LECTURE Spread infections in maxillofacial area. Abscesses and phlegmons of maxillofacial area: reasons of origin, classification, main symptoms, diagnostics, treatment. Spread infections in maxillofacial area. Abscesses and phlegmons of maxillofacial area: reasons of origin, classification, main symptoms, diagnostics, treatment.

Inflammation may spread in three ways:  1. By continuity through tissue spaces and planes.  2. By way of the lymphatic system.  3. By way of blood circulation.

Most Common Teeth and Associated Periodontium Involved in Clinical Presentations of Abscesses and Fistulae. Most Common Teeth and Associated Periodontium Involved in Clinical Presentations of Abscesses and Fistulae. Maxillary vestibule Maxillary central or lateral incisor, all surfaces, and roots. Maxillary canine, all surfaces, and roots (short roots below levator anguli oris). Maxillary premolars, buccal surfaces, and roots. Maxillary molars, buccal surfaces, or buccal roots (short roots below buccinator). Penetration of nasal floor Maxillary central incisor, roots. Maxillary canine, all surfaces, and root (long root above levator anguli oris). Palate Maxillary lateral incisor, lingual surfaces, and roots. Maxillary premolars, lingual surfaces, and roots. Maxillary molars, lingual surfaces, or palatal roots. Perforation Into maxillary sinus Maxillary molars, buccal surfaces, and buccal roots (long roots). Maxillary molars, buccal surfaces, and buccal roots (long roots above buccinator). Mandibular first and second molars, buccal surfaces, and buccal roots (long roots below buccinator). Mandibular vestibule Mandibular incisors, all surfaces, and roots (short roots above mentalis). Mandibular canine and premolars, all surfaces, and roots (all roots above depressors). Mandibular first and second molars, buccal surfaces, and roots (short roots above buccinator). Submental skin region Mandibular incisors, roots (long roots below mentalis). Sublingual region Mandibular first molar, lingual surfaces, and roots (all roots above mylohyoid). Mandibular second molar, lingual surfaces, and roots (short roots above mylohyoid). Submandibular skin region Mandibular second molar, lingual surfaces, and roots (long roots below mylohyoid). Mandibular third molars, all surfaces, and roots (all roots below mylohyoid).

Possible Space. Teeth, and Periodontium Involved With a Clinical Presentation of Phlegmon from the Spread of Dental Infection. Possible Space. Teeth, and Periodontium Involved With a Clinical Presentation of Phlegmon from the Spread of Dental Infection.

SPREAD BY SPACES  The spaces of the head and neck can allow the spread of infection from the teeth and associated oral tissues because the pathogens can travel within the fascial planes, from one space near the infected site to another distant space, by the spread of the related inflammatory exudate. When involved in infections, the space can undergo phlegmon or abscess, which can cause a change in the normal proportions of the face.

Frontal section of the head and neck highlighting the submandibular and sublingual spaces.

SPREAD BY LYMPHATICS  The lymphatics of the head and neck can allow the spread of infection from the teeth and associated oral tissues. This occurs because the pathogens can travel in the lymph through the lymphatics that connect the series of nodes from the oral cavity to other tissues or organs. Thus, these pathogens can move from a primary node near the infected site to a secondary node at a distant site.

Superficial cervical lymph nodes and associated structures.

Deep cervical lymph nodes and associated structures.

SPREAD BY THE BLOOD SYSTEM  The blood system of the head and neck can allow the spread of infection from the teeth and associated oral tissues, because pathogens can travel in the veins and drain the infected oral site into other tissues or organs. The spread of dental infection by way of the blood system can occur from bacteremia or an infected thrombus.

Pathways of the internal jugular vein and facial vein, as well as the location of the cavernous venous sinus.

SPREAD TO THE PARANASAL SINUSES  The paranasal sinuses of the skull can become infected through the direct spread of infection from the teeth and associated oral tissues, resulting in a secondary sinusitis. A perforation in the wall of the sinus can also be caused by an infection. Secondary sinusitis of dental origin occurs mainly with the maxillary sinuses, since the maxillary posterior teeth and associated tissues are in close proximity to these sinuses.

Lateral view of the skull and the paranasal sinuses.

Dental abscess An abscess is a collection of pus. Pus is a thick fluid that usually contains white blood cells, dead tissue and bacteria (germs). The usual cause of an abscess is an infection with bacteria. A dental abscess is an infection in the centre of a tooth which spreads through the tooth to infect supporting bone and other nearby tissues. Dental abscess is common. It may develop as a complication of tooth decay (caries), or from an infection in the gums.

CAUSES The cause of these infections is direct growth of the bacteria from an existing cavity into the soft tissues and bones of the face and neck.  An infected tooth that has not received appropriate dental care can cause a dental abscess to form. Poor oral hygiene, (such as not brushing and flossing properly or often enough) can cause cavities to form in your teeth. The infection then may spread to the gums and adjacent areas and become a painful dental abscess.

Classification abscesses and phlegmons of maxillofacial area:  1.Abscesses and phlegmons of the maxilla region.  2.Abscesses and phlegmons of the mandible region.  3.Abscesses and phlegmons of the bottom oral cavity.  4.Abscesses and phlegmons of the tongue and of the neck.

Symptoms of a dental abscess include:  Pain (toothache) which can quickly become worse. It can be severe and throbbing.  Swelling of the gum which can be tender.  Swelling of the face. The skin over an abscess may become red and inflamed.  The affected tooth may become tender to touch, and may even become loose.  High temperature and feeling generally unwell.  In severe cases there may be spasm of the jaw muscles with difficulty swallowing and/or breathing.

PHYSICIAN DIAGNOSIS  A doctor or dentist can determine by physical examination if you have a drainable abscess. X-rays of the teeth may be necessary to show small abscesses that are at the deepest part of the tooth. Signs observed by the doctor, including nausea, vomiting, fever, chills, or diarrhea, may indicate that the infection has progressed to the point where it is making your whole body sick.

PHYSICIAN TREATMENT  The doctor may decide to cut open the abscess and allow the pus to drain. Unless the abscess ruptures on its own, this is the only way that the infection can be cured. People with dental abscesses are typically prescribed pain relievers and, at the discretion of the doctor, antibiotics to fight the infection. An abscess that has extended to the floor of the mouth or to the neck may need to be drained in the operating room under anesthesia.

Directions of cuts during treatment of purulent processes in maxillofacial area.

Prognosis If treated, the outlook is good. The pus can usually be drained and the tooth can be saved if it is not badly broken down. If treated, the outlook is good. The pus can usually be drained and the tooth can be saved if it is not badly broken down. If left untreated, complications may develop which can include: If left untreated, complications may develop which can include:  Spread of infection  The abscess may 'burst' onto the skin of the face, or into the mouth. This may leave a sinus tract (a channel) between a persistent focus of infection and the skin or mouth which can discharge pus from time to time.  Cavernous sinus thrombosis - a serious infection and clotting of a blood vessel in the brain.  Sinusitis - spread of infection to the nearby sinus in the face bone.  A dental cyst (fluid filled cavity) may develop.