Transcript Deep space infections of the neck and floor of mouth

Abscesses, phlegmons of the MFA: definition,
classification, etiology, pathogenesis, clinical
features, principles of treatment, complications,
prevention.
Etiological and pathogenetical principles treatment
of inflammatory processes of the MFA.
Lymphadenitis of the MFA, etiology, pathogenesis,
clinical features, diagnosis, treatment and
prevention.
Furuncles and carbuncles of the MFA: etiology,
pathogenesis, clinical course, treatment.
• An abscess is a localized collection of pus
in part of the body, formed by tissue
disintegration and surrounded by an
inflamed area, collection of pus
(neutrophils) that has accumulated within
a tissue because of an inflammatory
process in response to either an infectious
process (usually caused by bacteria or
parasites) or other foreign materials (e.g.,
splinters, bullet wounds, or injecting
needles).
• Phlegmon is a spreading
diffuse inflammatory process
with formation of
suppurative/purulent exudate
or pus. This is the result of
acute purulent inflammation
which is due to bacterial
infection.
Potential pathways of extension of deep fascial space infections of the
head and neck
Fascial spaces around the mouth and face
Figure 69-4 Natural progression of dental infection. The pathways by which such infections may travel are: 1, postzygomatic (from canine fossa in cuspid and bicuspid
region; pterygomaxillary fossa communicates from rear); 2, vestibular; 3, facial; 4, submandibular; 5, sublingual; 6, palatal; 7, antral; 8, pterygomandibular; 9,
parapharyngeal; 10, masseteric. (Redrawn from Rose LF, Hendler BH, Amsterdam JT: Temporomandibular disorders and odontic infections. Consultant 22:125, 1982.)
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Early appearance of patient who has Ludwig’s angina with characteristic
submandibular ‘’woody’’ swelling
Anatomic relationships in submandibular infections
Routes of spread of odontogenic orofacial infections along planes of
least resistance
Early Ludwig's angina
Early Ludwig's angina
Figure 69-6 Extensive spread of infection of odontogenic origin involving masseteric, sublingual, submental, and
submandibular spaces with extension to mediastinum. A, Preoperative. B, Postoperative. Note drainage from
mediastinum. (From Guernsey LH: Practical problem solving in oral surgery. In Cohen DW [ed]: Continuing Dental
Education, vol 2, suppl 10. Philadelphia, University of Pennsylvania School of Dental Medicine, 1979.)
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Figure 69-6 Extensive spread of infection of odontogenic origin involving masseteric, sublingual, submental, and
submandibular spaces with extension to mediastinum. A, Preoperative. B, Postoperative. Note drainage from
mediastinum. (From Guernsey LH: Practical problem solving in oral surgery. In Cohen DW [ed]: Continuing Dental
Education, vol 2, suppl 10. Philadelphia, University of Pennsylvania School of Dental Medicine, 1979.)
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© 2007 Elsevier
Potential pathways of extension of deep fascial space infections of the
head and neck
Retropharyngeal abscess
Retropharyngeal space
Buccal Cellulitis (Hib)
Masticator space infection with trismus
Deep temporal space infection with spread to parotid space
The admission decision
• Airway issues
• High fever
• Dehydration
• Need for I+D
• Inpatient control systemic disease
• Immune compromise
Airway security
• Protect against aspiration
• ETT ruptures abscess
• Trismus / Swelling
• Maintain airway reflexes during intubation
Surgical treatment
• Gravity dependent surgical drainage
• Antibiotics secondary
• Tooth extraction
Antibiotic therapy
• Predominately anaerobic nature
• Initially: aerobic streptococci ( penicillin )
• Later: anaerobic bacteria ( penicillin resistant )
• Synergistic interaction
Mediastinitis
• Airway security
• Contrast CT
• Open thoracotomy
• Broad spectrum antibiotics
Cavernous sinus thrombosis
• Ascending septic thrombophlebitis
• Anterior route – angular vein (infraorbital space)
• Posterior route – facial vein (buccal space)
• Congestion retinal veins
• CN 6 paresis → ophthalmoplegia / blindness
• Severe orbital / periorbital / infraorbital swelling
Cavernous Sinus Thrombosis
• Treatment:
•
•
•
•
Tooth extraction root canal
Drainage deep spaces
High dose IV antibiotics
Anticoagulation
THE MAINS WAYS OF FLOWING LYMPH FROM
LOWER AND APPER LIPS
• Lymphadenitis is often a complication of a
bacterial infection of a wound, although it can
also be caused by viruses or other disease
agents. Lymphadenitis may be either
generalized, involving a number of lymph nodes;
or limited to a few nodes in the area of a
localized infection. Lymphadenitis is sometimes
accompanied by lymphangitis, which is the
inflammation of the lymphatic vessels that
connect the lymph nodes.
Causes
• Streptococcal and staphylococcal bacteria are the most
common causes of lymphadenitis, although viruses,
protozoa, rickettsiae, fungi, and the tuberculosis bacillus
can also infect the lymph nodes. Diseases or disorders
that involve lymph nodes in specific areas of the body
include rabbit fever (tularemia), cat-scratch disease,
lymphogranuloma venereum, chancroid, genital herpes,
infected acne, dental abscesses, and bubonic plague. In
children, tonsillitis or bacterial sore throats are the most
common causes of lymphadenitis in the neck area.
Diseases that involve lymph nodes throughout the body
include mononucleosis, cytomegalovirus infection,
toxoplasmosis, and brucellosis.
