Diagnosis of facial infections

1
Diagnosis of facial infections
2
Diagnosis of infections

• 1. 5 cardinal signs of inflammation which is the
  bodys response to infection are
• redness
• heat
• pain
• swelling
• loss of function

3
Diagnosis of infections cont

• Redness
• Dilatation of blood vessels of inflamed area,
• Seen as bluish in the skin/mucosa
• Compare with color of the same region with the
  same region on the other side

4
Diagnosis of infections cont

• Heat
• Determined by palpating the region with dorsal
  surface of fingers (reason-skin is thinner and
  more sensitive to temperature than palmar side)
• Compare region of the affected side with same
  region on the other side.

5
Diagnosis of infections cont

• Pain
• Associated with amount of oedema building up
  within the infected tissue spaces,
• Incipient infection is less tender
• Incision and drainage (ID) releases pressure,
  therefore decreases amount of pain

6
Diagnosis of infections cont

• Swelling
• Obvious when arising from superficial infection,
• Deep seated infection examine the whole face and
  neck and compare one side with the other,
• Describe the swelling in terms of its anatomical
  boundaries such as muscles that delimit the
  swelling and relationship of the swelling to the
  maxilla or mandible.

7
(No Transcript)
8
Diagnosis of infections cont

• Loss of function
• Ominous sign in infection of the head and neck,
• Trismus eg. In pterygomandibular space infection
  due to inflammation in the muscles of
  mastication,
• It indicates infection spreading to deeper
  structures.

9
2.Systemic signs

• Indicates potentially serious course of disease
• Require proper evaluation and prompt treatment.
• Fever
• Normal temperature 98.6ºF (37ºC),
• Elevation beyond 100ºF is significant

10
Systemic signs cont

• Dehydration
• Serious oral infection interfere with the normal
  intake of food and fluids
• Serious rise in temperature rises the rate of
  water loss through skin by radiation and
  sweating,
• Dehydrated patient has hot dry skin, chapped
  lips, dry oral mucosa and decrease salivary flow.

11
Systemic signs cont

• Malaise
• A very sensitive indicator of the presence of an
  infection is how the patient feels subjectively.
• Malaise can be described a feeling of weakness,
  lack of energy and appetite, loss of interest in
  ones surrounding and vague, generalized
  discomfort.

12
Systemic signs cont

• Lymphadenopathy
• Tender, palpable freely mobile lymphnodes
  frequently accompany significant infection,
• Understanding drainage pattern of lymph nodes is
  important.

13
3.Hematological signs

• High WBC (N 4,000-10,000 cells/mm3)
• High PMNL- acute bacterial infection
• High lymphocytes chronic bacterial infection or
  viral infection
• High eosinophils common cold, asthma,
  allergies, and certain parasitic infections

14
Periapical abscess

• This is either an acute or chronic suppurative of
  the periapical tissues of the periodontium
  following pulp infection, traumatic injury of the
  teeth, or irritation of the apical tissues by
  mechanical or chemical manipulation.
• It is also known s dentoalveolar abscess,
• Clinical presentations depends whether it is
  acute or chronic,

15
Periapical infections

• Acute periapical periodontitis
• Patient complain of severe pain,
• Patient can indicate precisely the tooth that is
  aching,
• Pain on eating,
• Pain increases when drinks hot liquids
• Pain decreases when drinks cold drinks
• Tooth is tender on vertical percussion

16
Periapical abscess cont

• Acute
• Extremely painful tooth,
• Slightly extruded from the socket,
• Lymphadenitis
• Fever,
• Chronic
• There may be draining sinus tract in the alveolar
  mucosa,
• Otherwise it is asymptomatic

17
Complications of periapical abscess

• Osteomyelitis,
• Fistula formation,
• Fascial spaces infection,
• Bacteremia,
• Periapical granuloma or cyst,

18
Lateral periodontal abscess

• It is related to the pre-existing periodontal
  pocket,
• Clinically presents
• Pocket depth of 5-8 mm
• Pain,
• Swelling destroying the cortical plate of bone
  ballooning the overlying tissues,
• Tooth tender to percussion

19
Subperiosteal abscess

• It is the result of pus from the apical or
  dentoalveolar abscess perforating through the
  lingual or buccal cortical plate of bone without
  perforating through the overlying periosteum,
• Can also arise after mucoperiosteal flap has been
  raised from the bone as during the surgical
  extraction of teeth,
• Usually this occurs when small piece of necrotic
  bone or foreign material has been left behind
  underneath the flap acts as a nidus of infection

20
Cnt

• Clinically presents as a rounded swelling
  overlying the cortical plate of maxilla or
  mandible,
• Quite firm on palpation due to because of the
  pressure of the underlying fluid,
• Extremely painfully,

21
Pericoronitis

• It is an inflammation of soft tissues
  surrounding the crown of a partially erupted or
  unerupted tooth,
• Common site is usually the soft tissue of the
  crown of wisdom teeth of lower jaw.

