CRANIOFACIAL & SKULL BASE

SURGERY

DENVER, COLORADO

K. K. CHOWDHURY MD, MBA, FRCSC

CHOWDHURY MD, MBA, FRCSC

Complications of Odontogenic and

Head & Neck Infections

K. CHOWDHURY MD, MBA, FRCSC

Center for Craniofacial & Skull Base DisordersDenver, Colorado

Complications of Odontogenic and

Head & Neck Infections

Complications Arise From:

❖ Odontogenic infections

❖ Pharyngeal infections

❖ Sinus infections

❖ Orbital Infections

❖ Temporal Bone and Ear infections

Complications of Odontogenic and

Head & Neck Infections

Complications of Odontogenic and

Head & Neck Infections

Complications of Odontogenic and

Head & Neck Infections

How Does Infection Spread?

1) Local or Direct extension

• Adjacent SPACES…………………to Deep Neck Spaces

• Osteitis…………………………….to OSTEOMYELITIS

Complications of Odontogenic and

Head & Neck Infections

How Does Infection Spread?

1) Local or Direct extension

Complications of Odontogenic and

Head & Neck Infections

How Does Infection Spread?

1) Local or Direct extension

• OSTEOMYELITIS

Complications of Odontogenic and

Head & Neck Infections

How Does Infection Spread?

2) LYMPHATIC

• Lymphadenopathy - common

• Suppurative Lymphadenitis…….communicate with

Deep Neck Spaces!!

Complications of Odontogenic and

Head & Neck Infections

How Does Infection Spread?

2) LYMPHATIC

Complications of Odontogenic and

Head & Neck Infections

How Does Infection Spread?

3) VENOUS or Septic Thrombo-phlebitis

• Direct or indirect…….example: Jugular vein thrombosis

• Septicemia

• Midface and Maxilla:

--Veins are valve less!!

--Drain intracranially

(via ophthalmic and pterygoid venous systems!!)

Complications of Odontogenic and

Head & Neck Infections

How Does Infection Spread?

3) VENOUS or Septic Thrombo-phlebitis

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACE ANATOMY & INFECTIONS

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACE ANATOMY & INFECTIONS

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACE ANATOMY & INFECTIONS

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACE ANATOMY & INFECTIONS

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACE ANATOMY & INFECTIONS

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACE ANATOMY & INFECTIONS

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACE ANATOMY & INFECTIONS

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACES

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACE INFECTIONS

Complications of Odontogenic and

Head & Neck Infections

DEEP NECK SPACE INFECTIONS

Complications of Odontogenic and

Head & Neck Infections

Clinical Presentation

Complications of Odontogenic and

Head & Neck Infections

Clinical Presentation

Complications of Odontogenic and

Head & Neck Infections

IMAGING

Complications of Odontogenic and

Head & Neck Infections

IMAGING

Complications of Odontogenic and

Head & Neck Infections

IMAGING

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT

❖ Prevention of Complications from Odontogenic Infections is the best and gold standard

❖ Early Odontogenic infections should be treated promptly with appropriate antibiotics +/- drainage as needed

❖ Uncontrolled odontogenic infections resulting in complications …………..significant morbidity and mortality(pre-antibiotic era)

❖ Complications from Head & Neck/Odontogenic infections are less common in post antibiotic era…..do not under estimate morbidity!

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT

❖ When Complications occur: prompt recognition, early diagnosis, and aggressive treatment………..minimize morbidity and mortality !❖ These Patients are toxic and very ill.

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT PROBLEMS

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT PROBLEMS

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT PROBLEMS

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT PROBLEMS

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT - LUDWIG’S ANGINA (Submandibular & Submental)

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT - LUDWIG’S ANGINA (Submandibular & Submental)

❖ > 50 % mortality (airway & sepsis) 1900-1935!!

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT - LUDWIG’S ANGINA (Submandibular & Submental)

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT - LUDWIG’S ANGINA (Submandibular & Submental)

Complications of Odontogenic and

Head & Neck Infections

INTRACRANIAL COMPLICATIONS

❖ Meningitis

❖ Osteomyelitis

❖ Subdural Empyema

❖ Brain Abscess

❖ Cavernous Sinus Thrombosis

Complications of Odontogenic and

Head & Neck Infections

INTRACRANIAL COMPLICATIONS

Complications of Odontogenic and

Head & Neck Infections

INTRACRANIAL COMPLICATIONS

Cavernous Sinus Thrombosis

Complications of Odontogenic and

Head & Neck Infections

INTRACRANIAL COMPLICATIONS

Cavernous Sinus Thrombosis

Complications of Odontogenic and

Head & Neck Infections

INTRACRANIAL COMPLICATIONS

Cavernous Sinus Thrombosis

Complications of Odontogenic and

Head & Neck Infections

INTRACRANIAL COMPLICATIONS

Complications of Odontogenic and

Head & Neck Infections

Craniofacial & Skull Base Surgery

Craniofacial & Skull Base Surgery

Complications of Odontogenic and

Head & Neck Infections

Complications of Odontogenic and

Head & Neck Infections

MANAGEMENT