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Infection in the

Maxillofacial region
Bag./SMF Bedah
FK UNPAD/RSHS Bandung

Learning objectives :
At the end of the lecture, you will be able to:

Describe the basic anatomical


considerations infection the head and neck
region
Explain the diagnostic approach to infection
in the head & neck region

Learning objectives :

Explain the common surgical infections in


cervical and head regions, including:
Lymphadenitis
Sinusitis
Deep neck abscess
Salivary gland infection
Oral cavity: dento-alveolar abscess

Introduction

Infections in the maxillofacial region can be


simple or complex, and life threatening.

Type: community acquired, nosocomial


(surgically related procedure)

Only infections which require surgical


intervention

Anatomic
considerations

Anatomic location:
Maxillofacial bones: sinuses, osteomyelitis (rare),

dento-alveolar infection
Soft tissue: oral mucosa, potential spaces, salivary
glands, tonsils, lymph-nodes

The patterns of spread of infection require the


understanding of the anatomical relationship
between structures and organ

Anatomic considerations:
lymphnode

Diagnostic approach

History:
Lump, swelling, pain, fever, bleeding?, halitosis.
Life threatening signs: stridor, tachypneu (signs of

airway obstruction)
Onset? Duration?

Physical Diagnosis:
Determine the nature of the swelling or lump: size,

location, shape, temperature, color, fluctuance,


tenderness, surface characteristics

Diagnostic approach
Oral cavity examination:

Look for any possible sources: caries, gingivitis,


salivary glands: parotis, sublingual, submandibular,
tongue, pharyng, and tonsils
Regional lymph-nodes: any enlargement, tenderness.
Skin: any change? Redness? ulcer?

Special investigations:
Routine blood examinations
X-rays: Skull, waters, panoramic, CT-scan
MRI

Lymphadenitis

Lymphnode enlargement due to infection:


acute or chronic

The cervical region:


Specific infection: tuberculosis
Non specific: bacterial, virus
Etiology:

Primary: TBC, viral


Secondary: inflammatory response to adjacent

organ infections,

Lymphadenitis

Management:
Look for any primary causes
For non specific infection: antibiotics is adequate
If no, improvement: Biopsy is required to

determine the histopathology


TBC: tuberculostatics

Sinusitis

Common, but self limited

can occur in :
maxillary, ethmoid, para nasal, and frontal sinuses

Etiology:
secondary to allergies, viruses, or bacteria.
patients who undergo prolonged nasal intubation.
Fungal infection (less frequent: diabetic, or

immuno-compromised patients)

Sinusitis

Complications: rare, spread to adjacent sinus,


meningitis, abscess.

Diagnosis:
Routine radiographs
CT scans are often required: sinus opacification

Treatment:
Uncomplicated: antibiotics
Aspiration and drainage
Chronic infection: Cadwell luc operation

Peri-tonsilar abscess

Etiology: complications of acute tonsillitis.

Pathology:
Infection is deep to the tonsillar capsule: forms between the

tonsillar capsule and the superior constrictor muscle.

Manifestations:
Massive edema of the entire soft palate
edema of the lateral pharyngeal wall.
inflammation of the pterygoid muscles can result in trismus.
may be so large that the airway is compromised.

Peri-tonsilar abscess

Management:
Tracheostomy may be necessary before it is safe

to drain the abscess.(air way obstruction)


Cellulitis: high doses of penicillin
If pus is present: incision and drainage, through a
transoral approach, with an incision along the
anterior tonsillar pillar, and drains when the patient
swallows.
These abscesses recur frequently: an indication
for tonsillectomy.

Parapharyngeal
abscess

Parapharyngeal infections and abscesses are


unusual in adults.
Can be secondary to tonsillitis or pharyngitis,
Often present as marked swelling in the
anterior cervical triangle between the carotid
sheath and superior constrictor muscles.
Common micro-organisms: streptococcus

Parapharyngeal
abscess
Management:

Penicillin is the antibiotic of choice,


Because of the proximity of the carotid artery,
these infections should be drained extraorally through an incision anterior to the
border of the sternocleidomastoid muscle.

Retro-pharyngeal
abscess

Retropharyngeal infections are unusual in


adults and
can be caused by tumor perforation or
perforation by a foreign body.
Management: best drained by means of an
incision through the posterior wall of the
pharynx;
concomitant administration of antibiotics is a
necessity.

Salivary gland infection

are unusual
most often are seen in patients with poor
dental care.
Acute inflammation may be seen when the
salivary duct is obstructed, as with a stone:
usually self-limited and controlled with
antibiotics and removal of the stone.
When unresponsive to antibiotics: excision of
the necrotic gland may be necessary.

Parotitis

can occur in :
The comunitiy (community acquired)
surgical patients, particularly elderly,
dehydrated patients.

Therapy should be directed towards:


rehydration,
enhancing salivation,
ensuring that no mechanical obstruction of the duct of

Stensen is present, obtaining stains and cultures,


administering antibiotics directed against S aureus (the most
common offending organism).