INFECTIONS OF THE

MAXILLOFACIAL
REGION
GENERAL TERMS
⚫ Nonspecific soft tissue infections are the most
common diseases of MF region;
⚫ The type, number and virulence;
⚫ Local and general factors of the organism;
⚫ The goal of treatment: improvement in body defense
with the help of surgical, pharmacological and
physical methods
ACCORDING TO THE ORIGIN
OF INFECTIOUS INVADERS:
⚫ exogenous infection
⚫ endogenous infections
⚫ reinfection
⚫ secondary infection
⚫ combined infection
⚫ latent infection
EXUDATIVE FORMS OF
INFLAMMATION
⚫ serous
⚫ fibrinous
⚫ pyogenic
⚫ phlegmonous
⚫ gangrenous
⚫ haemorrhagic
⚫ necrotic
CLINICAL SIGNS OF
INLAMMATION (on the course):
⚫ acute inflammation
⚫ chronic inflammation
⚫ recurrent inflammation
GENERAL SIGNS OF
INFLAMMATION:
⚫ Changes in body temperatures (effect of pyrogenic
substances)
⚫ Changes in blood (leukocytosis leukopenia,
lymphocytosis ....)
⚫ Changes in sedimentation
⚫ General intoxication (toxemia, bacteremia, and
sepktikemia, septikopiemia)
⚫ Rapid pulse
LOCAL SIGNS OF
INFLAMMATION
⚫ Swelling (tumor) due to increased permeability of
blood vessel walls,
⚫ Redness (rubor) due to the accelerated circulation
⚫ Increased local temperature (calor) increasing the
level of oxidative processes
⚫ Pain (dolor) increased pH
⚫ Dysfunction (functio laesa)
CLINICAL FORMS OF
INFLAMMATION
⚫ edema
⚫ infiltrate
⚫ abscess
⚫ phlegmon
⚫ fistula
DIAGNOSIS:
⚫ HISTORY
⚫ CLINICAL REVIEW
⚫ RADIOGRAPHY
THERAPY:
⚫ Extraction or tooth trepanation
⚫ Incision and drainage
⚫ Antibiotic therapy
COMPLICATIONS
⚫ mediastinitis
⚫ thrombosis of cavernous sinus
⚫ brain abscess
⚫ sepsis
⚫ exitus letalis (death)
DENTITIO DIFFICILIS OF
LOWER THIRD MOLARS
⚫ abscess
⚫ osteomyelitis
⚫ trismus
ODONTOGENIC INFECTIONS
AND PHLEGMON OF THE
NECK
⚫ During 10 years (1996-2006) 930 patients were
hospitalized at the Clinic for Maxillofacial Surgery in
Novi Sad
⚫ 85% of patients were treated by:
⚫ dentists
⚫ GP
⚫ other specialists
⚫ Infection - the successful invasion
of of microorganisms, colonization
and proliferation in the body of the
host and release of products
which lead to tissue damage
⚫Inflammation - a
response to infection
According to the characteristics of exudat
inflammation can be:
⚫ Serous
⚫ Fibrinous
⚫ Pyogenic
⚫ Phlegmonous
⚫ Hemorrhagic
⚫ Gangrenous
⚫ Necrotic
According to the course of infection is divided into:
⚫ Acute
⚫ Chronic

According to the localization of infection:

⚫ Soft tissue
⚫ Bone tissue
Local signs of inflammation:
⚫ Tumor
⚫ Rubor
⚫ Calor
⚫ Dolor
⚫ Functio laesa
Infections that
originate from
diseased teeth:
odontogenic infections
ETIOPATHOGENESIS
⚫ Causes of odontogenic infection:
1. Apical periodontitis
2. Semiimpakted and impacted teeth
3. Perikorononitis
4. Periodontal disease
5. Gingivitis
6. Inflamed cysts
7. Fractures of the jaw
Clinical manifestations depend on:
⚫ Defense capabilities of organism
(general and local)
⚫ Type, number and virulence of
microorganisms
The most common clinical
manifestations:
⚫ Localized abscess infection
⚫ Phlegmons - diffuse spreading
Predominant bacterial species encountered in acute dental infections
(Brooks I, Lewis M. Oral Surgery, Oral Medicine, Oral Pathology, Oral
Radiology, and Endodontology
Volume 100, Issue 5 , November 2005, Pages 550-558)

Anaerobic bacteria
Gram-positive cocci
Gram-negative bacilli
Peptostreptococcus species Veillonella species
Peptostreptococcus micros Prevotella species
Gram-positive bacilli Prevotella nigrescens
Porphyromonas species
Actinomyces species Porphyromonas gingivalis
Eubacterium species Bacteroides species
Propionibacterium species Bacteroides forsythus
Lactobacillus species Fusobacterium species
Fusobacterium nucleatum
Spirochetes
Treponema denticola
Facultative anaerobic bacteria
Gram-positive cocci
Streptococcus species
β-hemolytic streptococci
Streptococcus milleri group
Gram-positive bacilli
Lactobacillus species
Gram-negative Coccobacilli
Actinobacillus actinomycetemcomitans
Microorganisms agents:
Aeroba ~ 40% Anaerobes ~ 60%
Staphylococcus
Streptococcus
Pneumococcus Bacteroides sp.
Fusobacterium
Corynebacterium
Peptostreptococcus
Lactobacillus ...
Naiseria
PATH OF SPREADING OF
INFECTIONS
It depends on:

