Orofacial Infections-Part-4.pdf

Oral and Dental Surgery - II Orofacial Infections - Part-IV Asst. Prof. Mustan Barış SİVRİ School of Dental Medicine Department of Oral and Maxillofacial Surgery [email protected] Course Content 1. Spaces of Neck 2. Sequelae of Space Infections Learning Outcomes At the end of this...

Oral and Dental Surgery - II Orofacial Infections - Part-IV Asst. Prof. Mustan Barış SİVRİ School of Dental Medicine Department of Oral and Maxillofacial Surgery [email protected] Course Content 1. Spaces of Neck 2. Sequelae of Space Infections Learning Outcomes At the end of this course you will; ✓Define spaces of neck ✓Know sequelae of space infections Resource • Hupp, J. R., Tucker, M. R., & Ellis, E. (2019). Contemporary Oral and maxillofacial surgery. 7th Ed., Elsevier. Chapter 16 Spaces of Neck Parapharyngeal Space ❑ The spaces around the pharynx form a ‘Ring’ and a pathway for spread of infections from the orofacial region to the neck and mediastinum. ❑ The Parapharyngeal space includes Lateral Pharyngeal space and Retropharyngeal space. Lateral Pharnygeal Space ❑Source of Infection • From other spaces which includes; Pterygomandibular space&Submandibular space • From tonsils • From the lower third molar region ❑Contents • Lymph nodes • Ascending Pharyngeal artery and Facial artery • Carotid sheath • Glossopharyngeal nerve, Spinal Accessory nerve, Hypoglossal nerve Lateral Pharnygeal Space ❑ Boundaries • Superior: Base of the skull. • Inferior: Hyoid bone. • Anterior: Pterygomandibular raphe, Superior and middle pharyngeal constrictor. • Posterior: Carotid sheath, Stylohyoid, Styloglossus, and Stylopharyngeus. • Medial: Superior constrictor of Pharynx and Retropharyngeal space. • Lateral: Medial pterygoid muscle, Deep lobe of the parotid gland. Lateral Pharnygeal Space ❑Clinical Features 1. No or minimal external swelling on the lateral aspect of the neck. 2. Moderate limitation of mouth opening. 3. Rotation of neck to contralateral side is painful. 4. Dysphagia. 5. Uvula is pushed to opposite side. 6. Pharyngeal bulging is seen (Swelling over pillars of fauces and superior constrictor). Lateral Pharnygeal Space ❑ Management ✓ A combination of intra-oral and extra-oral approaches are advised for the management of infections of the lateral pharyngeal space. They are preferably done under general anesthesia with care taken to secure the airway. Retropharyngeal Space ❑Source of infection • From Lateral pharyngeal space. • From the lymph nodes that drain into Waldeyer’s ring. • Rarely from upper respiratory infections. ❑Contents • Lymph nodes. Retropharyngeal Space ❑Clinical Features 1. Stiff neck. 2. Sore throat. 3. Dysphagia. 4. Lateral neck swelling and occasional erythema. 5. Fever. 6. Dyspnea. 7. Mediastinitis is the most feared complication of this space. Retropharyngeal Space ❑ Boundaries • Superior—Base of the skull. • Inferior—Fusion of alar and Prevertebral fascia. • Anterior—Superior and Medial constrictors. • Posterior—Alar fascia. • Lateral—Carotid sheath and Lateral pharyngeal space. Retropharyngeal Space ❑ Management ➢ Most important is to secure airway, may be an elective tracheostomy or fiber optic intubation is considered for airway maintenance. ➢ Combination of intraoral and extraoral approach. Peritonsillar Abscess ❑ Source of infection • From tonsillitis. • Rarely from Pericoronitis. • From Lateral pharyngeal space. ❑Clinical Features 1. Pain in the throat radiating to ear. 2. Fever. 3. Dehydration. 4. Dysphagia. 5. Swelling visible at anterior pillar of tonsillar fauces. 6. Redness and edema may be extended to soft palate. 7. Drooling of saliva. 8. Change of voice and speech difficulty in case of bilateral involvement. 9. Mouth opening difficulty may not be present. Peritonsillar Abscess ❑ Boundaries • Anterior—Anterior pillar of fauces. • Posterior—Posterior pillar of fauces. • Medially—Tonsil. • Laterally—Superior constrictor muscle ❑Management • Intraoral approach Sequelae of Space Infections, if Ignored Sequelae of Space Infections, if Ignored Ludwig’s Angina Ludwig’s Angina ❑ Ludwig’s Angina is defined as an acute, involving bilateral firm, non-suppurating, necrotizing cellulitis Submandibular, Sublingual, and Submental spaces. ❑ The condition has been described by medical practitioners, by three unique features, starting with the alphabet ‘F’—Feared, Fluctuant rarely, Fatal often. Ludwig’s Angina ❑ • • • • • • • Source of infection Predominantly (90%) odontogenic in origin, from the lower jaw. Infection from 2nd and 3rd molar teeth may be Acute dentoalveolar abscess, Periodontal Abscess. Pericoronal Abscess. Infected cyst at the body and the angle of the mandible. Traumatic injuries especially to the mandible, either ignored or not managed well leading to sepsis. Salivary gland infections. Iatrogenic reasons. Hematogenous infections. Predisposing Factors • Immunosuppression. • Uncontrolled Diabetes. • Steroid therapy. • Debilitating conditions. Ludwig’s Angina ❑Clinical Features Ludwig’s Angina ❑Management • It should be treated as life-threatening situation and intervened aggressively. • The treatment of Ludwig’s Angina is primarily surgical. • The first priority in the management is always the life-saving measure. • If the patient shows any signs of dyspnea, Tracheostomy should be performed promptly Ludwig’s Angina Necrotizing Fasciitis • Necrotizing fasciitis is an uncommon soft tissue infection, occurs due to polymicrobes and spreads rapidly in the subcutaneous tissue and above superficial fascia, and as the disease progresses, muscle and skin involve giving rise to myonecrosis. • The other name for this condition is Hospital Gangrene given by Brooks in 1966 and Hemolytic streptococcal gangrene. • Necrotizing fasciitis may affect any part of the body; however, it most commonly affects the extremities, abdominal wall, and the perineum following trauma or surgery. The condition shows no clear boundaries or palpable limits, mainly occurs with immunocompromised patients and those suffering from systemic illnesses. Necrotizing Fasciitis Cavernous Sinus Thrombosis ❑Cavernous sinuses are the venous sinuses situated on either side of the sella tursica. The cavernous sinus on either side communicates freely with each other by anterior and posterior intracavernous sinuses they also communicate with sagittal sinus, transverse, sinus and sigmoid sinus. ❑The cavernous sinus communicates extra cranially with veins of the head and neck. Cavernous Sinus Thrombosis • The area of the face between the inner canthus of the eyes and the corners of the mouth is called `Danger Triangle` of the face and any kind of severe sepsis in this area can spread in a retrograde manner and can extend to the cavernous sinus through the angular vein and ophthalmic vein. • The ophthalmic vein and angular veins into the anterior facial vein. • Through emissary veins from the pterygoid plexus of veins. Meningitis It is one of the neurological complications resulting from the infection of oro-facial region. It may develop from metastatic spread or may be due to nearby thrombophlebitis. ❑ Clinical Features 1. High fever with chills 2. Irritability and mental confusion 3. Head ache 4. Vomiting 5. Stiff neck 6. Convulsions THANK YOU..