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Infection in Oral & Maxillofacial Region

Infection in Oral & Maxillofacial Region. Pandect. Yu Chuang-Qi. Infection--- in oral & maxillofacial region. Pandect. Infection Conception Trait Anatomy Arising Route Mutation Influence factors Diagnosis Principles Treatment Principles. Infection---conception.

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Infection in Oral & Maxillofacial Region

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  1. Infection inOral & Maxillofacial Region Pandect Yu Chuang-Qi

  2. Infection--- inoral & maxillofacial region Pandect • Infection Conception • Trait Anatomy • Arising Route • Mutation Influence factors • Diagnosis Principles • Treatment Principles

  3. Infection---conception Infectious agent(bacteria) Host Inflammatory reaction protective and defensive Beneficial Elimination the infectious pathogen Repair tissue injury Harmful Hypersensitivity Autoimmune disease

  4. Trait of anatomy • Oral and nasal cavity • Tooth • Space • Blood and Lymphoid system • Bacteria

  5. Temperature + Moisture (Beneficial) Reproduction + Developing Trait of anatomy • Oral and nasal cavity • Maxillary sinus(上颌窦) Bacteria---Exist

  6. Trait of anatomy Tooth Caries Pulpitis Apical infection Alveolar bone Soft tissue Fascial space

  7. Trait of anatomy Fascial space(间隙)---loose connective tissue Among skin, maxillary and muscle • Purulent--- spreading way • Do not exist in healthy state • Become filling during infection

  8. Trait of anatomy Blood and lymphoid system Beneficial Abundance Harmful Encephalic infection • Dangerous triangle • Lacking valves • Cavernous sinus Cavernous sinus thrombosis

  9. Varied Numerous Streptococcus hemolyticus (溶血性链球菌) Staphylococcus aureus (金黄色葡萄球菌) Escherichia coli (大肠杆菌) Anaerobe (厌氧菌) Trait of pathogenic bacterium Flora(菌丛) • Sterile • Simple • Complex

  10. Route of infection • Odontogenic infection • Adenogenous(腺源性) infection • Traumatic infection • Hematogenous(血源性) infection • Iatrogenic(医源性) infection

  11. Odontogenic infection • Periapical infection • Pericoronitis(冠周炎)

  12. Fistular(瘘) Septicemia(败血症) Acute-chronic Periapical infection Cellulitis (蜂窝织炎) Deep fascial space infection Intraoral soft tissue abscess (脓肿) Osteomyelitis (骨髓炎) Ascending facial-cerebral infection Periapical infection

  13. Pathways of Periapical infection

  14. Pericoronitis (冠周炎) Lower third molar

  15. Infection---Arising • Host--- defense system • Microbe---virulence quantity • Local circumstance Balance Imbalance Scale

  16. Mutation • Influence factors • Changing directions

  17. Influence factors • Host--- defense system • Microbe---virulence quantity • Treatment strategy

  18. Changing directions • Localization and recovery • Acute chronic • Diffusion Blood system---Septicemia lymphoid system---Lymphadenopathy From submandible space infection to chest region

  19. How to diagnose? • Local Signs and Symptoms • Systemical Signs and Symptoms Signs and Symptoms

  20. Local Signs and Symptoms • Pain • Swelling • Surface erythema • Pus formation • Limitation of motion Locally

  21. Systemical Signs and Symptoms • Fever • Lymphadenopathy • Malaise • Toxic appearance • Elevated white blood cell count

  22. How to treat? • Acute stage • Chronic stage

  23. Acute stage • Host • Antibiotic therapy • Surgical drainage and incision

  24. Migration of white blood cell Production of antibodies Most important factor --- final outcome The infections--- cured by the host, not by antibiotics Host Defense Mechanisms Critical Principles

  25. Principles for choosing appropriate antibiotic • causative organism(致病菌) • sensitivity • specific, narrow-spectrum antibiotic • least toxic antibiotic • drug history(success, allergic and toxic) Antibiotic era

  26. Principles of antibiotic administration • Proper dose • Proper time interval • Proper route of administration(oral, parenteral) • Combination antibiotic therapy

  27. Surgical drainage and incision • How to judge the pus formation? • Purposes of surgical drainage and incision • Principles of surgical drainage and incision

  28. Three stages Inoculation Cellulitis Abscess Duration--- >5 days Palpation---Fluctuant Appearance---Reddened Needle aspiration B-ultrasound CT How to judge the pus formation? Characteristic

  29. Fluctuant examination

  30. Purposes of surgical drainage & incision • Rid the body of toxic purulent material • Decompress the tissues • Allowing better perfusion of blood containing antibiotics and defensive elements • Increased oxygenation of the infected area

  31. Infection in masseteric space

  32. Infection in multi-space Ludwig’s angina

  33. Principles of surgical drainage & incision • Place the incision in an esthetically acceptable • Place the incision in a dependent position to encourage drainage by gravity • Dissect bluntly through deeper tissues and explore all portions of the abscess • Place a drain and stabilize it with sutures

  34. Principles of surgical drainage & incision

  35. Chronic stage Surgical removal of the focus(病灶) • Lesion tooth---Impacted tooth • Osteomyelitis

  36. Conclusion Infection in oral & maxillo-facial region • The trait of Infection • Odontogenic infection • mutation of infectious • Diagnosis of the infection • Diagnosis of the abscess formation • The principles of the treatment

  37. Thank you

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