Inflammatory disease of Inflammatory disease of maxillofacial area (odontogenicmaxillofacial area (odontogenic and and

non odontogenicnon odontogenic).). CLASSIFICATION OF INFLAMMATORY PROCESSES OF MFA. CLASSIFICATION OF INFLAMMATORY PROCESSES OF MFA.

PERIOSTITIS, OSTEOMYELITIS, ABSCESS, PLEGMONAS: PERIOSTITIS, OSTEOMYELITIS, ABSCESS, PLEGMONAS: ETIOLOGY, PATHOGENESIS, CLINICAL COURSE OF, ETIOLOGY, PATHOGENESIS, CLINICAL COURSE OF,

COMPLICATIONS, PROPHYLAXIS. COMPLICATIONS, PROPHYLAXIS.

Course of maxillofacial surgery and stomatology Course of maxillofacial surgery and stomatology of of Tashkent Medical Academy, associate professor Tashkent Medical Academy, associate professor

Sh.A.BoymuradovSh.A.Boymuradov

Table of ContentTable of Content Overview

     General symptoms of inflammation    Clinical manifestations of inflammation   Differential diagnosis   Differential diagnosis   Causes   Causes   Spectrum of bacterial therapy   Spectrum of bacterial therapy   Prevalence of different abscesses   Prevalence of different abscesses   Classification of abscesses   Classification of abscesses          

OverviewOverview

Inflammation is a defence reaction Inflammation is a defence reaction of the organism to local injuries of of the organism to local injuries of any type, to infection.any type, to infection.Infection is a pathological state Infection is a pathological state resulting from the invasion of the resulting from the invasion of the body by pathogenic microorganisms body by pathogenic microorganisms and their proliferation within the and their proliferation within the organism.organism.

Inflammation diseasesInflammation diseases

Non odontogenicNon odontogenicOdontogenicOdontogenic

Non odontogenic Non odontogenic inflammation diseases inflammation diseases

1. 1. FufuruncleFufuruncle 2. 2. AnthrexAnthrex 3.3. erysipelas erysipelas 4. 4. Sibir cankerSibir canker 5. 5. Noma (gangrenuos stomstitis)Noma (gangrenuos stomstitis)

Non-odontogenic causes of Non-odontogenic causes of soft tissue infectionssoft tissue infections

Infected fractureInfected fracture Infected soft tissue wounds or tumorsInfected soft tissue wounds or tumors Infection by foreign bodiesInfection by foreign bodies Infection after injectionInfection after injection Inflammatory of skin or mucosal Inflammatory of skin or mucosal

membrane disordersmembrane disorders Haematogeneous or lymphogeneious Haematogeneous or lymphogeneious

spreadingspreading

Furuncle (inflammation Furuncle (inflammation of pileous follicle)of pileous follicle)

Anthrex (inflammation a Anthrex (inflammation a lot of pileous follicle)lot of pileous follicle)

Complication of furuncle Complication of furuncle of the face: of the face:

Tromboflibitis of veinTromboflibitis of vein

Facial vasselsFacial vassels

Triangle of the deathTriangle of the death

Odontogenic inflammation Odontogenic inflammation disesases of the facedisesases of the face

1. 1. Acute odontogenic periostitisAcute odontogenic periostitis 2.2. Acute Acute osteomyelitis of jawsosteomyelitis of jaws 3. 3. Odontogenic abcsessesOdontogenic abcsesses 4. 4. Odontogenic phlegmonasOdontogenic phlegmonas 5. 5. Odontogenic lymfadinitisOdontogenic lymfadinitis

OdontogenicOdontogenic centre of centre of the inflammationthe inflammation

Classic signs of acute Classic signs of acute infection appearinfection appear

HeatHeat RednessRedness Tumor (oedema)Tumor (oedema) Loss of function (trismus, difficult to Loss of function (trismus, difficult to

swollow speech)swollow speech) Additional: leucocytosis and CRP Additional: leucocytosis and CRP

increasis increasis

CRP (C-reactive protein) is synthesised in the liver.CRP (C-reactive protein) is synthesised in the liver.It is one of the chemical mediators of inflammation and It is one of the chemical mediators of inflammation and its serum level increases faster and to higher levels its serum level increases faster and to higher levels than that of any other parameters in acute infectious than that of any other parameters in acute infectious and non-infectious inflammation.and non-infectious inflammation.

Therefore, CRP belongs to the group of acute-phase Therefore, CRP belongs to the group of acute-phase proteins. These are blood lipids the concentration of proteins. These are blood lipids the concentration of which increases in the course of inflammatory diseases.which increases in the course of inflammatory diseases.

