LECTURELECTURE

Spread infections in maxillofacial Spread infections in maxillofacial area. Abscesses and phlegmons area. Abscesses and phlegmons of maxillofacial area: reasons of of maxillofacial area: reasons of

origin, classification, main origin, classification, main symptoms, diagnostics, symptoms, diagnostics,

treatment. treatment.

IInflammation may spread nflammation may spread in three ways:in three ways:

1. By continuity through tissue 1. By continuity through tissue spaces and planes.spaces and planes.

2. By way of the lymphatic 2. By way of the lymphatic system.system.

3. By way of blood circulation.3. By way of blood circulation.

Most Common Teeth andMost Common Teeth and Associated Associated Periodontium Involved in Clinical Presentations of Periodontium Involved in Clinical Presentations of

Abscesses and FistulaeAbscesses and Fistulae..Maxillary vestibuleMaxillary vestibuleMaxillary central or lateral incisor, all surfaces, and roots.Maxillary central or lateral incisor, all surfaces, and roots.Maxillary canine, all surfaces, and roots (short roots below levator anguli oris).Maxillary canine, all surfaces, and roots (short roots below levator anguli oris).Maxillary premolars, buccal surfaces, and roots.Maxillary premolars, buccal surfaces, and roots.Maxillary molars, buccal surfaces, or buccal roots (short roots below buccinator).Maxillary molars, buccal surfaces, or buccal roots (short roots below buccinator).Penetration of nasal floorPenetration of nasal floorMaxillary central incisor, roots.Maxillary central incisor, roots.Maxillary canine, all surfaces, and root (long root above levator anguli oris).Maxillary canine, all surfaces, and root (long root above levator anguli oris).PalatePalateMaxillary lateral incisor, lingual surfaces, and roots. Maxillary premolars, lingual Maxillary lateral incisor, lingual surfaces, and roots. Maxillary premolars, lingual surfaces, and roots. Maxillary molars, lingual surfaces, or palatal roots.surfaces, and roots. Maxillary molars, lingual surfaces, or palatal roots.Perforation Into maxillary sinusPerforation Into maxillary sinusMaxillary molars, buccal surfaces, and buccal roots (long roots). Maxillary molars, Maxillary molars, buccal surfaces, and buccal roots (long roots). Maxillary molars, buccal surfaces, and buccal roots (long roots above buccinator). Mandibular first buccal surfaces, and buccal roots (long roots above buccinator). Mandibular first and second molars, buccal surfaces, and buccal roots (long roots below and second molars, buccal surfaces, and buccal roots (long roots below buccinator).buccinator).Mandibular vestibuleMandibular vestibuleMandibular incisors, all surfaces, and roots (short roots above mentalis).Mandibular incisors, all surfaces, and roots (short roots above mentalis).Mandibular canine and premolars, all surfaces, and roots (all roots aboveMandibular canine and premolars, all surfaces, and roots (all roots abovedepressors).depressors).Mandibular first and second molars, buccal surfaces, and roots (short rootsMandibular first and second molars, buccal surfaces, and roots (short rootsabove buccinator).above buccinator).Submental skin regionSubmental skin regionMandibular incisors, roots (long roots below mentalis).Mandibular incisors, roots (long roots below mentalis).Sublingual regionSublingual regionMandibular first molar, lingual surfaces, and roots (all roots above mylohyoid). Mandibular first molar, lingual surfaces, and roots (all roots above mylohyoid). Mandibular second molar, lingual surfaces, and roots (short roots above Mandibular second molar, lingual surfaces, and roots (short roots above mylohyoid).mylohyoid).Submandibular skin regionSubmandibular skin regionMandibular second molar, lingual surfaces, and roots (long roots below Mandibular second molar, lingual surfaces, and roots (long roots below mylohyoid). Mandibular third molars, all surfaces, and roots (all roots below mylohyoid). Mandibular third molars, all surfaces, and roots (all roots below mylohyoid).mylohyoid).

Possible Space.Possible Space. Teeth, and Periodontium Involved With a Clinical Teeth, and Periodontium Involved With a Clinical

Presentation of Phlegmon from the Spread of Dental InfectionPresentation of Phlegmon from the Spread of Dental Infection..