⚫ Attachment of the muscle and fascia

⚫ Morphology and position of the tooth’s roots
⚫ Bone structure of the jaws
⚫ Blood and lymphatic vessels
DIAGNOSIS
⚫ History
⚫ Clinical examination(inspection,
palpation)
⚫ Additional diagnostic methods?(X-ray,
CT, lab)
DIFFERENTIAL DIAGNOSIS
⚫ SIALOADENITIS
⚫ LYMPHADENITIS
⚫ EMPHYSEMA
⚫ HAEMATHOMA
⚫ ALLERGIC EDEMA
Complications are most often a result
of:
⚫ Reduced defense capacity of the body
⚫ Delayed and inadequate treatment
The most common complications:

⚫ MEDIASTINITIS
⚫ BRAIN ABSCESS
⚫ ABSCESS OR PHLEGMON OF ORBITE
⚫ THROMBOSIS OF CAVERNOUS SINUS
⚫ INFECTIOUS MYOCARDITIS
⚫ NECROTIZING FASCIITIS
⚫ SEPSIS
Dentist
⚫ Trepanation and drainage or tooth
extraction
⚫ Appropriate type and dose of
antibiotics
⚫ TOOTH EXTRACTION UNDER THE SWELLING
IS A MUST!
Except in the following cases:
Contraindications:
1. Inability to complet the extraction without surgery
(osteotomy)
2. Impossibility to aply the anesthesia
3. In teeth in wich can be trough the channel establish
drainage (anterior teeth)
4. Trismus
SURGEON

⚫ Adequate incision and drainage

⚫ Proper administration of the types and rates of
antibiotics
Antibiotic therapy(anaerobes
and gram positive aerobes)
⚫ EMPIRICAL
⚫ PER OS
1. Amoxicillin + metronidazole
2. Clindamycin
⚫ PARENTERAL
1. Penicillin + metronidazole
2. Clindamycin

⚫ To antibiogram
OSTEOMYELITIS OF
THE JAWS
⚫ ETIOLOGY:

⚫ trauma 6
⚫ 6 after the osteosynthesis (due the fracture 2 + the
other 4 )
⚫ odontogenic 5
⚫ per continuitatem 1
⚫ postradiation 1
⚫ INFLAMMATION OF BONE MARROW BASED ON
INFECTION
⚫ ETIOLOGY: HEMATOGENOUS, PER
CONTINUITATEM
⚫ SWELLING IN THE CENTER OF INFECTION IN
RESPONSE TO INFECTIOUS IRRITATION, PH
MOVES TOWARD ACIDIC ENVIROMENT,
INTRAMEDULLARY PRESSURE IS INCREASED
⚫ BONE MARROW NECROSIS IN THE CENTER OF
INFLAMMATION
⚫ REDUCTION OF CIRCULATION OF BLOOD
VESSELS DUE OBLITERATION AND
THROMBOSIS
⚫ OSTEOCLAST ACTIVITY ON THE EDGE OF
INFECTION, WHERE IS MORE BLOOD VESSELS
⚫ CREATING SEQUESTRATION
⚫ ACUTE AND CHRONIC
⚫ SUPPURATIVE I NONSUPPURATIVE
⚫ SPECIFIC AND NONSPECIFIC
SYMPTOMATOLOGY (ACUTE
FORM)
⚫ Fever
⚫ Disorder of general condition
⚫ Sparse local findings
⚫ Vincent sign
⚫ Dominates the local symptoms
TUMOR, RUBOR, DOLOR,
CALOR, FUNCTIO LAES
⚫ fistula
⚫ HISTORY
⚫ CLINICAL EXAMINATION
⚫ RADIOGRAPHY
⚫ SCINTIGRAPHY( depostion of radioactive isotopes)

THERAPY:
1. CONSERVATIVE
2. SURGICAL
SINUSITIS MAXILLARIS
ANATOMY
⚫ Three-sided pyramids 16-18 ml
⚫ The front wall FOSSA CANINA
⚫ Posterior wall: TUBER MAXILLAE AND MAXILLARY
INFRATEMPORAL SIDE
⚫ Upper wall: LOWER WALL OF THE ORBITE
⚫ Inner wall: BONE WALL towards the nasal cavity
Extensions (recess)
⚫ zygomatic
⚫ frontal
⚫ palatal
⚫ alveolar
FUNCTION OF MAXILLARY
SINUS
⚫ Resonance of voice
⚫ Heating the air during breathing
⚫ Reduces the weight of skull
⚫ Amortized force against the skull base
ETIOLOGY OF SINUSITIS
⚫Rhinogenic
⚫Dentigerous (10%)
⚫Allergic
CLINICAL FORMS
⚫ Acute inflammation of the maxillary sinus
⚫ Chronic inflammation of the maxillary sinus
SYMPTOMATOLOGY OF
ACUTE SINUSITIS
⚫ PAIN in supraorbital, temporal and upper jaw regions
and the area of the tooth
⚫ Fever
⚫ Amplification of pain on exertion and during bending
the head
CHRONIC SINUSITIS
⚫ SLIGHTLY SYMPTOMS
⚫ RADIOLOGICAL FINDINGS
DIAGNOSIS
⚫ HISTORY
⚫ CLINICAL EXAMINATION
⚫ RADIOGRAPHY (X-ray of paranasal sinuses, CT)
DIFFERENTIAL DIAGNOSIS
⚫ Dentigerous cysts
⚫ Malignant tumors

THERAPY:
1. CONSERVATIVE
2. SURGICAL (CALDWELL-LUC, DENKER)