CRP binds to invading foreign substances and activates CRP binds to invading foreign substances and activates important steps of the immune system with important steps of the immune system with macrophages and the complement system. Due to its macrophages and the complement system. Due to its relatively short half-life of 24 hours, changes in CRP relatively short half-life of 24 hours, changes in CRP concentration indicate changes in the inflammatory concentration indicate changes in the inflammatory process.process.

Odontogenic chronic Odontogenic chronic inflammation centreinflammation centre

Inflammation centreInflammation centre

The clinical picture of acute The clinical picture of acute periostitis of the jaws. periostitis of the jaws.

1.1.Presence of causal teethPresence of causal teeth 2. 2. Smoothness of a transitive foldSmoothness of a transitive fold 3. Fluctuation of a transitive fold3. Fluctuation of a transitive fold 4. 4. Painful percussion of causal toothPainful percussion of causal tooth Increases of temperature up to 38 грIncreases of temperature up to 38 гр Dysfunctions: opening of a mouth, Dysfunctions: opening of a mouth,

chewing, speech, swallowing.chewing, speech, swallowing.

Acute odontogenic Acute odontogenic periostitisperiostitis

Tipes of osteomyelitis of Tipes of osteomyelitis of the jaw on the pelationship the jaw on the pelationship

of causesof causes 1. 1. Odontogenig osteomylitisOdontogenig osteomylitis 2. 2. Traumatic osteomylitisTraumatic osteomylitis 3. 3. Hematogen osteomylititsHematogen osteomylitits

DevelopmentDevelopment infections infections from a top of a root of a from a top of a root of a

toothtooth

The theory of progress of The theory of progress of osteomylitis of jawsosteomylitis of jaws

1.1. The infectious-embolic theory The infectious-embolic theory Infringements innervationInfringements innervation of jawsof jaws The theory a sensitizationThe theory a sensitization

The mechanism of The mechanism of progress of an infectionprogress of an infection

Stages of current of an Stages of current of an osteomyelitis of jawsosteomyelitis of jaws

1. 1. AcuteAcute 2. 2. under acuteunder acute 3. 3. chronicchronic

Clinical picture of a acute Clinical picture of a acute osteomyelitisosteomyelitis

1 1 Looseness of a causal toothLooseness of a causal tooth Infringement of function: opening of a Infringement of function: opening of a

mouth, chewing, speeches and mouth, chewing, speeches and swallowingswallowing

Mobility of a several teethMobility of a several teeth Smoothness of a transitive fold from Smoothness of a transitive fold from

two sides.two sides. Rise in temperature of a body up to 41 Rise in temperature of a body up to 41

гр.гр. FeverFever

Acute necrotic Acute necrotic osteomyelitisosteomyelitis

TreatmentTreatment of of osteomyelitis of lawsosteomyelitis of laws

Elimination of cause (causal teeth Elimination of cause (causal teeth extraction)extraction)

IncisionIncision discharge of pus discharge of pus Spreading of the abcsses cavitySpreading of the abcsses cavity Osteoperforation of injure boneOsteoperforation of injure bone drainage of the pus cavitydrainage of the pus cavity Facultative antibiotic treatmentFacultative antibiotic treatment

Types of abscesses and Types of abscesses and phlegmonasphlegmonas

1. 1. Superficial locatedSuperficial located 2. 2. middle deep locatedmiddle deep located 3. 3. deep locateddeep located

AbscessAbscess

submucous abscess, smooth vestibulesubmucous abscess, smooth vestibuleLocalized collection of pus an a cavity Localized collection of pus an a cavity caused by necrosis of tissue due to caused by necrosis of tissue due to bacterial infectionbacterial infection

Demarcation by abscess mambrane Demarcation by abscess mambrane (granulation tissue)(granulation tissue)

Firm elastic consestenceFirm elastic consestence Fluctuation can be palpated only in Fluctuation can be palpated only in

superficial abscessessuperficial abscesses

Odontogenic abscesses Odontogenic abscesses

OedemaOedema Oedematous swelling of the ocular region Oedematous swelling of the ocular region

in abscess of the canine fossa in abscess of the canine fossa concomitant oedema of the upper lip in concomitant oedema of the upper lip in submucous abscess in region 11 submucous abscess in region 11 accumulation of fluid in tissue accumulation of fluid in tissue

classic sign of any acute inflammation classic sign of any acute inflammation (tumour)(tumour) soft and elastic on palpation soft and elastic on palpation.. Due Due to the anatomical situation in the to the anatomical situation in the maxillofacial region, the typical fluctuation maxillofacial region, the typical fluctuation of an abscess is absent in the majority of of an abscess is absent in the majority of cases or only rarely identifiablecases or only rarely identifiable