22
Pericoronitis cont

• Clinical features
• General features includes high temperature,
  severe malaise.
• Local features include severe sharp pain of
  throbbing type, discomfort in swallowing,
  mastication, trismus,
• Swollen and tender gum flap (operculum)
• Pus discharge beneath the flap
• Tender and enlarged sub-mandibular lymph nodes
• In chronic situation there is dull pain, slight
  trismus

23
Cellulitis

• This is a diffuse inflammation of the soft
  tissue/ loose connective tissue which tends to be
  self limiting and eventually may become an
  abscess,
• It is a very serious infection and it can life
  threatening,
• It is a potential complication of all acute
  dental infection
• If the infection involves the submandibular,
  sublingual and submental spaces it is called
  Ludwigs angina,

24
Cellulitis cont

• It is characterized by absence of pus initially,
• Infection may remain localized if the defense
  factors are capable of walling off the infection
  and preventing it from spreading,
• Occasionally it can be the
• Bacterial infection is over whelming and
  extremely virulent,
• Bacteria are resistant to antibiotics
• Body resistance is low and the invasion is
  unimpeded as it progresses through the
  surrounding tissues.

25
Cellulitis cont

• Sources
• The mainly responsible organism is the
  ß-hemolytic streptococcus, which has great
  invasive ability (produce hyaluronidase-spreading
  factor, and fibrinosins)
• Commonest cause of cellulitis of neck is
  infection arising from the region of the lower
  molars,
• Many fascial spaces infection can be easily seen
  because of
• The apices of the second and more especially 3rd
  molars are often close to the lingual surface of
  the mandible,
• The mylohyoid muscle inclines upwards as it runs
  backwards, the apices of the 3rd molar are
  usually and of the 2nd molar are often below this
  line,

26
Cellulitis cont

• Clinical features
• Gross edema of the tissues,
• induration or boardlike (hardness) on palpation
• Pain or tender on palpation,
• It has diffuse /ill defined borders,
• It is reddish in colour,
• The presence of pus indicates that the body has
  walled off the infection and that the local host
  resistance mechanism are bringing the infection
  under control.

27
Ludwigs angina

• It is an extension of infection from mandibular
  molar teeth into the floor of the mouth.
• Causes usually involves the molars of the lower
  jaw-generally 2nd and 3rd, because the apices of
  these teeth are lingual in localization and lie
  below the level of the mylohyoid line,
• Infection spreads first to submandibular, and
  later submental and sublingual and later to the
  submandibular space on the other side.

28
Ludwigs angina cont

• Clinical features
• Respiratory distress,
• Dysphagia, difficult in eating and breathing
• Tissue may becomes gangrenous and have peculiar
  lifeless appearance on cutting

29
Ludwigs angina cont

• A noticeable margins exists between involved
  tissues and the surrounding normal tissues,
• Three fascial spaces are involved
  bilaterally-submandibular, sublingual, and
  submental,
• Patient has typical open mouth appearance,
• Floor of mouth is elevated, and tongue protruded
  making breathing difficult.
• Fever, salivation, stiffness in tongue movements,
• Trismus (inability to open the mouth),
• Tissue of the neck becomes boardlike and
• Patient becomes toxic, breathing is difficult,
  and larynx is edematous.

30
Actinomycosis

• Actinomycosis is a relatively uncommon infection
  of the soft tissue of the jaws,
• It is usually caused by Actinomyces israeli but
  may also be caused by A. naeslundii or A.
  viscosus, which cause subacute or chronic
  infection most frequently located around the jaws

31
Actinomycosis cont

• Diagnosis is established by examination of the
  pus which contains sulphur granules,
• These yellow granules are formed by the hyphae of
  the actinomysetes and can be examined under the
  microscope or cultured.

32
Osteomyelitis

• this is an inflammatory disease of the jaw bone
  with the accumulation of pus in the bone marrow.
• It affects the bone marrow.

33
Osteomyelitis cont

• Clinical features
• In the initial stage there is no swelling,
• Patient has malaise,
• Elevation body temperature,
• Enlargement of regional lymph nodes
• Teeth in the affected area become painful and
  loose,
• Difficult in chewing,
• Swelling and pain,
• Pus ruptures through the periosteum into the
  muscular and subcutaneous fascia,
• Eventually discharged through the skin surface
  through the fistula,

34
Osteomyelitis cont

• In early stages little or no radiographic
  changes,
• After two weeks the bone become radioluscent in
  the affected areas,
• Later sequestrum visible as a radioluscent area
  surrounded by radio-opaque areas representing the
  new bone or involucrum.

35
Thank you for your attention