1 / 55

Complex Odontogenic Infections

Complex Odontogenic Infections. Part 1. Topographical Anatomy. Connective Tissue. Types Areolar (or loose) connective tissue Dense connective tissue  Elastic tissue Reticular connective tissue  Adipose tissue . Fascia.

oral
Download Presentation

Complex Odontogenic Infections

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Complex Odontogenic Infections Part 1

  2. Topographical Anatomy

  3. Connective Tissue • Types • Areolar (or loose) connective tissue • Dense connective tissue  • Elastic tissue • Reticular connective tissue  • Adipose tissue 

  4. Fascia •  A sheet of connective tissue covering or binding together body structures • Types • Superficial Fascia • Deep Fascia

  5. Superficial Fascia • Muscles of facial expression • Continuous with superficial Cervical fascia http://media-2.web.britannica.com/eb-media/56/118356-004-EE793D60.jpg

  6. Deep Fascia- • Geography of Deep Fasica • Deep fascia of head and Neck

  7. Deep Fascia of Jaws • Muscles of Mastication • Temporal Fascia • Masseteric fascia • Parotidomasseteric fascia • Pterygoid fascia Continuous with Deep Fascia of Neck

  8. What are fascial spaces? • Fascia lined tissue compartments filled with loose, areolar connective tissue that can be inflamed when invaded with microorganisms. • Potential spaces • Loose areolar tissue within these spaces serve as cushion to adjacent muscles, vessels, nerves, glands • Allows movement

  9. Clinical Correlation

  10. Spaces of the Jaws • Deep Facial Spaces associated with any tooth • Vestibular • Subcutaneous • Buccal • Deep Facial Spaces associated with Maxillary teeth • Palatal • Infraorbital • Canine • Periorbital • Orbital • Cavernous Sinus • Deep Facial Spaces associated with Mandibular teeth • Space of the body of the mandible • Sublingual • Submandibular • Submental • Masticator • Submasseteric • Pterygomandibular • Superficial Temporal • Deep Temporal • Parotid

  11. Spaces • Vestibular- • potential space between oral vestibular mucosa and muscles of facial expression

  12. Palatal Space • Infected by lateral incisors and palatal roots • Subperiosteal space of the palate • C/F : Very painful swelling • (rich innervation of the periosteum)

  13. Palatal • Anatomic considerations • Greater Palatine artery • Greater palatine nerve • Minor salivary glands

  14. Infraorbital Space/ Canine space • Thin potential space between levator anguli Oris and levator labii superioris muscles. • Source of Infection : • Infections from Maxillary canines and bicuspids • Extension from buccal space • Skin infection from nose and upper lip

  15. Infraorbital Space/ Canine space • Signs and Symptoms • Cheek Swelling and Redness • Obliteration of the nasolabial fold • Edema of upper and lower eye lid • Tenderness and severe pain secondary to infra orbital nerve edema and inflammation • Abscess drains through the medial or lateral canthus of the eye • (levatorlabiisuperioris attaches along the center of the inferior orbital rim)

  16. Buccal Space • Portion of subcutaneous space • Contents: Buccal fat pad, stensen’s duct, facial artery • Borders • Anterior-Corner of the mouth • Posterior-Masseter muscle • Superior – Maxilla • Inferior –Mandible • Superficial -subcutaneous tissue • Deep-Buccinator muscle • Source of Infection • Infection from the upper and lower premolars and molars

  17. Buccal Space • Signs and symptoms • Cheek swelling (Below Zygomatic arch and above inf.border of Mandible) • Redness anterior to the masseter muscle • Can spread through subcutaneous tissues into the periorbital space • and past the inferior border of the mandible to the subcutaneous tissues lying superficial to the submandibular space.

  18. Buccal-space • Posteriorly communicates with the submasseteric space • Other communications • Pterygomandibular space • Infratemporal space (via pterygoid plexus) • Lateral pharyngeal space (via pterygomandibular raphe) • Superficial Temporal space (via buccal fat pad) • Subcutaneous spaces (superficial to submandibular space)

  19. Incision and Drainage • Drained percutaneously when fluctuance occurs • Drainage should be performed inferior to the point of fluctuance • Recurrent Buccal space infections can occur as a complication of crohn’s disease

  20. Cavernous Sinus Thrombosis • CS are bilateral venous drainage channels for the contents of the middle cranial fossa(esp. – Pitutary gland) • Anatomy: • Anteriorly-Bound by Sup.Orbital fissure • Receives a tributory Inf.Opthalmic vein • (orbital infections pass thru’ CS) • Drained by sup and Inf Opthalmic veins • Posteriorly-Trigeminal ganglion

  21. Cavernous Sinus Thrombosis • Maxillary OI erode the Infra Orbital vein in the infra orbital space or the Inf Opthalmic vein via the sinuses • Follow Common Opthalmic vein through the superior ophthalmic fissure • Extends to Cavernous Sinus • Resulting inflammation caused by invading bacteria • Stimulates the clotting pathways • CS thrombosis

  22. Cavernous Sinus Thrombosis • C/F: • Congestion of retinal veins of eye of unaffected side • Papilledema, retinal hemorrhages, and decreased visual acuity and blindness may occur from venous congestion within the retina. • Fever, tachycardia, sepsis may be present. • Headache with nuchal rigidity may occur.

