Specialized Pathology Part 1

- Infection

- Maxillary sinus

- Feeling of disorientation

- Soft tissue injuries

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Lesson 28

MAXILLOFACIAL INFECTION

1. Inflammatory diseases caused by teeth :

Most maxillofacial infections are caused by tooth decay that then progresses to pulpitis or acute or chronic periapical inflammation. When there is pus at the tip of the tooth, it escapes through three routes: the root canal, the periodontal membrane, and the alveolar bone. In this case, pus can reach the jawbone. Therefore, in cases of periodontitis or wisdom tooth eruption, pus can also enter the periosteum and then penetrate the bone into the soft tissue , causing infection in the loose tissue or osteomyelitis. For baby teeth, because the roots are short, it rarely causes inflammation in the loose tissue.

1.1. Cellulitis :

Cellulitis is a loose connective tissue, if inflamed it spreads to the soft tissue and is not limited to abscesses . Inflammation can be localized or spread throughout the facial tissue. The cause is often due to rotten pulp due to decay or trauma, creating lesions around the root tip such as granulomas, abscesses , cysts, etc. or due to inflammation around the tooth when wisdom teeth grow, periodontitis, trauma. There is no specific type of bacteria that causes cellulitis, but all types of bacteria commonly found in the mouth.

such as staphylococci, streptococci, spirochetes, anaerobic bacteria. Cell tissue becomes inflamed when pus invades directly, or due to bacterial toxins, or due to infection spreading through the lymphatic system. Cellulitis can be divided into focal and diffuse cellulitis.

1.1.1. Condensed cellulitis:

The most common forms of the disease are acute, subacute, chronic and gangrenous.

a. Acute inflammation :

* Serous inflammation: [serosive cellulitis] is the first stage of coagulative cellulitis, with circulatory disturbances [vasoconstriction, vasodilation] and serous leakage.

- Clinical symptoms:

+ Unclear systemic symptoms.

+ Local symptoms: swelling covers the grooves and depressions on the face, the face swells more or less depending on the location of the tooth, the cause and the toxicity of the bacteria, the skin is shiny, feels a bit hot to the touch, a little red, not very painful, no finger marks.

- Diagnosis:

+ Identification: based on medical history of toothache...

+ Differentiate: inflammation due to nail, trauma due to foreign objects penetrating the mucosa, jaw osteomyelitis, lymphadenitis...

- Progress: cured after a few days if the cause is treated or progresses to the pus stage.

- Treatment: endodontic treatment to preserve the tooth or tooth extraction depending on the patient's condition and each specific case.

* Purulent phlegmon : [purulent cellulitis] when the disease progresses to this stage, systemic and local symptoms become more evident.

- Symptom:

+ Whole body: high fever, rapid pulse, headache [when pus begins to collect, fever subsides].

+ Local: swollen face, red skin, hot to the touch, constant pain, unable to open mouth wide, bad breath. For the lower jaw, when the tooth is further back, the condition of trismus becomes more severe, the pain causes loss of appetite and sleep, taking medicine does not help, causing physical deterioration. At first, it is difficult to see the signs of wave change indicating pus accumulation.

- Diagnosis:

+ Identification: based on history of toothache, location of swelling related to the causative tooth.

+ Differentiation: in the lower jaw, it can be mistaken for inflammation of the floor of the mouth due to blockage of the Wharton's salivary duct , purulent mastoid cyst, and submandibular lymphadenitis. In the upper jaw, inflammation spreading to the lower eyelid can be mistaken for dacryocystitis.

- Progression: when pus escapes through the skin or mucous membranes in the mouth, forming a fistula , the disease will improve, but if the cause is not treated, it will relapse and progress to the chronic stage. If the patient's health deteriorates or the bacterial toxins are strong, it will cause more serious complications such as blood infection, widespread inflammation, osteomyelitis, etc.

- Treatment: Combination of systemic and local treatment. Use high doses of antibiotics, use an antibiotic susceptibility test to find an effective antibiotic, pay attention to improving the health. Resolve the cause of the tooth, in case of recurrence, it should be extracted as soon as possible. After extraction, although part of the pus has escaped through the tooth socket, some pus still remains, so the pus must be incised and drained. If the disease progresses to the surrounding area, the abscess must be incised to drain the pus. When the disease persists or does not improve, pay attention to causes such as granulomas, osteomyelitis of the jaw, due to

The tooth next to the root cause also has dead pulp or other causes of physical weakness.

b. Subacute inflammation :

Occurs when the pathogen is weak and the infection progresses slowly, giving the body time to develop resistance. There are two types:

+ Type 1 abscess : after the inflammatory stage with serum, the skin is red and swollen, sometimes purple, slightly hot to the touch, the swelling has a clear, round border, the center is soft and the surrounding area is hard with signs of wave motion, shaking and feeling the swelling area is stuck to the bone. Opening the mouth is limited when the cause is a molar located near the chewing muscle. Examination of the oral cavity shows that the corridor is full, the mucosa is red and shiny, the cause of the tooth is slightly painful or has just been extracted a few days ago. If not treated well, the pus will burst, creating a deep hole in the skin and sticking to the bone .

+ Multiple abscesses : also appear after inflammation with serum but located in the jaw angle and neck area, exploration shows that the abscess is very shallow and the surrounding skin is not sclerotic, the swelling is painful and soft, gradually showing signs of wave change, then pus bursts out of the skin, then abscesses appear in the surrounding area and then burst again. There are cases where the tooth is intact.

Abscesses continue to appear after extraction because the inflammation spreads from one place to another, maintaining the fistula.

Early treatment and good drainage will avoid this situation.

This.

c. Chronic inflammation :

Appears after acute or subacute inflammation. The inflamed area does not completely collapse but is gathered under the skin with a round finger, no pain, clear boundary, mobile but feels attached to the bone, normal color. After a while, there is a fistula in the skin, distinguishing it from tuberculous lymphadenitis because it does not attach to the bone and creates many slow-healing fistulas [needs tuberculin test, lymphadenectomy].

Treat the underlying tooth, incise the abscess intraoral to avoid scarring. If the pus leaks for a long time, the fistula must be scraped, irrigated, and drained.

d. Gangrene :

This is an intermediate condition between stasis and diffuse inflammation, with foul-smelling pus collected in a cavity of loose tissue and debris of necrotic tissue.

Symptoms: high fever, general fatigue, mass

swelling in the face is rough to the touch.

Progression: If not treated promptly or adequately, the disease will become widespread.

Treatment: deep and wide incision for good drainage, antibiotics, and improved physical condition.

1.1.2.Diffuse cellulitis:

This is an inflammation that spreads without limit and at the same time, there is widespread necrosis of the inflamed tissues. The first few days have no pus. The pus does not accumulate immediately but is eliminated with the necrotic tissue. The disease often occurs after acute periodontal arthritis, periodontal inflammation or after difficult tooth extraction. It is sometimes seen after jaw fracture or osteomyelitis.

- Symptom:

In the first days, the systemic symptoms are very severe: chills, high fever, rapid pulse, delirium, difficulty breathing, vomiting, diarrhea. The swelling depends on the location of the inflamed area. The patient may die after the 2nd or 3rd day due to systemic poisoning.

If the pus collects after the 5th or 6th day, it then escapes through the skin due to skin perforation due to necrosis or after incision, the pus comes out with the necrotic tissue.

Specialized Pathology Part 1 - 27

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