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กลุ่มงานทันตกรรม รพ. วานร นิวาส Odontogenic infection in maxillofacial region.

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Presentation on theme: "กลุ่มงานทันตกรรม รพ. วานร นิวาส Odontogenic infection in maxillofacial region."— Presentation transcript:

1 กลุ่มงานทันตกรรม รพ. วานร นิวาส Odontogenic infection in maxillofacial region

2 Infection in oral and maxillofacial region Odontogenic infection Necrotizing facciitis, frequently odontogenic source Osteomyelitis Osteoradionecrosis Bisphosphonate-relaed osteonecrosis Salivary grand infection Fungal & viral infection

3 Odontogenic infection

4 Dental infection => space infection

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6 Host Anatomical factor Microbial factor

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9 Subperiosteal abscess Severity score= 1

10 Low severity Vestibular abscess Severity score= 1

11 Low severity Canine space abscess Severity score= 1 ระวัง Periorbital!!!

12 Low severity Buccal space abscess Severity score= 1

13 Submasseteric space Pterygomandibular space Temporal space Limited mouth opening ( 1cm) Submasseteric space Pterygomandibular space Temporal space Limited mouth opening ( 1cm) Severity score= 2

14 Submandibular space abscess Submental space infection Severity score= 2

15 Ludwig’s angina Involvement submandibular spaces bilaterally,submental space,sublingual Rapid spread to lateral pharyngeal / retropharyngeal space Rapidly obstruct upper airway

16 Severity score= 3

17 Danger space, Mediasternum Severity score= 4

18 The most frequent cause of death in reported cases of odontogenic infection is Airway Obstraction The most frequent cause of death in reported cases of odontogenic infection is Airway Obstraction Clinical apparent partial air way obstruction with lowO 2 sat => secure airway

19 Management of odontogenic infection Step 1.Determine the severity of infection ---Anatomical location ---Rate of progression : Inoculation,Cellulitis, Abscess ---Air way compromise

20 Step 2. Evaluated host defend DM* Steroid therapy Organ transplants Malignancy Chemotherapy Chronic renal failure* Malnutrition Alcoholism End-stage AIDS

21 Step 3.Decide on setting care -Refer > Severe score 2 -IPD : score 1, mild score 2 fever, dehydration, control host disease -OPD : mild score 1-2 follow up in *few days (7 days may be too long)

22 Step 4.Treat surgically Surgical drain (intraoral or extraoral) --If drain inserted, drains should be discontinued when drainage cease <72hrs --Irrigate with NSS daily Mild  root canal treatment or Tooth extraction ?

23 Stage of Infection

24 Early incision and drainage aborts the spread of infection into deeper and more critical anatomic space, even when it is in the cellulitis stage Williams and Guralnick N Engl J med 1943 Flyn TR, AAOMS 1999 แต่ถ้าแก่มากๆหรือในเด็ก ถ้าไม่ได้บวมมากก็สามารถ ชะลอไปก่อนได้

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26 Step 5. support medically Control fever& adequate hydration

27 Step 6. Choose antibiotic therapy Usual Odontogenic infection : 70%= gram(+)cocci :Streptococus sp. 30% = anaerobic : gram (-) rod, Bacteroid sp, prevotella, prophyromonas, fusobacterium, Klebsiella Step 7.Administer the antibiotics

28 Usual Odontogenic infection

29 In thailand รพ. ศูนย์ต่างๆพบว่าการรักษาคนไข้ในประเทศ ไทย IV FOR ODONTOGENIC INFECTION 1 st line drug : PGS + Metronidazole or 1 st gen cephalosporin+Metronidazole กรณีมี Staphlylococus(skin) เก็บ clindamycin ไว้กรณี severe infection

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33 Culture& sensitivity testing Expensive&time consumimg!! Can be dalayed for as mush as 2 weeks When dealing with Unusual Infection ** subjected to multiple course of antibiotics DM : Klebsiella pneumoniae HIV/AIDS :Mycobacteria IV Drug abusers : Staphylococus aureus Gram stain?cheap screen!!

34 Step 8.Evaluated the patient frequenly No fever 1-2 days, การบวมลดลง, การ ปวดลดลง, รับประทานข้าวได้ เปลี่ยนเป็นยากินและ D/S ได้ นัด F/U

35 Step 1.Determine the severity of infection Step 2. Evaluated host defend Step 3.Decide on setting care Step 4.Treat surgically Step 5. support medically Step 6. Choose antibiotic therapy Step 7.Administer the antibiotics Step 8.Evaluated the patient frequenly


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