The document discusses several serious head and neck infections including Ludwig's angina, cavernous sinus thrombosis, and osteomyelitis. It describes the causes, signs and symptoms, and treatments for each condition. It also provides details on antimicrobial agents used to treat orofacial infections.
The document discusses several serious head and neck infections including Ludwig's angina, cavernous sinus thrombosis, and osteomyelitis. It describes the causes, signs and symptoms, and treatments for each condition. It also provides details on antimicrobial agents used to treat orofacial infections.
The document discusses several serious head and neck infections including Ludwig's angina, cavernous sinus thrombosis, and osteomyelitis. It describes the causes, signs and symptoms, and treatments for each condition. It also provides details on antimicrobial agents used to treat orofacial infections.
The document discusses several serious head and neck infections including Ludwig's angina, cavernous sinus thrombosis, and osteomyelitis. It describes the causes, signs and symptoms, and treatments for each condition. It also provides details on antimicrobial agents used to treat orofacial infections.
Ludwig`s Angina It is a life threatening condition involving spaces bilaterally Submandibular Submental Sublingual
Signs & Symptoms
1. Tense , brawny and tender swelling limited to suprahyoid region of the neck 2. Edema , induration , tenderness and elevation of the floor of the mouth 3. Protrusion of the tongue 4. Difficulty in speech 5. Respiratory difficulties as a result of congestion of the floor of the mouth , posterior pressure on the pharynx and edema of the m.m of the larynx and epiglottis 6. Patient is cyanotic
Etiology 1. Dentoalveolar infection 2. Penetrating injury of the floor of the mouth e.g gunshot wound 3. Osteomyleitis of the mandible 4. Compound fracture 5. Submandibular S.G sialoadenitis
Treatment 1. Hospitalization is a must 2. Antibiotics & analgesics IV 3. Adequate fluid intake 4. Heat application (↑ blood supply to localize infection) 5. Crico-thyroidotomy ( Tracheostomy ) 6. I & D (through and through: drain from submental/submandibular bilaterally to provide complete pathway for pus drainage)
Tracheostomy
9 Cavernous sinus thrombosis A blood clot in the cavernous sinus (in middle cranial fosa) The cause of cavernous sinus thrombosis is usually a bacterial infection that has spread from the sinuses, ears, eyes, nose, or skin of the face. This emissary vein connects the cavernous sinus and the pterygoid plexus
Structures passing inside the C.S
1. Cranial nerve III 2. Cranial nerve IV 3. Cranial nerve V (ophthalmic & maxillary) 4. Cranial nerve VI 5. Internal carotid artery
Symptoms 1. Bulging eyeballs 2. Cannot move the eye in a particular direction 3. Drooping eyelids 4. Vision loss 5. Bluish discoloration around eye
10 Osteomyelitis Inflammation of bone and bone marrow i.e osteoid and myeloid tissues
Incidence: Mandible > Maxilla because of Etiology
1- Blood supply 1. Odontogenic infection 2- Characteristics of bone 2. Compound fractures 3. Infected cyst or tumor 4. Haematogenous Pathogenesis
Sequestrum It is the separated dead bone Involucrum It is the new bone surrounding the sequestrum (not calcified yet)
Classification ( Types ) 1. Acute Suppurative 2. Subacute (Pyogenic) 3. Chronic 1. Focal sclerosing Non suppurative 2. Diffuse sclerosing (Sclerosing) 3. Chronic sclerosing with proliferative periostitis ( Garre`s osteomyelitis ) Specific infectious - T.B, Syphilis, Actinomycosis osteomyelitis - Thermal (e.g no coolent during cutting) Osteomyelitis due - Chemical (e.g chemotherapy, sodium hypochlorite) to specific etiology - Physical ( Osteo-radio-necrosis)
BRONG (bisphosphonate related osteonecrosis of the jaw)
- Bisphosphonates are a group of drugs that work by slowing bone loss used to treat and prevent osteoporosis or, bone thinning which occurs when the bones lose calcium and other minerals that help keep them strong and compact. - BRONG occur with the mandible (more bone deposition in the mandible (already compact bony jaw) lead to more decrease in blood supply) eventually end by jaw necrosis and fracture
11 Suppurative osteomyelitis Acute suppurative osteomyelitis Chronic suppurative osteomyelitis 1. Pain and Swelling 2. Loosening of the teeth 1. Mild pain and swelling Signs & 3. Pus oozing around the neck of the teeth 2. Fistula formation Symptoms 4. General constitutional symptoms 5. Lymphadenitis 6. Foul odor and salty taste Radioopaque area surrounded by radiolucent area and completely Radiographic Acute stage is (- Ve ) in X ray separated from the bone picture (worm eaten or moth eaten appearance ) Involucrum is represented as radio- opaque margin around the sequestrum
Acute suppurative osteomyelitis
Complications Rare but include: Pathological fracture Extensive bone destruction. Chronic osteomyelitis Inadequate treatment. Cellulitis Spread of virulent bacteria. Septicemia Immuno-compromised patient.
Management Essential Adjunctive treatment 1. Bacterial sampling and culture 1. Sequestrectomy. 2. Emperical antibiotic treatment. 2. Decortication (if necessary to ↑ blood 3. Drainage supply) 4. Analgesics. 3. Hyperbaric oxygen. 5. Specific antibiotics based on culture & sensitivity. 4. Resection & reconstruction for extensive 6. Debridement. bone destruction. 7. Remove source of infection, if possible
- Localized areas of bone sclerosis. - Bony reaction to low-grade peri-apical infection or unusually strong host defensive response. - Association with an area of inflammation is critical. - Radiology Localized but uniform increased radio-density related to tooth. Widened periodontal ligament space or peri-apical area. Sometimes an adjacent radiolucent inflammatory lesion may be present. Increased areas of radio-density surrounding apices of non-vital mandibular first molar
12 Chronic sclerosing osteomyelitis with proliferative periostitis “Garre`s osteomyelitis” - A rare chronic inflammatory form of osteomyelitis is disease resulting in thickening of cortices with loss of medullary canal without any signs of active infection (asymptomatic without any signs of local inflammation) - Radiographically Is characterized by the presence of lamellae of newly formed periosteal bone outside the cortex, giving the characteristic appearance of "onion skin" (thickened bone)
Treatment of osteomyelitis General Treatment 1. Hospitalization 2. High dose of antibiotics 3. Culture and sensitivity test 4. General supportive care of patient with acute infection
Antimicrobial agents useful for oro-facial infections
Drug Mechanism Use
drug of choice for treatment of odontogenic infections Penicillin Bactericidal ⚠ (5 % incidence of allergy ) Slightly broader spectrum Cephalosporin Bactericidal ⚠ Cautious use in penicillin-allergic patients (cross sensitivity) Metronidazole Bactericidal Excellent against anaerobes only - First choice for treatment of odontogenic infections after penicillin Clindamycin Bacteriostatic - Effective against anaerobes - Stop taking if signs of diarrhea are developed Erythromycin Bacteriostatic The drug of choice in penicillin allergic patients
How to write the prescription
R / Name of the antibiotic Dosage Form How many times per day & the duration R / Augmentin 1000 mg tab Every 12 hours for 4 days R / Ampiclox 500 mg cap Every 8 hours for 5 days
