture

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

50. References:
 Books
Neville, et. al: Oral and Maxillofacial Pathology
3rd Edition
• (pages 138-144)