Differential diagnosisDifferential diagnosis of of abcsessesabcsesses

swelling caused by neoplasms swelling caused by neoplasms (sarcomas, malignant lymphomas, (sarcomas, malignant lymphomas, carcinomas) carcinomas)

salivary gland diseasesalivary gland diseasess

Inflammation more 2 Inflammation more 2 anatomical region anatomical region

(phlegmonas)(phlegmonas)

Phlegmon (cellulitis)Phlegmon (cellulitis) diffusely spreading inflammation between diffusely spreading inflammation between

superficial tissue levels (without being superficial tissue levels (without being limited to them) limited to them)

No demarcationNo demarcation infection by highly virulent bacteria (release infection by highly virulent bacteria (release

of lytic enzymes) of lytic enzymes) impaired defence mechanisms of the impaired defence mechanisms of the

organism organism serous-purulent and necrotising serous-purulent and necrotising inflammation inflammation

serous-purulent and necrotising serous-purulent and necrotising inflammation inflammation

firm to hardfirm to hard on palpation on palpation

Several phlegmonas Several phlegmonas submandibular and submandibular and

parapharigial regionparapharigial region

Odontogenic causes of Odontogenic causes of soft tissue infectionssoft tissue infections

In 92-94% of the cases, infections in In 92-94% of the cases, infections in the oro-maxillofacial region are of the oro-maxillofacial region are of odontogenic originodontogenic origin

Periapical periodontitisPeriapical periodontitis Infection after teeth extractionInfection after teeth extraction difficult dentition (pericoronitis)difficult dentition (pericoronitis) Marginal priodontitisMarginal priodontitis infected retained root fragmentsinfected retained root fragments

Phlegmona of infrairbital Phlegmona of infrairbital regionregion

CT ckanner of CT ckanner of inflammation diseasesinflammation diseases

Orbital phlegmonasOrbital phlegmonas

Orbital pflegmona Orbital pflegmona

Anaerobic floraAnaerobic flora Odontogenic infections are always caused by Odontogenic infections are always caused by

a mixed flora of aerobic and anaerobic a mixed flora of aerobic and anaerobic bacteria. bacteria.

The count of anaerobic bacteria always The count of anaerobic bacteria always outnumbers that of aerobic bacteria (at least outnumbers that of aerobic bacteria (at least by 10by 1022). ).

Pure anaerobic mixed infections also occur. Pure anaerobic mixed infections also occur. Anaerobic bacteria play a predominant role in Anaerobic bacteria play a predominant role in the generation and spreading of odontogenic the generation and spreading of odontogenic soft tissue infections. Infection by clostridia as soft tissue infections. Infection by clostridia as well as mixed infections by yeasts and well as mixed infections by yeasts and bacteria may occur bacteria may occur 

Several phlegmona of flor Several phlegmona of flor of mouse (ludvig angina)of mouse (ludvig angina)

TherapyTherapy

The following statement that Galen The following statement that Galen made almost 2,000 years ago - "ubi made almost 2,000 years ago - "ubi pus, ibi evacua" (if there is pus, pus, ibi evacua" (if there is pus, remove it) which is still valid in the era remove it) which is still valid in the era of antibiotics could be considered the of antibiotics could be considered the clinical conclusion from the abscess clinical conclusion from the abscess pathophysiology explained above. pathophysiology explained above. Therefore, incision and drainage are Therefore, incision and drainage are the primary therapy of an phlegmonas the primary therapy of an phlegmonas

Incision of an abscess is advisable, Incision of an abscess is advisable, possibly by a sufficiently wide incision possibly by a sufficiently wide incision at the maximum point of the swelling.at the maximum point of the swelling.

Obtain sufficient discharge of pus Obtain sufficient discharge of pus with the incision. Prepare for with the incision. Prepare for drainage of the purulent exudatedrainage of the purulent exudate

In smaller abscesses, it is usually In smaller abscesses, it is usually sufficient to insert a Iodoform gauze sufficient to insert a Iodoform gauze packing strip for 2-3 days; extensive packing strip for 2-3 days; extensive abscess cavities are drained through a abscess cavities are drained through a tube that is fixed in place with suturestube that is fixed in place with sutures

rinsing of the abscessrinsing of the abscess Culture and antibiotic sensitivity Culture and antibiotic sensitivity

testingtesting Antibiotics for parenteral therapyAntibiotics for parenteral therapy

Infections are classified as mild, Infections are classified as mild, moderate or severe infections.moderate or severe infections.Differential surgical and antibiotic Differential surgical and antibiotic treatment is indicated according to the treatment is indicated according to the extension tendency and severity grade extension tendency and severity grade of infection as well as the general of infection as well as the general condition of the patient.condition of the patient.

Health teethHealth teeth, , no no complication complication

Thank you for attentionThank you for attention