Transcript Infection in Oral & Maxillofacial Region Yu Chuang

Infection in
Oral & Maxillofacial
Region
Pandect
Yu Chuang-Qi
Infection--- in
oral & maxillofacial region
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Infection
Trait
Arising
Mutation
Diagnosis
Treatment
Pandect
Conception
Anatomy
Route
Influence factors
Principles
Principles
Infection---conception
Infectious agent(bacteria)
Host
Inflammatory reaction
protective and defensive
Beneficial
Elimination the infectious pathogen
Repair tissue injury
Harmful
Hypersensitivity
Autoimmune disease
Trait of anatomy
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Oral and nasal cavity
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Tooth
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Space
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Blood and Lymphoid system
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Bacteria
Trait of anatomy
Bacteria---Exist
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Oral and nasal cavity
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Maxillary sinus(上颌窦)
Temperature + Moisture
(Beneficial)
Reproduction + Developing
Trait of anatomy
Tooth
Caries
Alveolar bone
Pulpitis
Soft tissue
Apical
infection
Fascial space
Trait of anatomy
Fascial space(间隙)---loose connective tissue
Among skin, maxillary and muscle
•Purulent--- spreading way
•Do not exist in healthy state
•Become filling during infection
Trait of anatomy
Blood and lymphoid system
Beneficial
Abundance
Harmful
Encephalic infection
Dangerous triangle
•Lacking valves
•Cavernous sinus
Cavernous sinus thrombosis
Trait of pathogenic bacterium
Flora(菌丛)
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Varied
Numerous
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• Sterile
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• Simple
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• Complex
Streptococcus hemolyticus
(溶血性链球菌)
Staphylococcus aureus
(金黄色葡萄球菌)
Escherichia coli
(大肠杆菌)
Anaerobe
(厌氧菌)
Route of infection
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Odontogenic infection
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Adenogenous(腺源性) infection
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Traumatic infection
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Hematogenous(血源性) infection
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Iatrogenic(医源性) infection
Odontogenic infection
• Periapical infection
• Pericoronitis(冠周炎)
Periapical infection
Fistular(瘘)
Cellulitis
(蜂窝织炎)
Intraoral soft
tissue abscess
(脓肿)
Septicemia(败血症)
Acute-chronic
Periapical infection
Deep fascial
space infection
Osteomyelitis
Ascending facialcerebral infection
(骨髓炎)
Pathways of Periapical infection
Pericoronitis (冠周炎)
Lower third molar
Infection---Arising
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Host--- defense system
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Microbe---virulence
quantity
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Local circumstance
Balance
Imbalance
Scale
Mutation
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Influence factors
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Changing directions
Influence factors
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Host--- defense system
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Microbe---virulence
quantity
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Treatment strategy
Changing directions
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Localization and recovery
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Acute
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Diffusion
chronic
Blood system---Septicemia
lymphoid system---Lymphadenopathy
From submandible space
infection to chest region
How to diagnose?
Signs and Symptoms
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Local Signs and Symptoms
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Systemical Signs and Symptoms
Local Signs and Symptoms
Locally
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Pain
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Swelling
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Surface erythema
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Pus formation
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Limitation of motion
Systemical Signs and Symptoms
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Fever
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Lymphadenopathy
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Malaise
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Toxic appearance
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Elevated white blood cell count
How to treat?
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Acute stage
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Chronic stage
Acute stage
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Host
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Antibiotic therapy
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Surgical drainage and incision
Host
Defense Mechanisms
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Migration of white blood cell
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Production of antibodies
Critical Principles
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Most important factor --- final outcome
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The infections--- cured by the host, not by antibiotics
Principles for choosing appropriate antibiotic
Antibiotic era
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causative organism(致病菌)
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sensitivity
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specific, narrow-spectrum antibiotic
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least toxic antibiotic
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drug history(success, allergic and toxic)
Principles of antibiotic administration
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Proper dose
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Proper time interval
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Proper route of administration(oral, parenteral)
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Combination antibiotic therapy
Surgical drainage and incision
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How to judge the pus formation?
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Purposes of surgical drainage and incision
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Principles of surgical drainage and incision
How to judge the pus formation?
Characteristic
Three stages
Inoculation
Cellulitis
Abscess
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Duration--- >5 days
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Palpation---Fluctuant
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Appearance---Reddened
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Needle aspiration
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B-ultrasound
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CT
Fluctuant examination
Purposes of surgical drainage & incision
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Rid the body of toxic purulent material
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Decompress the tissues
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Allowing better perfusion of blood containing antibiotics
and defensive elements
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Increased oxygenation of the infected area
Infection in masseteric space
Infection in multi-space
Ludwig’s angina
Principles of surgical drainage & incision
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Place the incision in an esthetically acceptable
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Place the incision in a dependent position to
encourage drainage by gravity
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Dissect bluntly through deeper tissues and explore all
portions of the abscess
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Place a drain and stabilize it with sutures
Principles of surgical drainage & incision
Chronic stage
Surgical removal of the focus(病灶)
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Lesion tooth---Impacted tooth
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Osteomyelitis
Conclusion
Infection in oral & maxillo-facial region
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The trait of Infection
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Odontogenic infection
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mutation of infectious
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Diagnosis of the infection
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Diagnosis of the abscess formation
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The principles of the treatment
Thank you