ORO FACIAL INFECTION INTRODUCTION Infections of Orofacial region, particularly those of odontogenic origin are most common. These infections can be managed successfully without any complications but if not treated these can produce serious complications and can prove fatal.

Early recognition of orofacial infection, its cause and quick appropriate therapy is essential. Proper knowledge of anatomy, anatomical landmarks and vital structures of the face and neck is necessary to predict pathways of spread of infections and to drain these spaces.

Causes & Types of Infection Odontogenic infection are infections that arise within the jaw bones and can be classified on the basis of etiology as : 1. Based on the origin of infection. Odontogenic Pulp disease Periodontal disease Infected cysts Remaining roots Residual infection Pericoronal infection Traumatic Implant surgery From contaminated needle punctures Salivary gland infections

2. Based on the causative organisms. Bacterial infections ( GRAM +VE & GRAM –VE ) Fungal infections Viral infections

Types of infection Acute Acute peri-apical abscess Acute periodontal abscess Cellulitis Chronic Chronic abscess leading to fistulous tract or sinus formation

SPREAD & PATHWAY OF ODONTOGENIC INFECTION Invasion of the dental pulp by bacteria after decay of a tooth Inflammation, edema and lack of collateral blood supply Venous congestion or avascular necrosis Reservoir for bacterial growth Periodic egress of bacteria into surrounding alveolar bone Periapical infection progress to other areas or spaces

Stages/Phases of Dento-alveolar Infections Peri-apical osteitis Intra-bony abscess Cellulitis Facial abscess

General Factors Affecting Spread of Infection Host resistance (BODY). Virulence of infecting organism. Bacterial quantity.

Body Resistance Depends On Humoral factors Cellular factors Humoral factors include polymorphonuclear leukocytes, monocytes, lymphocytes and tissue macrophages. Cellular factors involves immunoglobulins derived from sensitized B- lymphocytes or plasma cells and complement.

Local Factors Affecting Spread of Infections Anatomic location of the tooth Position of muscle and facial attachments Intact Anatomical Barriers Alveolar bone Periosteium Adjacent muscles and fascia

Routes / Spread of Orofacial Infection By direct continuity through the tissues By lymphatics to regional lymph nodes By blood stream

Phases & Fate of Infection If untreated or improperly treated, infections can lead to Focal osteomyelitis Widespread osteomyelitis Fistulous tract which may be INTRAORAL/EXTRAORAL

Intraoral or Extraoral cutaneous soft tissue abscess Cellulitis Bacteremia – septicemia Deep fascial space infection Ascending facial cerebral infection

Diagnosis of Infection History of toothache/headache with chills & fever. Previous history of soft or hard tissue trauma. History of localized swelling which may be tender. Enlarged lymph nodes.

Extraoral & intraoral sinus tracts. Trismus. Dysphagia. Radiological examination. Other diagnostic aids.

Radiological Examination Helpful in locating offending tooth or any other underlying cause : IOPA OPG Lateral Oblique. CT guided needle aspiration. CT Scan. MRI.