SPREAD BY SPACESSPREAD BY SPACES

The spaces of the head and neck can allow The spaces of the head and neck can allow the spread of infection from the teeth and the spread of infection from the teeth and associated oral tissues because the associated oral tissues because the pathogens can travel within the fascial pathogens can travel within the fascial planes, from one space near the infected planes, from one space near the infected site to another distant space, by the site to another distant space, by the spread of the related inflammatory spread of the related inflammatory exudateexudate. . When involved in infections, the When involved in infections, the space can undergo phlegmon or abscess, space can undergo phlegmon or abscess, which can cause a change in the normal which can cause a change in the normal proportions of the face. proportions of the face.

Frontal section of the head and neck highlighting the Frontal section of the head and neck highlighting the

submandibular and sublingual spaces.submandibular and sublingual spaces.

SPREAD BY LYMPHATICSSPREAD BY LYMPHATICS

The lymphatics of the head and neck can The lymphatics of the head and neck can allow the spread of infection from the allow the spread of infection from the teeth and associated oral tissues. This teeth and associated oral tissues. This occurs because the pathogens can travel occurs because the pathogens can travel in the lymph through the lymphatics that in the lymph through the lymphatics that connect the series of nodes from the oral connect the series of nodes from the oral cavity to other tissues or organs. Thus, cavity to other tissues or organs. Thus, these pathogens can move from a primary these pathogens can move from a primary node near the infected site to a secondary node near the infected site to a secondary node at a distant site .node at a distant site .

Superficial cervical lymph nodes Superficial cervical lymph nodes and associated structures.and associated structures.

Deep cervical lymph nodes and Deep cervical lymph nodes and associated structures.associated structures.

SPREAD BY THE BLOOD SPREAD BY THE BLOOD SYSTEMSYSTEM

The blood system of the head and neck The blood system of the head and neck can allow the spread of infection from can allow the spread of infection from the teeth and associated oral tissues, the teeth and associated oral tissues, because pathogens can travel in the because pathogens can travel in the veins and drain the infected oral site into veins and drain the infected oral site into other tissues or organs. The spread of other tissues or organs. The spread of dental infection bydental infection by way of the blood way of the blood system can occur from bacteremia or an system can occur from bacteremia or an infected thrombus. infected thrombus.

Pathways of the internal jugular vein and facial Pathways of the internal jugular vein and facial vein, as well as the location of the cavernous vein, as well as the location of the cavernous

venous sinus.venous sinus.

SPREAD TO THE PARANASAL SPREAD TO THE PARANASAL SINUSESSINUSES

The paranasal sinuses of the skull can The paranasal sinuses of the skull can become infected through the direct spread become infected through the direct spread of infection from the teeth and associated of infection from the teeth and associated oral tissues, resulting in a secondary oral tissues, resulting in a secondary sinusitis. A perforation in the wall of the sinusitis. A perforation in the wall of the sinus can also be caused by an infection. sinus can also be caused by an infection. Secondary sinusitis of dental origin occurs Secondary sinusitis of dental origin occurs mainly with the maxillary sinuses, since the mainly with the maxillary sinuses, since the maxillary posterior teeth and associated maxillary posterior teeth and associated tissues are in close proximity to these tissues are in close proximity to these sinusessinuses..

Lateral view of the skull and the Lateral view of the skull and the paranasal sinuses.paranasal sinuses.

DDental abscess ental abscess An abscess is a collection of pus. An abscess is a collection of pus. Pus is a thick fluid that usually Pus is a thick fluid that usually

contains white blood cells, dead contains white blood cells, dead tissue and bacteria (germs). The tissue and bacteria (germs). The usual cause of an abscess is an usual cause of an abscess is an infection with bacteria. A dental infection with bacteria. A dental

abscess is an infection in the abscess is an infection in the centre of a tooth which spreads centre of a tooth which spreads

through the tooth to infect through the tooth to infect supporting bone and other supporting bone and other

nearby tissues. Dental abscess is nearby tissues. Dental abscess is common. It may develop as a common. It may develop as a complication of tooth decay complication of tooth decay

(caries), or from an infection in (caries), or from an infection in the gums.the gums.

CAUSESCAUSESThe cause of these infections is direct growth of the The cause of these infections is direct growth of the bacteria from an existing cavity into thebacteria from an existing cavity into the soft tissuessoft tissues

and bones of the face and neck.and bones of the face and neck.

An infected tooth that has not received An infected tooth that has not received appropriate dental care can cause a dental appropriate dental care can cause a dental abscess to form. Poor oral hygiene, (such abscess to form. Poor oral hygiene, (such as not brushing and flossing properly or as not brushing and flossing properly or often enough) can cause cavities to form often enough) can cause cavities to form in your teeth. The infection then may in your teeth. The infection then may spread to the gums and adjacent areas spread to the gums and adjacent areas and become a painful dental abscess. and become a painful dental abscess.

