Infection in Oral & Maxillofacial Region

Pandect

Yu Chuang-Qi

Infection--- in oral & maxillofacial region

Pandect

Infection Trait Arising Mutation Diagnosis Treatment

Conception Anatomy Route Influence factors Principles Principles

Infection---conception
Infectious agent(bacteria) Host

Inflammatory reaction protective and defensive Elimination the infectious pathogen

Beneficial Repair tissue injury

Harmful Hypersensitivity Autoimmune disease

Trait of anatomy

Oral and nasal cavity

Tooth Space Blood and Lymphoid system Bacteria

Trait of anatomy
Bacteria---Exist

Oral and nasal cavity Maxillary sinus()

Temperature + Moisture
(Beneficial) Reproduction + Developing

Trait of anatomy Tooth

Caries Alveolar bone

Pulpitis
Soft tissue Apical infection Fascial space

Trait of anatomy
Fascial space()---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()

Varied Numerous

Sterile

Simple

Complex

Streptococcus hemolyticus () Staphylococcus aureus () Escherichia coli () Anaerobe ()

Route of infection

Odontogenic infection

Adenogenous() infection
Traumatic infection

Hematogenous() infection
Iatrogenic() infection

Odontogenic infection

Periapical infection Pericoronitis()

Periapical infection
Fistular()
Acute-chronic Periapical infection Deep fascial space infection

Septicemia()

Cellulitis ()

Intraoral soft tissue abscess

Osteomyelitis ()

Ascending facialcerebral infection

()

Pathways of Periapical infection

Pericoronitis ()
Lower third molar

Infection---Arising

Host--- defense system Microbe---virulence quantity

Local circumstance
Balance Imbalance Scale

Mutation

Influence factors Changing directions

Influence factors

Host--- defense system Microbe---virulence

quantity

Treatment strategy

Changing directions

Localization and recovery Acute Diffusion chronic

Blood system---Septicemia
lymphoid system---Lymphadenopathy

From submandible space infection to chest region

How to diagnose?
Signs and Symptoms

Local Signs and Symptoms Systemical Signs and Symptoms

Local Signs and Symptoms

Locally

Pain

Swelling
Surface erythema Pus formation Limitation of motion

Systemical Signs and Symptoms

Fever Lymphadenopathy

Malaise
Toxic appearance Elevated white blood cell count

How to treat?

Acute stage Chronic stage

Acute stage

Host
Antibiotic therapy Surgical drainage and incision

Host
Defense Mechanisms

Migration of white blood cell Production of antibodies

Critical Principles

Most important factor --- final outcome The infections--- cured by the host, not by antibiotics

Principles for choosing appropriate antibiotic

causative organism() sensitivity

Antibiotic era

specific, narrow-spectrum antibiotic least toxic antibiotic

drug history(success, allergic and toxic)

Principles of antibiotic administration

Proper dose Proper time interval Proper route of administration(oral, parenteral) Combination antibiotic therapy

Surgical drainage and incision

How to judge the pus formation?

Purposes of surgical drainage and incision

Principles of surgical drainage and incision

How to judge the pus formation?

Characteristic
Three stages
Inoculation Cellulitis

Duration--- >5 days Palpation---Fluctuant Appearance---Reddened Needle aspiration B-ultrasound CT

Abscess

Fluctuant examination

Purposes of surgical drainage & incision

Rid the body of toxic purulent material Decompress the tissues Allowing better perfusion of blood containing antibiotics and defensive elements Increased oxygenation of the infected area

Infection in masseteric space

Infection in multi-space
Ludwigs angina

Principles of surgical drainage & incision

Place the incision in an esthetically acceptable Place the incision in a dependent position to encourage drainage by gravity Dissect bluntly through deeper tissues and explore all portions of the abscess

Place a drain and stabilize it with sutures

Principles of surgical drainage & incision

Chronic stage
Surgical removal of the focus()

Lesion tooth---Impacted tooth Osteomyelitis

Conclusion
Infection in oral & maxillo-facial region

The trait of Infection

Odontogenic infection mutation of infectious Diagnosis of the infection Diagnosis of the abscess formation

The principles of the treatment

Thank you