• OROFACIAL INFECTIONS

Dr. Meti T. (MD)

03/20/2024 DR Meti T. 1
OROFACIAL INFECTIONS

• Infection and inflammation of oral and facial regions.

• Affects the skin or mucous membranes of the face and oral
cavity and goes through facial spaces and other organs.
• May be localized and indolent or invasive and life-threatening.

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• Etiology
• Implant surgery
• Pulp disease • Reconstructive surgery
• Periodontal disease • Infections of maxillary sinus
• Secondarily infected cyst & • Infections of salivary glands
odontomes • Secondary to oral malignancies
• Remaining root fragment
• Pericoronal infection
• Trauma

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Microbiology
• Aerobic gram positive cocci bacteria - streptococci milleri,
strep. sanguis, strep. salivarius, strep. mutans.
• Anaerobic cocci - peptostreptococcus.
• Bacteriodes - porphyromonas, prevotella

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• SPREAD OF ORAL INFECTION
Routes of spread
1. Direct continuity through tissues
2. By lymphatic's to the lymph nodes,
from lymph nodes to tissues; results in secondary areas of
cellulitis or tissue space abscess.
3. By blood stream; pathogens (bacteremia) & local
thrombophlebitis (infected thrombus) may spread via the
veins to be carried out in blood stream.
• It may drain the infected oral site to organs causing
Endocarditis, cavernous sinus thrombosis & septicemia.
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 Classifications of Orofacial infections

A. Acute Orofacial infections

1. Abscess
2. Cellulitis
3. Fulminating infection
B. Chronic Orofacial infections

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1. Abscess:-
• It is a circumscribed collection of pus in a pathologic tissue
space.
• usually occurs as a result of an untreated dental cavity,
injury or prior dental work.
• Infections are characterized
by staphylococci.

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2. Cellulitis:-
• Spreading infection of loose connective tissues.
• Diffuse, erythomatous, mucosal or cutaneous infection.
• Acute & edematous spread of acute inflammatory process

• It is Streptococcal infection.

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3.Fulminating infections:-
• It involves secondary spaces to vital structures.

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• LUDWING`S ANGINA

• A serious, potentially life-threatening infection, of the floor

of the mouth, usually occurring in adults
• If left untreated, may obstruct the
airways, necessitating tracheostomy.

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• It is bilateral infection of the floor of the mouth that consists
of submandibular, submental and sublingual spaces.
• it is an aggressive rapidly spreading cellulitis often without
marked LAP with potential for air way obstruction

• most commonly arise from infected second and third

mandibular molar tooth
• other source include peritonsillar abscess , suppurative
parotitis, sialolithiasis

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• A massive, firm, brawny, cellulitis or induration
• lack lymphadenopathy and abscess formation

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Etiology
• viridan streptococcus
• peptostreptococcus
• fusobacterium nucleatum
• porphyromonas
• actinomyces
• MRSA in immunocompromised

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 Clinical Features

• Fever,Anorexia, Dysphagia, Chills, Malaise

• drooling of saliva, mouth pain, dysphagia
• prefer leaning forward…
• Impaired speech / muffled voice
• stridor
• Mouth remains open due to edema of sublingual tissues
• Increased salivation
• Reduced tongue movements

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• Firm or hard swelling bilateral
• Swelling; non-pitting, non fluctuant, tender with ill defined
borders
• some times palpable crepitus
• Raised floor of mouth and Tongue against palate
• Restricted mouth opening
• Air way obstruction
• Increased respiratory rate and Cyanosis

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Diagnosis
• diagnosis is based on clinical finding with imaging support
• CT of neck with IV contrast

finding
• soft tissue thickening
• increased attenuatin of subcutaneous fat
• loss of fat plane in submandibular space
• muscle edema
• bubble sign (Gas bubble within soft tissue )
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Treatment

Maintenance of air way

fiberoptic intubation via nasal route
May necessitate urgent tracheostomy in severe cases

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Antibiotic therapy
• ampicillin sulbactum or
• ceftriaxone plus metronidazole or
• levofloxacin 750 mg PO D plus metronidazole or
• vancomycin if known or suspected to be colonized by
MRSA
Duration2- 3wks
Hydration
Surgical decompression
Extraction of offending tooth
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Complication
• air way compromise
• mediastinitis
• pericarditis
• carotid artery rupture
• jugular vein thrombosis
• empeyma

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 Chronic stage
Chronic fistulous tract or sinus formation:-
• Abscesses neglected for a long time may discharge intra-orally
or extra-orally (gum boil).
• Formation of a tunnel conducting pus from one infection site to
another or outside.
• Destruction of intervening tissue between the two sites due to
pressure from the abscess.

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 • Complications

 Osteomyelitis
 Maxillary sinusitis
 Septicemia
 Mediastinitis
 Pericarditis
 Jugular vein thrombosis
 Meningitis
 Brain abscess
 Cavernous sinus thrombosis
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• OSTEOMYELITIS
• It is an inflammatory condition of bone that begins as an
infection of medullary spaces haversian systems of the
cortex & extends to involve the periosteum of the affected
area.
• It is mainly caused by Bacterial Infections

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 Etiology
• Odontogenic Infections
 Pulpal and Periodontal • Infections of Orofacial Regions
Infection
 Periostitis from gingival
 Infected Cysts ulceration
 Tumors  Peritonsillar Abscess
• Trauma • Infections from Hematogenous
• Compound Fractures Route
• Surgery  URT Infection
 Middle ear Infection
 Systemic TB
 Wound on the Skin
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 clinical feature
• Pain and Tenderness on • Trismus
the area and the tooth
• Bad Odor
Involved
• Dehydration
• Fever
• Regional
• Malaise
Lymphadenopathy
• Nausea
• Indurated Swelling
• Vomiting
• Pathologic fracture of the
• Anorexia jaw involved

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• Conservative Management
 Complete Bed rest
 Supportive therapy – Nutritional support
 Rehydration – Oral or IV
• Analgesics
• Antibiotics

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Surgical Management

 Extraction of the offending tooth, if any

 Incision and drainage
 Debridement
 Sequestrectomy
 Resection
 Reconstruction
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•

THANK YOU!

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• Reading assignment

• Local anesthesia
• Tooth extraction

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