Physical examination
• The diagnosis of lymphadenitis is usually based
on a combination of the patient's history, the
external symptoms, and laboratory cultures. The
doctor will press (palpate) the affected lymph
nodes to see if they are sore or tender. Swollen
nodes without soreness are often caused by catscratch disease. In children, the doctor will need
to rule out mumps, tumors in the neck region,
and congenital cysts that resemble swollen
lymph nodes.
PALPATION OF SUBMANDIBLE
LYMPH NODES
PALPATION OF SUBMENTAL
LYMPH NODES
PALPATION OF RETROMANDIBLE
LYMPH NODES
CLINICAL CLASSIFICATION
OF LYMPHADENITIS
• -Acute: serous, purulent.
• -Chronic: hyperplastic, purulent.
Symptoms
•
Lymphadenitis is marked by swollen
lymph nodes that are painful, in most
cases, when the doctor touches them.
If the lymphadenitis is related to an
infected wound, the skin over the
nodes may be red and warm to the
touch.
Acute lymphadenitis
Chronic lymhadenitis
Operation of removed lymph nodes
attached chronical inflammation
Operation of removed lymph nodes
attached chronical inflammation
Removed lymph nodes
Treatment
• The medications given for lymphadenitis vary according
to the bacterium or virus that is causing it. If the patient
also has lymphangitis, he or she will be treated with
antibiotics, usually penicillin G (Pfizerpen, Pentids),
nafcillin (Nafcil, Unipen), or cephalosporins.
Erythromycin (Eryc, E-Mycin, Erythrocin) is given to
patients who are allergic to penicillin. Supportive care of
lymphadenitis includes resting the affected limb and
treating the area with hot moist compresses. Cellulitis
associated with lymphadenitis should be treated
surgically because of the risk of spreading the infection.
Pus is drained only if there is an abscess and usually
after the patient has been started on antibiotic treatment.
In some cases, a biopsy of an inflamed lymph node is
necessary if no diagnosis has been made and no
response to treatment has occurred.
A furuncle is an infection of a
hair follicle.
A carbuncle is a skin infection that
often involves a group of hair
follicles.
Risk factors
Although anyone — including otherwise healthy people —
can develop boils or carbuncles, the following factors can
increase your risk:
•
Poor general health. Having chronic poor health makes it harder for your
immune system to fight infections.
•
Diabetes. This disease can make it more difficult for your body to fight
infection, including bacterial infections of your skin.
•
Clothing that binds or chafes. The constant irritation from tight clothing
can cause breaks in your skin, making it easier for bacteria to enter your
body.
•
Other skin conditions. Because they damage your skin's protective
barrier, skin problems, such as acne and dermatitis, make you more
susceptible to boils and carbuncles.
•
Immune-suppressing medications. Long-term use of corticosteroids,
such as prednisone or other drugs that suppress your immune system, can
increase your risk.
FURUNCLE (the first stage of
development)
FURUNCLE (the second stage of
development)
Furuncle of face
Furuncle of face
Carbuncle of face
Carbuncle of the lower lip
Signs and symptoms
• A boil usually appears suddenly as a painful pink or red bump that's
generally not more than 1 inch in diameter. The surrounding skin
also may be red and swollen.
• Within a few days, the bump fills with pus. It grows larger and more
painful for about five to seven days, sometimes reaching golf ball
size before it develops a yellow-white tip that finally ruptures and
drains. Boils generally clear completely in about two weeks. Small
boils usually heal without scarring, but a large boil may leave a scar.
• A carbuncle is a cluster of boils that often occurs on the back of the
neck, shoulders or thighs, especially in older men. Carbuncles
cause a deeper and more severe infection than single boils do. In
addition, carbuncles develop and heal more slowly and are likely to
leave a scar. Carbuncles sometimes occur with a fever.
• Boils and carbuncles often resemble the inflamed, painful lumps
caused by cystic acne. But compared with acne cysts, boils are
usually redder or more inflamed around the border and more painful.
Treatment
Doctor may drain a large boil or carbuncle by
making a small incision in the tip. This relieves
pain, speeds recovery and helps lessen
scarring. Deep infections that can't be
completely cleared may be covered with sterile
gauze so that pus can continue to drain.
Sometimes doctor may prescribe antibiotics to
help heal severe or recurrent infections.
Self-care
The following measures may help the infection
heal more quickly and prevent it from spreading:
• Apply a warm washcloth or compress to the affected area. Do
this for at least 10 minutes every few hours. If possible, first soak the
cloth or compress in warm salt water. This helps the boil rupture and
drain more quickly. To make salt water, add 1 teaspoon of salt to 1
quart of boiling water and cool to a comfortable temperature.
• Gently wash the boil two to three times a day. After washing,
apply an over-the-counter antibiotic and cover with a bandage.
• Never squeeze or lance a boil. This can spread the infection.
• Wash your hands thoroughly after treating a boil. Also, launder
clothing, towels or compresses that have touched the infected area.
Prevention
Although it's not always possible to prevent
boils, especially if you have a compromised
immune system, the following measures may
help you avoid staph infections:
• Thoroughly clean even small cuts and
scrapes. Wash well with soap and water and
apply an over-the-counter antibiotic ointment.
• Avoid constricting clothing. Tight clothes may
be stylish, but make sure they don't chafe your
skin.
THANK YOU FOR
ATTENTION