  23. Cavernous Sinus Thrombosis • C/F: Congestion of retinal veins of eye of unaffected side • Papilledema, retinal hemorrhages, and decreased visual acuity and blindness may occur from venous congestion within the retina. • Fever, tachycardia, sepsis may be present. • Headache with nuchal rigidity may occur.

  24. Cavernous Sinus Thrombosis (C/F) • Pupil may be dilated and sluggishly reactive. • Infection can spread to contralateral cavernous sinus within 24–48 hr of initial presentation. • Cranial nerve most commonly affected is Abducens (VI) • Classic presentations are abrupt onset of • unilateral periorbital edema, • headache, • photophobia, • Proptosis

  25. Sublingual space • Defined superiorly by FOM mucosa and inferiorly by mylohyoid • Anterior/lateral-mandible • Medially-tongue and genioglossus • Posterior-superior, posterior, and medial portion of the submandibular space

  26. Sublingual Space • Sublingual space communicates with submandibular space around the posterior border of the mylohyoid. • Infections from sublingual space can pass through this gap and directly enter the lateral pharyngeal space

  27. Sublingual Space

  28. Sublingual Space-Clinical features • Brawny, erythematous, tender swelling, FOM • Begins close to mandible and extends to the midline • Elevation of the tongue (late cases) • DD: • Cellulitis • Sialolith of wharton’s duct

  29. Sublingual Space- Treatment • Place incision intraorally parallel to the wharton’s duct bilaterally • If submandibualr space is involved then both spaces can be reached through an extra oral submandibular approach

  30. Submental Space • Potential space in the chin • Infected either by Mandibular incisors or indirectly by the SM space • Submental-midline; bordered laterally by anterior digastrics • Superficial border-anterior layer of Deep Cervical Fascia, platysma, sup.fascia, skin • Contents: Filled with areolar CT, submental lymph nodes and anterior jugular veins

  31. Clinical Features-Submental Space • Chin appears grossly swollen • Firm , erythematous swelling • Chronic infection drains as a fistula from the submental region

  32. Submental space -treatment • Drainage-Achieved by percutaneous approach • Horizontal incision in the most inferior portion of the chin • Use natural skin crease • Cosmetically acceptable scar • Intra oral drainage • Through the mentalis muscle through labial vestibule

  33. Submandibular-Boundaries • Anterior/Posterior Borders-ant/post digastrics • Posterior boundary also includes stylohyoid muscle and middle/superior pharyngeal constrictors. • Superior border-inferior border and lingual surface of mandible below mylohyoid line. • Medial border-mylohyoid muscle which extends from mylohyoid line to the hyoid

  34. Submandibular • Communication to sublingual space around posterior border of mylohyoid (following path of submandibular gland and duct) • Contents • Gland/duct • Facial artery • Facial vein • lymph

  35. Submandibular space • Communication around posterior digastric leads to lateral pharyngeal; • Around anterior digastric leads to submental space

  36. Submandibular space • Separated from overlying sublingual space by mylohyoid muscle • Cause of infection : Mandibular second and third molars • Root apices of these teeth lie inferior to mylohyoid line of the muscle attachment

  37. Submandibular Space • Diagnosis: Brawny or soft swelling, correlate with offending tooth • May commonly cross the midline into the contralateral space • Treatment

  38. Ludwig’s Angina • Late seventeenth century extraction of abscessed teeth was considered dangerous • 3’F’s became evident: It was to be feared, it rarely became fluctuant, and it often was fatal (Topazian et al) • Definition: • Firm, acute, Toxic cellulitis of submandibular, and sublingual spaces bilaterally and of the submental space

  39. Clinical features as described by Wilhelm Friedrich von Ludwig.. In the late seventeenth century.. • Erysepalous angina • Temperature swings • Discomfort while swallowing • Develops on both sides

  40. Clinical features • Severe swelling • Elevation and displacement of tongue • Tense hard bilateral induration of submandibular region, superior to hyoid bone • Trismus • Drooling of Saliva • Inability to swallow • Infection progresses at an alarming speed to cause airway obstruction-Often leads to death

  41. Ludwig’s Angina • Secure airway • Prompt early aggressive I & D surgery • Antibiotic therapy

  42. Ludwig’s Angina-Treatment

  43. Masticator Space • Space is enclosed by the splitting of the anterior fascia around the muscles of mastication. • Infections affect discrete portions of the space • Submasseteric • Pterygomandibular • Superficial temporal • Deep temporal

  44. Masticator Space (Contd.) • Submasseteric • Lies between parotideomasseteric fascia and lateral surface of ascending ramus • Communicates with pterygomandibular space via the sigmoid notch • Openly communicates with the superficial temporal space deep to ZM arch

  45. Masticator Space (Contd.) • Source of Infection: • Molars esp.Third molars • Signs and Symptoms • Swelling of the face • Severe trismus • Dysphagia • Swelling of the retromolar triangle area

  46. Masticator Space (Contd.) • Infections result in significant trismus • Differentiate from parotid swellings because submasseteric infections obscure earlobe from frontal view whereas parotid swellings elevateit.

  47. Masticator Space (Contd.) • Pterygomandibular space-infections correlate with pericoronitis, needle tracts • Borders • Lateral-ascending ramus • Medial-medial pterygoid • Inferior-pterygomasseteric sling • Superior-lateral pterygoid • Posterior-parotid • Anterior-pterygomandibular raphe • Commonly communicates with lateral pharyngeal by passing around the anterior border of the medial pterygoid

More Related