This document discusses various odontogenic infections including cellulitis, Ludwig's angina, cavernous sinus thrombosis, and osteomyelitis. Ludwig's angina is described in detail, including its clinical features such as massive neck swelling and potential airway obstruction. Treatment involves maintaining the airway, incision and drainage, high dose antibiotics, and eliminating the original source of infection. Chronic and recurrent cases may require surgical intervention. Cavernous sinus thrombosis and osteomyelitis are also summarized briefly.

1. ODONTOGENIC
INFECTIONS
Prepared by:
Dr. Rea Corpuz

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

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

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

8. (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

16.  Treatment & Prognosis
• cricothyroidotomy
(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

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

20.  edematous periorbital
enlargement
 with involvement of eyelids +
conjunctiva
(3) Cavernous Sinus
Thrombosis

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

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

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

40. (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)

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

47.  Radiographic Features
(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)

50. References:References:
 BooksBooks
Neville, et. al: Oral and Maxillofacial PathologyNeville, et. al: Oral and Maxillofacial Pathology
33rdrd
EditionEdition
• (pages 138-144)(pages 138-144)