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TBR Odontogenic Infections
TBR Odontogenic Infections
TBR Odontogenic Infections
ODONTOGENIC
INFECTIONS
Demographics
Although any tooth can produce an
odontogenic infection, most infections
involve the mandibular first, second, and
third molars
In the pediatric population, odontogenic
infections are less common overall, but are
more likely to occur in maxillary teeth
Microbiology
Normal flora in the oral cavity
contains over 1,000,000 organisms
per cubic centimeter of which 10%
are aerobic cocci and 90% anaerobic
bacteria:
Streptococci are the most common aerobic
bacteria found in the oral cavity
Staph are more prevalent in the setting of
a mixed flora infection.
Anaerobes increase in number in the
setting of chronic infections like
periodontitis all cases
Sublingual Space
Infections of the sublingual space typically
start out as tender brawny swellings of the
lateral floor of the mouth near the
mandible. As the infection progresses, it
spreads towards midline and often to the
opposite sublingual space.
Submandibular space
The submandibular space is separated from
the overlying sublingual space by the
mylohyoid muscle.
The lateral extent of the submandibular
space is the skin, superficial fascial and
platysma muscle.
Submandibular space
The medial limits of the space are the
mylohyoid. hypoglossus, and styloglossus
muscles, while the inferior border is the
anterior and posterior digastric muscles.
The anterior portion of the submandibular
space communicates freely with the
submental space, while the posterior
portion communicates with the sublingual
space and deeper neck spaces
Submental Space
The submental space represents a midline
space beneath the anterior aspect of the
lower jaw.
Its boundaries both anterior digastric muscles,
while the roof consists of the mylohyoid
muscle and the floor of the mouth mucosa.
The anterior and lateral borders are formed by
the anterior mandible arch, while the hyoid is
the posterior border.
Angina Ludwig
Ludwig angina is a distinct pattern of
infection that usually originates in the
submandibular or sublingual space and then
disseminates to all the floor of the mouth
spaces by way of the posterior border of the
mylohyoid to involve the submandibular
and sublingual spaces bilaterally as well as
the submental space.
Angina Ludwig
The infection begins as a cellulitis,
advances to a fasciitis, and then becomes a
true suppurative infection.
Over 90% of cases of Ludwig angina are
odontogenic, usually arising from infected
second and third mandibular molars
Angina Ludwig
Ludwig infections tend to spread quickly from one
space to another, resulting in progressive brawny
edema of the anterior and lateral neck skin with
the floor of the mouth swelling and elevation of
the tongue odynophagia, dysphagia, drooling.
Effective treatment of Ludwig angina involves
three critical elements. These are (a) securing a
safe airway, (b) administering appropriate
antibiotics, and (c) surgical drainage of the
infected spaces.
Angina Ludwig
When the diagnosis of Ludwig angina is made
and the disease puts the airway at risk, all
authors agree that establishing a secure
airway is critical tracheostomy prior to
surgical drainage of the infection if necessary
Surgical drainage is clearly indicated for
patients with an abscess, patients with
impending complications, and those showing
no improvement after 24 to 48 hours of
appropriate parenteral antibiotics.
Angina Ludwig
Traditional surgical management of Ludwig
angina called for a horizontal incision
placed superior to the hyoid and extending
laterally to a few centimeters below each
angle of the mandible.
Recent studies reported early surgical
drainage using multiple small incisions as
equally effective in treating the infection.
General Treatment
Guidance
The appropriate management of an
odontogenic infection can involve medical,
surgical, or dental treatment or some
combination of all of these.
The use of drains in treating infections has
not been studied specifically. Some
surgeons prefer suction drains, while others
favor passive dependent drainage.
Imaging
Complications Of Odontogenic
Infections
Deep Neck Space Infections
The deep neck space infections associated
with odontogenic sources include infections
involving the retropharyngeal space and the
parapharyngeal space require treatment
with incision and drainage and administration
of systemic antibiotics.
Complications Of Odontogenic
Infections
Cervical Necrotizing Fasciitis
Necrotizing fasciitis is a rare but severe
bacterial infection of the soft tissues of the
neck and its fascia
When the diagnosis is missed or when
treatment is delayed, the infection can spread
rapidly to involve the subcutaneous fat, deep
fascia, and muscles
Complications Of Odontogenic
Infections
Mediastinitis
Infections that reach the deep neck spaces as
well as those that extend in the soft tissues of
the lower neck can extend to involve the
mediastinum.
These infections are potentially lethal and must
be treated aggressively.
Surgical drainage of both the neck and
mediastinum, eradication of the odontogenic
source and broad-spectrum intravenous
antibiotic therapy are all required.
Thank You