02.space infections clinical features & treatment
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Transcript of 02.space infections clinical features & treatment
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SPACE INFECTIONSCLINICAL FEATURES & TREATMENT
Dr V.RAMKUMAR
CONSULTANT DENTAL&FACIOMAXILLARY SURGEON
REG N0:4118-TAMILNADU-INDIA(ASIA)
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POTENTIAL SPACES FOR INFECTION
1. Vestibular abscess
2. Buccal space
3. Palatal abscess
4. Sublingual space
5. Submandibular space
6. Maxillary sinus
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BUCCINATOR & ODONTOGENIC INFECTION
In maxilla Above the attachment
Root apex Extraoral
Below the
attachment
Intraoral swelling
(In Mandible it is vice versa)
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MYLOHYOID & ODONTOGENIC INFECTIONS
Anteriors Posteriors
(Root apex below) (Root apex below)
Intraoral Extraoral
(Floor of the mouth) (submandibular)
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SUBLINGUAL SPACE
SUBMANDIBULAR SPACE
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SUBMASSETRIC SPACE(MASSETER & ODONTOGENIC INFECTION)
3- Layers (superficial, middle and deep)
Infection spreads between these three layers
Swelling less, pain is more
(Infection is usually caused by impacted mandibular, pulpally or periodontally involved third molars)
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PTERYGOMANDIBULAR SPACE
Prime muscles of mastication
Infection
Trismus
(usually because of impacted tooth and contaminated injection in to the space)
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TEMPORAL SPACE
(Superficial and Deep Temporal space
with Buccal space)
Dumb-bell shaped swelling
Trismus(usually through PSA nerve blocks, infection from maxillary
molars, spread of infection from other spaces)
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HIGHWAY TO DANGER
• Pterygoid plexus
• Lincon’s highway
• Multispace infections
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THE DANGER ZONES
• Cavernous sinus thrombosis
• Ludwig’s Angina (Multispace infection)
• Mediastinitis
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ROOT CAUSE FOR DANGER
• Brain infection
• Respiratory obstruction
• Descending neck infection (mediastinitis, pericarditis)
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LUDWIG’S ANGINA
(Sublingual, Submental and Sub mandibular space infection)
Swelling in the floor of the mouth
Lifting of the tongue
Obstruction of airway
Creating an emergency situation
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Ludwig’s AnginaMaintain Airway
(Tracheostomy)
Control Infection
Medically Surgically
(Systemic Antibiotics) (Tube Drain)
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CAVERNOUS SINUS THROMBOSIS
Pterygoid plexus
Infraorbital fissure
Terminal part of inferior ophthalmic vein
Superior orbital fissure
Cavernous sinus(Thrombosis)
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MANAGEMENT
Antibiotic crossing blood brain barrier
(Chloramphenicol, Ciprofloxacin)
Anticoagulant therapy
(To prevent venous thrombosis)
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RETROPHARYNGEAL SPACE
Retropharyngeal space
Danger space(space between the alar and prevertebral layer
of the deep cervical fascia)
Mediastinitis/ Carotid sheath infection(FATAL)
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MANAGEMENT
Incision and Drainage (along the anterior border of he sternocleidomastoid muscle
at the level of the hyoid bone and the middle third respectively)
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DESCENDING NECK INFECTION
Superficial Deep
Mediastinitis Acute necrotizing fascitis (malnourished & immuno-
compromised patients)
Pericarditis
(Stridor - fatal)
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MANAGEMENT
DESCENDING NECK INFECTION
Acute necrotizing fascitis Deep
Control infection
(Appropriate systemic antibiotics)
Debridement, local antibiotic dressing, reconstruction of the necrosed skin with graft or flap
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If retropharyngeal space is involved, posterosuperior mediastinum may also become infected secondarily. If prevertebral space is infected, the inferior boundary is diaphragm, so entire mediastinum is at risk.
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TREATMENT OF SPACE INFECTION
• Empirical antibiotic therapy• Incision and Drainage• Culture and Sensitivity• Appropriate antibiotic therapy• Removal of the cause (teeth if odontogenic)• Supportive therapy• Physiotherapy (to improve mouth opening)
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INCISION & DRAINAGE (Principle & Technique)
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PRINCIPLE OF ANTIBIOTIC THERAPY
• Identification of causative organism• Determination of antibiotic sensitivity• Use of specific narrow spectrum antibiotic• Use of least toxic antibiotic• Patient drug history• Use of bactericidal rather than bacteriostatic drug
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PRINCIPLE OF ANTIBIOTIC ADMINISTRATION
• Proper dosage• Proper time interval• Proper route of administration• Combination antibiotic therapy• Patient monitoring
– Response to treatment– Development of adverse reaction– Superinfection and recurrent infection
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THERAPEUTIC USE OF ANTIBIOTICS IN MAXILLOFACIAL INFECTION
• Penicillin– Acute dentoalveolar abscess– Cellulitis– Acute pericoronitis
• Osteomyelitis– Culture sensitivity– Antibiotic therapy is for longer period
• Infected soft tissue wounds– Wound debridement with topical antibiotic– Amoxycillin with clavulanic acid– Metronidazole for anaerobic infection
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THANK YOU