Transcript Non odontogenic inflammation diseases

Inflammatory disease of
maxillofacial area (odontogenic and
non odontogenic).
CLASSIFICATION OF INFLAMMATORY PROCESSES OF
MFA. PERIOSTITIS, OSTEOMYELITIS, ABSCESS,
PLEGMONAS: ETIOLOGY, PATHOGENESIS, CLINICAL
COURSE OF, COMPLICATIONS, PROPHYLAXIS.
Course of maxillofacial surgery and stomatology of Tashkent
Medical Academy, associate professor Sh.A.Boymuradov
Table of Content

Overview
General symptoms of inflammation
Clinical manifestations of inflammation
Differential diagnosis
Causes
Spectrum of bacterial therapy
Prevalence of different abscesses
Classification of abscesses
Overview

Inflammation is a defence reaction of the
organism to local injuries of any type, to
infection.
Infection is a pathological state resulting from
the invasion of the body by pathogenic
microorganisms and their proliferation within
the organism.
Inflammation diseases
Non
odontogenic
Odontogenic
Non odontogenic inflammation
diseases





1. Fufuruncle
2. Anthrex
3. erysipelas
4. Sibir canker
5. Noma (gangrenuos stomstitis)
Non-odontogenic causes of soft tissue
infections






Infected fracture
Infected soft tissue wounds or tumors
Infection by foreign bodies
Infection after injection
Inflammatory of skin or mucosal membrane
disorders
Haematogeneous or lymphogeneious spreading
Furuncle (inflammation of
pileous follicle)
Anthrex (inflammation a lot of
pileous follicle)
Complication of furuncle of the
face: Tromboflibitis of vein
Facial vassels
Triangle of the death
Odontogenic inflammation disesases
of the face





1. Acute odontogenic periostitis
2. Acute osteomyelitis of jaws
3. Odontogenic abcsesses
4. Odontogenic phlegmonas
5. Odontogenic lymfadinitis
Odontogenic centre of the
inflammation
Classic signs of acute infection
appear





Heat
Redness
Tumor (oedema)
Loss of function (trismus, difficult to swollow
speech)
Additional: leucocytosis and CRP increasis

CRP (C-reactive protein) is synthesised in the liver.
It is one of the chemical mediators of inflammation and its
serum level increases faster and to higher levels than that of any
other parameters in acute infectious and non-infectious
inflammation.

Therefore, CRP belongs to the group of acute-phase proteins.
These are blood lipids the concentration of which increases in
the course of inflammatory diseases.

CRP binds to invading foreign substances and activates
important steps of the immune system with macrophages and
the complement system. Due to its relatively short half-life of 24
hours, changes in CRP concentration indicate changes in the
inflammatory process.
Odontogenic chronic
inflammation centre
Inflammation centre
The clinical picture of acute
periostitis of the jaws.






1.Presence of causal teeth
2. Smoothness of a transitive fold
3. Fluctuation of a transitive fold
4. Painful percussion of causal tooth
Increases of temperature up to 38 гр
Dysfunctions: opening of a mouth, chewing,
speech, swallowing.
Acute odontogenic periostitis
Tipes of osteomyelitis of the jaw on
the pelationship of causes



1. Odontogenig osteomylitis
2. Traumatic osteomylitis
3. Hematogen osteomylitits
Development infections from a
top of a root of a tooth
The theory of progress of
osteomylitis of jaws



1. The infectious-embolic theory
Infringements innervation of jaws
The theory a sensitization
The mechanism of progress of an
infection
Stages of current of an osteomyelitis
of jaws



1. Acute
2. under acute
3. chronic
Clinical picture of a acute
osteomyelitis






1 Looseness of a causal tooth
Infringement of function: opening of a mouth,
chewing, speeches and swallowing
Mobility of a several teeth
Smoothness of a transitive fold from two sides.
Rise in temperature of a body up to 41 гр.
Fever
Acute necrotic osteomyelitis
Treatment of osteomyelitis of
laws







Elimination of cause (causal teeth extraction)
Incision
discharge of pus
Spreading of the abcsses cavity
Osteoperforation of injure bone
drainage of the pus cavity
Facultative antibiotic treatment
Types of abscesses and phlegmonas



1. Superficial located
2. middle deep located
3. deep located
Abscess




submucous abscess, smooth vestibule
Localized collection of pus an a cavity caused by
necrosis of tissue due to bacterial infection
Demarcation by abscess mambrane (granulation
tissue)
Firm elastic consestence
Fluctuation can be palpated only in superficial
abscesses
Odontogenic abscesses
Oedema


Oedematous swelling of the ocular region in
abscess of the canine fossa concomitant
oedema of the upper lip in submucous abscess
in region 11 accumulation of fluid in tissue
classic sign of any acute inflammation (tumour)
soft and elastic on palpation. Due to the
anatomical situation in the maxillofacial region,
the typical fluctuation of an abscess is absent in
the majority of cases or only rarely identifiable
Differential diagnosis of
abcsesses


swelling caused by neoplasms (sarcomas,
malignant lymphomas, carcinomas)
salivary gland diseases
Inflammation more 2 anatomical region
(phlegmonas)
Phlegmon (cellulitis)






diffusely spreading inflammation between
superficial tissue levels (without being limited to
them)
No demarcation
infection by highly virulent bacteria (release of
lytic enzymes)
impaired defence mechanisms of the organism
serous-purulent and necrotising inflammation
serous-purulent and necrotising inflammation
firm to hard on palpation
Several phlegmonas submandibular and
parapharigial region
Odontogenic causes of soft tissue
infections






In 92-94% of the cases, infections in the oromaxillofacial region are of odontogenic origin
Periapical periodontitis
Infection after teeth extraction
difficult dentition (pericoronitis)
Marginal priodontitis
infected retained root fragments
Phlegmona of infrairbital region
CT ckanner of inflammation
diseases
Orbital phlegmonas
Orbital pflegmona
Anaerobic flora



Odontogenic infections are always caused by a
mixed flora of aerobic and anaerobic bacteria.
The count of anaerobic bacteria always
outnumbers that of aerobic bacteria (at least by
102).
Pure anaerobic mixed infections also occur.
Anaerobic bacteria play a predominant role in
the generation and spreading of odontogenic
soft tissue infections. Infection by clostridia as
well as mixed infections by yeasts and bacteria
may occur
Several phlegmona of flor of mouse
(ludvig angina)
Therapy

The following statement that Galen made
almost 2,000 years ago - "ubi pus, ibi evacua" (if
there is pus, remove it) which is still valid in the
era of antibiotics could be considered the clinical
conclusion from the abscess pathophysiology
explained above. Therefore, incision and
drainage are the primary therapy of an
phlegmonas



Incision of an abscess is advisable, possibly by a
sufficiently wide incision at the maximum point
of the swelling.
Obtain sufficient discharge of pus with the
incision. Prepare for drainage of the purulent
exudate
In smaller abscesses, it is usually sufficient to
insert a Iodoform gauze packing strip for 2-3
days; extensive abscess cavities are drained
through a tube that is fixed in place with sutures



rinsing of the abscess
Culture and antibiotic sensitivity testing
Antibiotics for parenteral therapy
Infections are classified as mild, moderate or
severe infections.
Differential surgical and antibiotic treatment is
indicated according to the extension tendency
and severity grade of infection as well as the
general condition of the patient.
Health teeth, no complication
Thank you for attention