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17 Complex
Odontogenic
Infections
ABDUL SAMAD
BDS FINAL YEAR
BOLAN MEDICAL
COLLEGE QUETTA .
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Deep spaces
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Edema Cellulitis Abscess
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Cervical
Fascia
Deep Superficial
Subcutaneous tissue, connective
tissue, superficial nerves and veins.
Superficial Middle Deep layers Envelopes platysma muscle and
muscles of facial expression
Posterior
Muscular Visceral prevertebral
Anterior Alar
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Possible locations where infection
can spread depends on
1- Thickness of overlying bone and
2- Relationship of muscle
attachment
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Possible
Locations •
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Microbiology
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5.
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Primary antibiotics
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Infections •
arising from •
ANY Tooth •
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Infections arising from Maxillary
teeth
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Infections arising from Maxillary teeth : Palatal space
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Infections arising from
Maxillary teeth : Infraorbital
space infections
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Infections arising from
Maxillary teeth : Buccal
space infection
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Infections arising from Maxillary teeth : Infratemporal
space infection
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Infections arising from Maxillary teeth : Maxillary
sinus infection
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• Causes redness, swelling of eyelids and involvement of vascular
and neural components of orbit
• Causes of maxillary sinusitis include iatrogenic, implant-related,
traumatic, periapical osteitis, endodontic foreign bodies,
restorative materials, bone grafting materials, and retained tooth
or bone fragments
• The most common clinical findings in maxillary sinusitis include
facial pain, postnasal discharge, and congestion.
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Infections arising from Maxillary teeth : Maxillary
sinus infection
The most common anaerobic gram-negative bacteria found associated with
odontogenic-related maxillary sinusitis include
• Streptococcus
• Peptostreptococcus
• Fusobacterium species
Aerobes include
• Streptococcus
• Staphylococcus species
Surgical management of the sinus in odontogenic-related maxillary sinusitis includes open or
functional endoscopic-assisted sinus surgery.
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Infections arising
from Mandibular
teeth
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Infections arising from Mandibular teeth: Space of the
body of mandible
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Infections arising from
Mandibular teeth: Buccal
Space
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Infections arising from Mandibular teeth:
Submandibular space
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Infections arising from
Mandibular teeth:
Sublingual space
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Infections arising from Mandibular teeth: Submental
space infection
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Infections arising from Mandibular teeth: Ludwig’s
Angina
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Infections arising from Mandibular teeth: Ludwig’s
Angina
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Infections arising from Mandibular teeth: Masticator
spaces
• The most common offending tooth in
masticator space infections is the mandibular
✓
third molar due to pericoronitis.
✓
• The most common direct route of spread of
infection from the mandibular third molars is to
✓ the pterygomandibular space.
✓
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Masticator
spaces
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Sub masseteric space
Most commonly involved
Lies between masseter muscle and ascending
ramus of mandible
Involves mandibular third molars
[pericoronitis]
Masseter muscle is inflamed and swollen
Trismus
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Pterygomandibular
space
Lies between medial pterygoid and medial
surface of ascending ramus
Site of injection of LA during inferior alveolar
nerve block
Involves mandibular third molars
[pericoronitis]
Inflammation of tonsillar pillar
Trismus without swelling
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Superficial and Deep
temporal spaces
Rare
Only occur in severe infection
Swelling in temporal region, superior to
zygomatic arch
Hourglass shape from frontal view
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Deep Cervical
Fascial Space
Infections
Lateral Pharyngeal space and Retropharyngeal space
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Lateral Pharyngeal Space
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Lateral Pharyngeal Space
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Lateral Pharyngeal Space
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Retropharyngeal Space Infection
Retropharyngeal space
Lateral Pharyngeal space Contains loose areolar Posteriorly to the danger
infection connective tissue and lymph space
nodes
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Retropharyngeal space
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Danger Space Infection
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The prevertebral space is rarely involved with odontogenic
infections due to the tight adherence of the prevertebral
fascia with the vertebrae.
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Goals of Management of
Odontogenic Infections
1.
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3.
4.
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6.
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Cavernous Sinus
Infection
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Cavernous Sinus Infection
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• Another early finding in cavernous sinus thrombosis is congestion of the retinal veins of
the eye on the unaffected side
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Cavernous Sinus Infection
Posterior route: Infratemporal infections pass superiorly along the emissary veins of
pterygoid venous plexus – that are connected to the intracranial dura sinuses by the
foramina in the base of skull.
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Necrotizing Fasciitis [flesh eating bacterial infection]
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• Broad spectrum empiric bactericidal intravenous (IV) antibiotics are generally always
indicated in these case
• Medical optimization of the patient
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Osteomyelitis
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Acute Suppurative Chronic Suppurative Chronic sclerosing Garre’s Osteomyelitis
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Osteomyelitis Osteomyelitis Osteomyelitis
• Infection of medullary bone • Management : culture and • Causative organisms: Usually affects children
along with purulence sensitivity testing of a bone Actinomyces species and
• Often seen in biopsy Eikenella corrodens Associated with periapical
osteoradionecrosis or infection of the mandibular tooth
medication related • Aggressive debridement • Sclerosis and fibrosis of the
osteoradionecrosis of the of necrotic bone medullary space Radiograph: Paracortical bone
jaws [MRONJ] formation [onion-skinning]
• C/F : edema, restricted • Intense pain with mandibular C/F: expansion of mandible
movement of affected area, • High dose IV antibiotic expansion and soft tissue with pain, no purulence,
erythema and pain treatment edema drainage or erythema
• In acute phase, no • Antibiotic therapy for a • No purulence of drainage Malignancy has same
radiographic findings minimum of 6 weeks present radiographic finding, so biopsy
• Radiographic findings : moth required
eaten appearance • Radiographically an
increased trabecular bone Removal of infectious source
• Radiopaque areas in density is present in required
radiolucency mandible
• These radiopaque areas are • Antibiotic therapy with Short term antibiotic therapy
termed sequestra, and the hyperbaric oxygen therapy until inflammation resolves
surrounding radiolucent area • Surgical resection of
is termed an involucrum diseased bone
• Managed surgically with
aggressive debridement of
bone with adjunctive empiric
antibiotic therapy
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Actinomyses
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Candidiasis
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References
