Professional Documents
Culture Documents
Fatal Complications (Presentation) 2020-2021
Fatal Complications (Presentation) 2020-2021
Odontogenic Infections
Fatal complications
of head and neck
infections
Related to Related to
Maxilla Mandible
Orbital Infection
Cavernous Sinus Thrombosis
Brain Abscess
Odontogenic infections
Mediastinitis
Necrotizing Fasciitis
Why FATAL?
• Rapid progression
• Requires early diagnosis
• Prompt aggressive treatment
• Hospitalization ICU admission
• Consultation & Cooperation with other
medical specialties is a MUST
Ludwig's Angina
Involving: (5 spaces).
• Bilateral Submandibular
spaces
• Submental space
LUDWIG'S ANGINA
It is the name given
to a massive, firm, brawny
cellulitis/induration, and acute,
toxic stage, involving
simultaneously, the
submandibular,
sublingual and submental
spaces bilaterally
1. to be feared of
• Immuno-compromised patient
LUDWIG'S ANGINA
Signs & Symptoms
• Hard (Board like) diffuse swelling
• Painful
• Rapid onset
• Late Suppuration
LUDWIG'S ANGINA
Signs & Symptoms:
Systemic: Intraoral:
• High Fever
- Edema & congestion in floor
• Lymphadenopathy of mouth
• Malaise - Glottic Edema
- Elevated protruded tongue
• Toxic appearance
(Wooden)
• Elevated white blood cell count - Decreased mouth opening
• Altered blood gases - Excessive salivation
- Difficult swallowing
- Based on:
I. Early Diagnosis
II. Maintenance of patent airway
III. Intense and prolonged antibiotic therapy
IV.Surgical drainage and decompression
V. Removal of the cause
LUDWIG'S ANGINA
Treatment
• Rapid Hospitalization
• Secure Airway……..How?
• Supportive measures
• Massive prolonged IV
Antibiotics
• Early I & D
successful management
(Sphenoid Bone)
Cavernous sinus Thrombosis
Relations:
Superior: ICA
Inferior: Sphenoid bone (Body)
Medially: Pituitary gland
Sphenoid air sinus
Laterally: Temporal lobe brain
Trigeminal ganglion
Contents
• Internal Carotid Artery
• Nerves:
- Toxemia
- Meningitis
CAVERNOUS SINUS THROMBOSIS
- Ptosis
- Epistaxis
CAVERNOUS SINUS THROMBOSIS
Signs & Symptoms
Cranial nerves involvement: III-VI
- Diplopia (EARLY SIGN)
- Ophthalmoplegia
- Headache
As a
- Neck stiffness
- Vomiting consequence
- Convulsions of CST
- Confusion
or DE novo
- Rapid pulse
- Chills & Sweating
- Leukocytosis
CAVERNOUS SINUS THROMBOSIS
Treatment of CST
• hospitalization/ ICU
• Neurosurgical consultation
• Mannitol
• Heparinization
• Hospitalization
• Routes of spread:
- Ear infection
- Orbital infection
- Odontogenic infections
• Nuchal rigidity
• Convulsions
BRAIN ABSCESS
Diagnosis
• Clinical
• CT scan
• MRI
BRAIN ABSCESS
Treatment
• Hospitalization
IV chloramphenicol
• Drainage (Trephination)
Mediastinitis
• Potential space
• Contains a lot of vital
structures:
- Heart
- Aortic arch
- Pulmonary artery
-Esophagus , Trachea
- Carotid artery
Route of spread:
Ant neck…..Carotid sheath
Post neck….Retropharyngeal
MEDIASTINITIS
MEDIASTINITIS
Routes of spread:
Ant neck…..
-Carotid sheath
Post neck….
- Peritonsillar
- Retropharyngeal
- Prevertebral
MEDIASTINITIS
Signs & Symptoms
• Exacerbation of Fever
• Substernal pain
• Profound Leukocytosis
MEDIASTINITIS
Treatment
(early diagnosis, airway control, aggressive treatment)
• Hospitalization/ ICU
• Massive Antibiotics
• Supportive measures
• Acidosis
• Shock
NECROTIZING FASCIITIS
Treatment
• Hospitalization
• Massive Antibiotics
• Supportive measures
( Fluids, Calcium)
• Surgical drainage
• Repeated debridement
• Antiseptic dressings
• Hyperbaric Oxygen
Orbital Infection
Cavernous Sinus Thrombosis
Brain Abscess
Meningitis
Odontogenic infections
Mediastinitis