Odontogenic infections (4)

ODONTOGENIC INFECTIONS

Prepared by:Dr. Rea Corpuz

(1) Cellulitis

(2) Ludwig’s Angina

(3) Cavernous Sinus Thrombosis

(4) Osteomyelitis

Odontogenic Infections

if abscess is NOT able to establish drainage through the surface of skin or into oral cavity

may spread diffusely through facial planes of soft tissue

acute + edematous spread of acute inflammatory process

(1) Cellulitis

two dangerous forms:

Ludwig’s Angina

Cavernous Sinus Thrombosis

(1) Cellulitis

named after German physician who described the seriousness of disorder in 1836

Angina comes from Latin word angere

strangle


70% of cases, develop from spread of an acute infection from lower molar teeth

prevalence in patients who are immunocompromised secondary to disorders such as:

diabetes mellitus organ transplantation acquired immunodeficiency syndrome (AIDS) aplastic anemia


Clinical Features

massive swelling on neck

often extends close to clavicle

involvement of sublingual space results in

• elevation Woody Tongue• posterior enlargement can compromise• protrusion of tongue airway


Clinical Features

involvement of submandibular space results in

• enlargement• tenderness of neck above level of hyoid bone Bull Neck• pain in neck + floor of mouth• restricted neck movement


Clinical Features

involvement of submandibular space results in

• dysphagia• dysphonia• dysarthria• drooling• sore throat


Clinical Features

involvement of lateral pharyngeal space

• respiratory obstruction secondary to laryngeal edema

• tachypnea• dyspnea• tachycardia• patient needs to maintain erect position


Treatment & Prognosis

centers around 4 activities

• maintenance of airway• incision + drainage• antibiotic therapy• elimination of original focus

of inflammation



initial observation many clinicians administer

• systemic corticosteroid medications such as intravenous (IV) dexamethasone

attempt to reduce cellulitis



if signs or symptoms of impending airway obstruction:

• fiber-optic nasotracheal intubation

• tracheostomy

• cricothyroidotomy



if signs or symptoms of impending airway obstruction:


sometimes performed instead of tracheostomy

perceived lower risk of spreading infection to mediastinum



high dose of penicillin penicillin-

Clindamycin OR sensitive Choramphenicol patients

anitbiotic medication is adjusted according to patient’s response + culture result from aspirates of fluid from enlargement



if infection remains:

diffuse surgical intervention indurated is at discretion of clinician brawny + often governed by patient’s

response to noninvasive therapy



complications:

• Pericarditis• Pneumonia• Mediastinitis• Sepsis• Empyema• Respiratory Obstruction


edematous periorbital enlargement

with involvement of eyelids + conjunctiva


in cases, involving canine space

swelling along lateral border of nose

may extend up to medial aspect of eye + periorbital area

protrusion + fixation of eyeball



induration + swelling of adjacent forehead + nose

pupil dilation lacrimation may also photophobia occur loss of vision



pain over eye + along distribution of:

• opthalmic Trigeminal • maxillary branches Nerve



surgical drainage + high-dose antibiotic medication similar to those administered for patient’s with Ludwig’s Angina


an acute or chronic inflammatory process in extends

medullary spaces OR away from cortical surfaces of bone initial site of

involvement

(4) Osteomyelitis

caused by bacterial infections

result in expanding lytic destruction of involved bone

with suppuration sequestra formation

(4) Osteomyelitis

patients of all ages can be affected

strong male predominance

most cases involves mandible

(4) Osteomyelitis

Acute Supporative Osteomyelitis

Chronic Suppporative Osteomyelitis

(4) Osteomyelitis

acute inflammatory process spreads through medullary spaces of bone

insufficient time has passed for body to react to presence of inflammatory infiltrate

(4) Osteomyelitis (Acute Supporative Osteomyelitis)

Clinical Features

symptoms of acute inflammatory process less than1 month in duration

fever

leukocytosis


Clinical Features

lymphadenopathy

soft tissue swelling of affected area

on occasion, paresthesia of lower lip


Histopathologic Features

biopsy material from patients

• liquid content• lack of soft tissue component• consist predominantly of necrotic bone


Histopathologic Features

necrotic bone

• loss of osteocytes• peripheral resorption• bacterial colonization• acute inflammatory infiltrate

consists of polymorphonuclear leukocytes


Radiographic Features

ill- defined radioluscency

periosteal new bone formation may be seen

• response to subperiosteal spread of infection

• proliferations more common in young patients



periosteal new bone formation may be seen

• single-layered radioopaque line

• separated from normal cortex by an intervening radiolucent band



on occasion, exfoliation of fragments of necrotic bone

fragment of necrotic bone that has separated from adjacent vital bone is teremed sequestrum



on occasion, fragments of necrotic bone may become surrounded by new vital bone, known as involucrum


Treatment

if obvious abscess formation,

• antibiotics penicillin clindamycin cephalexin cefotaxime gentamicin

• drainage


defensive response leads to production of granulation tissue

subsequent forms dense scar tissue

• attempt to wall off infected area

(4) Osteomyelitis (Chronic Supporative Osteomyelitis)

subsequent forms dense scar tissue

• encircled dead space acts as reservoir for bacteria

• antibiotic medications have great difficulty reaching the site


Clinical Features

if acute osteomyelitis is not resolved expeditiously

entrenchment of chronic osteomyelitis occurs

sometimes may arise without previous acute episode


Clinical Features

swelling pain sinus formation purulent discharge sequestrum formation tooth loss pathologic fracture


Clinical Features

may experience acute exacerbations or periods of decreased pain associated with chronic smoldering progression


Histophathologic Features

biopsy material from patient

• soft tissue component• consists of chronically or subacutely inflammed connective tissue filling the intertrabecular areas of bone• scattered sequestra + pockets of abscess formation



patchy ragged ill-defined radiolucency

• often contains central radiopaque sequestra


Treatment

difficult to manage medically

• pockets of dead bone• organisms are protected from antibiotic drugs

due to surrounding wall of fibrous connective tissue


Treatment

surgical intervention is mandatory

antibiotic medications are similar to those used in acute form

• but must be given intravenously in high doses


References:References: BooksBooks

Neville, et. al: Oral and Maxillofacial PathologyNeville, et. al: Oral and Maxillofacial Pathology 33rdrd Edition Edition

• (pages 138-144) (pages 138-144)

Odontogenic infections (4)

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