Classification abscesses and Classification abscesses and phlegmons of maxillofacial area:phlegmons of maxillofacial area:

1.Abscesses and phlegmons of the 1.Abscesses and phlegmons of the maxilla region.maxilla region.

2.Abscesses and phlegmons of the 2.Abscesses and phlegmons of the mandible region.mandible region.

3.Abscesses and phlegmons of the 3.Abscesses and phlegmons of the bottom oral cavity.bottom oral cavity.

4.Abscesses and phlegmons of the 4.Abscesses and phlegmons of the tongue and of the neck. tongue and of the neck.

Symptoms of a dental abscess Symptoms of a dental abscess includeinclude::

Pain (toothache) which can quickly become Pain (toothache) which can quickly become worse. It can be severe and throbbing. worse. It can be severe and throbbing.

Swelling of the gum which can be tender. Swelling of the gum which can be tender. Swelling of the face. The skin over an abscess Swelling of the face. The skin over an abscess

may become red and inflamed. may become red and inflamed. The affected tooth may become tender to touch, The affected tooth may become tender to touch,

and may even become loose. and may even become loose. High temperature and feeling generally unwell. High temperature and feeling generally unwell. In severe cases there may be spasm of the jaw In severe cases there may be spasm of the jaw

muscles with difficulty swallowing and/or muscles with difficulty swallowing and/or breathing. breathing.

PHYSICIAN DIAGNOSISPHYSICIAN DIAGNOSIS

A doctor or dentist can determine by A doctor or dentist can determine by physical examination if you have a physical examination if you have a drainable abscess. X-rays of the teeth drainable abscess. X-rays of the teeth may be necessary to show small may be necessary to show small abscesses that are at the deepest part abscesses that are at the deepest part of the tooth. Signs observed by the of the tooth. Signs observed by the doctor, including nausea, vomiting, doctor, including nausea, vomiting, fever, chills, or diarrhea, may indicate fever, chills, or diarrhea, may indicate that the infection has progressed to the that the infection has progressed to the point where it is making your whole point where it is making your whole body sick. body sick.

PHYSICIAN TREATMENTPHYSICIAN TREATMENT

The doctor may decide to cut open the The doctor may decide to cut open the abscess and allow the pus to drain. Unless abscess and allow the pus to drain. Unless the abscess ruptures on its own, this is the the abscess ruptures on its own, this is the only way that the infection can be cured. only way that the infection can be cured. People with dental abscesses are typically People with dental abscesses are typically prescribed pain relievers and, at the prescribed pain relievers and, at the discretion of the doctor, antibiotics to fight discretion of the doctor, antibiotics to fight the infection. An abscess that has extended the infection. An abscess that has extended to the floor of the mouth or to the neck may to the floor of the mouth or to the neck may need to be drained in the operating room need to be drained in the operating room under anesthesia. under anesthesia.

Directions of cuts during treatment of Directions of cuts during treatment of purulent processes in maxillofacial area.purulent processes in maxillofacial area.

Directions of cuts during treatment of Directions of cuts during treatment of purulent processes in maxillofacial area.purulent processes in maxillofacial area.

PPrognosisrognosis If treated, the outlook is good. The pus If treated, the outlook is good. The pus

can usually be drained and thecan usually be drained and the tooth can be tooth can be saved if it is not badly broken down.saved if it is not badly broken down.

If left untreated, complications may If left untreated, complications may develop which can include:develop which can include:

Spread of infection Spread of infection The abscess may 'burst' onto the skin of the face, The abscess may 'burst' onto the skin of the face,

or into the mouth. This may leave a sinus tract (a or into the mouth. This may leave a sinus tract (a channel) between a persistent focus of infection channel) between a persistent focus of infection and the skin or mouth which can discharge pus and the skin or mouth which can discharge pus from time to time. from time to time.

Cavernous sinus thrombosis - a serious infection Cavernous sinus thrombosis - a serious infection and clotting of a blood vessel in the brain. and clotting of a blood vessel in the brain.

Sinusitis - spread of infection to the nearby sinus Sinusitis - spread of infection to the nearby sinus in the face bone. in the face bone.

A dental cyst (fluid filled cavity) may develop. A dental cyst (fluid filled cavity) may develop.