Odontogenic infection in maxillofacial region

1. Odontogenic infection in maxillofacial region กลุ่มงานทันตกรรม รพ.วานรนิวาส

2. Infection in oral and maxillofacial region Odontogenic infection Necrotizing facciitis, frequently odontogenic source Osteomyelitis Osteoradionecrosis Bisphosphonate-relaedosteonecrosis Salivary grand infection Fungal & viral infection

3. Odontogenic infection

4. Dental infection => space infection

5. Dental infection => space infection

6. Host Anatomical factor Microbial factor

9. Severityscore= 1 Subperiosteal abscess

10. Low severity Severityscore= 1 Vestibular abscess

11. Low severity Severityscore= 1 Canine space abscess ระวังPeriorbital!!!

12. Low severity Severityscore= 1 Buccal space abscess

13. Severityscore= 2 Submasseteric space Pterygomandibular space Temporal space Limited mouth opening ( 1cm)

14. Severityscore= 2 Submental space infection Submandibular space abscess

15. Ludwig’s angina Involvement submandibular spaces bilaterally ,submentalspace,sublingual Rapid spread to lateral pharyngeal / retropharyngeal space Rapidly obstruct upper airway

16. Severityscore= 3

17. Severityscore= 4 Danger space, Mediasternum

18. The most frequent cause of death in reported cases of odontogenic infection is Airway Obstraction Clinical apparent partial air way obstruction with lowO2sat => secure airway

19. Management of odontogenic infection Step 1.Determine the severity of infection ---Anatomical location ---Rate of progression : Inoculation,Cellulitis,Abscess ---Air way compromise

20. DM* Steroid therapy Organ transplants Malignancy Chemotherapy Chronic renal failure* Malnutrition Alcoholism End-stage AIDS Step 2. Evaluated host defend

21. Step 3.Decide on setting care • -Refer > Severe score 2 • IPD : score 1, mild score 2 • fever, dehydration, control host disease • OPD : mild score 1-2 • follow up in *few days • (7 days may be too long)

22. Step 4.Treat surgically Mild root canal treatment or Tooth extraction ? Surgical drain (intraoral or extraoral) --If drain inserted, drains should be discontinued when drainage cease <72hrs --Irrigate with NSS daily

23. Stage of Infection

24. Early incision and drainage aborts the spread of infection into deeper and more critical anatomic space, even when it is in the cellulitis stage Williams and Guralnick N Engl J med 1943 Flyn TR, AAOMS 1999 แต่ถ้าแก่มากๆหรือในเด็กถ้าไม่ได้บวมมากก็สามารถชะลอไปก่อนได้

26. Step 5. support medically Control fever& adequate hydration

27. Step 6. Choose antibiotic therapy Usual Odontogenic infection : 70%= gram(+)cocci :Streptococus sp. 30% = anaerobic : gram (-) rod , Bacteroid sp, prevotella, prophyromonas, fusobacterium, Klebsiella Step 7.Administer the antibiotics

28. Usual Odontogenic infection

29. In thailand รพ.ศูนย์ต่างๆพบว่าการรักษาคนไข้ในประเทศไทย IV FOR ODONTOGENIC INFECTION 1st line drug : PGS + Metronidazole or 1st gen cephalosporin+MetronidazoleกรณีมีStaphlylococus(skin) เก็บclindamycinไว้กรณี severe infection

33. Culture& sensitivity testing Expensive&timeconsumimg!! Can be dalayedfor as mush as 2 weeks When dealing with Unusual Infection **subjected to multiple course of antibiotics DM : Klebsiellapneumoniae HIV/AIDS :Mycobacteria IV Drug abusers : Staphylococusaureus Gram stain?cheap screen!!

34. Step 8.Evaluated the patient frequenly No fever 1-2 days, การบวมลดลง, การปวดลดลง,รับประทานข้าวได้ เปลี่ยนเป็นยากินและ D/S ได้ นัด F/U

35. Step 1.Determine the severity of infection • Step 2. Evaluated host defend • Step 3.Decide on setting care • Step 4.Treat surgically • Step 5. support medically • Step 6. Choose antibiotic therapy • Step 7.Administer the antibiotics • Step 8.Evaluated the patient frequenly