3319913603 by Unknown

Author:Unknown
Language: eng
Format: epub
Published: 2019-02-08T08:27:00+00:00

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G. Hayek et al.

Table 13.8 Relative severity of deep fascial space infections

Low severity—low risk to airway or vital structures

• Vestibular

• Subperiosteal

• Buccal

• Space of the body of the mandible

• Infraorbital

Moderate severity—hinders airway access

• Submandibular

• Sublingual

• Submental

• Masticator

• Submasseteric

• Pterygomandibular

• Superficial temporal

• Deep temporal

High severity—direct threat to airway or vital structures

• Perimandibular

• Lateral pharyngeal

• Retropharyngeal

• Pretracheal

• Danger space

• Mediastinum

• Intracranial infection

From: Hupp, J., and Ferneini, E. Principles of Antibiotic Therapy for Head, Neck, and Orofacial Infections. Head, Neck, and Orofacial Infections 2016; p 127

Whichever deep fascial space is infected, it is important to understand that the risk to the airway is real and compromise can occur quickly. Thus, it is important to quickly recognize the affected space so that treatment can be initiated. The relative severity of each potential space infection can be classified by the likelihood of threatening the airway or other vital structure (see Table 13.8). Low-severity infections are not likely to threaten any vital structure. Moderate-severity infections can hinder access to the airway via trismus or tongue elevation, potentially making endotracheal intubation difficult. High-severity infections can compress or deviate the airway or damage vital organs such as the heart, lungs, or brain.

13.4 Management and Treatment

When treating infections, the clinician must keep in mind all of the preceding information. Applying this information to a series of principles can be used stepwise to make treatment decisions.

13.4.1 Determine Severity of Infection

Though the above discussion on fascial planes can be intimidating, as previously mentioned, most odontogenic infections are mild and require only minor surgical therapy. The severity of infection can be determined with a complete history and

13 Odontogenic Infections

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physical examination to evaluate airway patency, anatomic location, and rate of progression. The history should be obtained as any other history would be, by starting with the chief compliant in the patient’s own words. The provider should then determine the onset of the infection. This can be obtained by asking the patient when they first began to experience symptoms such as pain, swelling, or drainage.

The provider will want to know if the infection has been constant, waxed and waned, or steadily grown worse. These questions will help the practitioner determine the rate of progression of the infection.

The signs and symptoms of the infection should be assessed at this time as well.

An infection is the body’s response to severe inflammation, and as such, the cardinal signs of inflammation are what to look for in on examination. These include dolor (pain), tumor (swelling), calor (warmth), rubor (erythema), and functio laesa (loss of function).

Pain is generally the most common complaint from patients. The clinician will want to know where the pain started and where the pain has spread. Swelling can range from subtle and difficult to notice to quite obvious. In cases of subtle swelling, the patient may be able to point out an area of their own body that doesn’t look right to them better than the practitioner, and as such the patient should be specifically asked if they have noticed any swelling. Similarly, the patient

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