Dr Shuja Presentation
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Transcript of Dr Shuja Presentation
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ODONTOGENICINFECTIONS OF THE
MAXILLO FACIAL &
NECK REGION
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ETIOLOGY
1. Pulp disease.
2. Periodontal disease.
3. Secondarily infected cysts or odontomes.
4. Remaining root fragment.
5. Residual infection.
6. Pericoronal infection.
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Bacteriology
Aerobic 7% G +ve Cocci ( Strep, Staph) & G-ve cocci (Neisseria)
G +ve rods (Corny ) & G-ve rods
Anaerobic 33% G +ve Cocci ( Strep, Pseudo strep) & G-ve
cocci(veiollonela)
G +ve rods (Lacto, Actino ) & G-ve rods (Bacteriodes)
Mixed 60%
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TYPES
ACUTE
In the acute stage infection may remain intrabony or spread into soft tissues in
following clinical forms:1. Abscess:
1.Circumscribed collection of pus in a pathologicaltissue space.
2.Thick walled cavity containing pus.
3.Aerobes & anaerobes--- large accumulation ofpus--- pointing & drainage.
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AbscessAbscess
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2. Cellulitis:
1.This is spreading infection of loose CT.
1.It is a diffuse, erythematous, mucosal or cutaneous
infection.
2.It is result of streptococci & does not result in large
accumulation of pus.
3.Streptococci produce streptokinase, hyaluronidase.
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3.Fulminating infections:
1.Spread of infection in various primary spaces in the
orofacial region.
2.Here secondary spaces along the pathway of least
resistance are involved.
3.Spread of deep cervical spaces and beyond.
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Acute Peri Apical Abscess1
This is due to vascular dilatation, an exudate of
neutrophil leucocytes & oedema in the peri apical
region.
It is due to persistent irritation from chronic pulpor acute virulent infection, or less host
resistance.
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Etiology Acute Peri Apical Abscess
Infective necrosis of pulp
Caries.
Traumatic exposure.
Traumatic necrosis
Blow on teeth.Mechanical &
Chemical
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CLINICAL FEATURESAcute Peri Apical Abscess
1- History of previous pulpitis.
2- Carious or heavily filled tooth.
3- Tender and felt extruded in socket.
4- When pus has formed severethrobbing
pain5- sensitive to percussion.
6- Over lying gum may or may not be
swollen
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TREATMENTAcute Peri Apical Abscess
Antibiotics ,Analgesics & Drainage through
pulp chamber.
Extraction or endodontic treatment.
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Acute Dento Alveolar Abscess
When pus does not remain confined to the peri
apical region.
It perforates the cortex and comes to lie under
periosteum--- SUB PERIOSTEAL ABSCESS.
The perforating abscess come into the soft tissues
then called as ACUTE DENTOALVEOLAR ABSCESS
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CLINICAL FEATURESAcute Dento Alveolar Abscess
Pain depend on the stage of disease.
Sub mucosal swelling (Intra Oral).
Facial swelling (extra Oral).
Fluctuation may come after few days.
If untreated may point or burst producing adischarging sinus.
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Radiographic featuresAcute Dento Alveolar Abscess
Little informative in acute phase except
little widening of periodontal ligament.
But previous pathology if present will be
seen.
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Treatment
Acute Dento Alveolar Abscess
Same i.e. endo- or ext-.
Intra or extra oral drainage
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CHRONIC PERI APICAL
PERIODONTITIS1
When the irritation in the peri apicaltissues persists either due to, incomplete resolution
In complete treatment of acute periodontitis orpulpitis leading to necrotic pulp
a forgotten blow or massive fillings orunsuccessful R.C.T lead to chronic
periodontitis. This goes on painlessly and become
chronic
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Skin Sinus Due Chronic infectionSkin Sinus Due Chronic infection
from deciduous molarfrom deciduous molar
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FACIAL SPACE INFECTIONFACIAL SPACE INFECTION
Fascialined areas-- potential spaces thatdo not exist in healthy persons.
Filled by pus or exudation during infection.
Neurovascular structure - compartments.
Loose areolar CT------ Clefts
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Primary facial spacesPrimary facial spaces
Primary spaces are adjacent to tooth bearing
area & are directly involved by infection.
Primary maxillary spaces.
Canine Buccal
Infratemporal.
Primary mandibular spaces. Submental.
Buccal.
Submandibular.
Sublingual.
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Secondary spacesSecondary spaces
MASTICATORY SPACES
Masseteric.
Pterygomandibular.
Superficial & deep temporal.
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CERVICAL SPACES
Lateral pharyngeal
Retropharyngeal
Prevertebral
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High Risk Infections or LethalHigh Risk Infections or Lethal
complicationscomplications
Orbital & peri orbital cellulitis.
Cavernous sinus thrombosis
Ludwigs angina
Cervical cellulitis ( Lung Abscess &
Mediastinitis)
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Orbital & Periorbital cellulitisOrbital & Periorbital cellulitis
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Cavernous Sinus ThrombosisCavernous Sinus Thrombosis
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LUDWIG S ANGINALUDWIG S ANGINA
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Cervical CellulitisCervical Cellulitis
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Principles of managementPrinciples of management
Determine the severity of infection
Evaluate the state of patients host defensemechanism
Determine , whether treated by GDP or refer tospecialist
Appropriate antibiotic & their properadministration
Treat infection surgically
Diet & i-v fluids
Evaluate pts frequently
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Surgical ManagementSurgical Management
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