inflammatory process short for students

8/9/2019 Inflammatory Process Short for Students

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Inflammatory process of the oral

and maxillo-facial region


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Etiology and pathogenesis of odontogenic inflammatory diseases

Etiology

Inflammatory diseases of maxillo-facial area inherently are

infectious inflammatory processes, caused by microorganisms,the majority of which under ordinary conditions perennate on

skin and oral mucosa. Depending on localization of site of

entry for microbes can be distinguished odontogenic,

stomatogenic, tonsillogenic, rinogenic dermatogenic and

idiopathicinfectious inflammatory processes.


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EtiologyDental and periodontal lesions !most fre"uent#


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$raumatic lesions of jaws !fractures, which may or

not in%ol%e teeth#


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&aw osteomyelitis often lead to a spread of infection

in adjacent soft tissues.

Inflammatory diseases of sali%ary gland !as well as

lithyasis#.


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&aw tumors, odontogenic and non-odontogenic cysts

'oreign bodies which penetrate the skin or mucosa.

$onsillar inflammatory process.

'uruncle and pyodermitis of head and neck regions.

(omplications of anesthesia

(omplications of tooth extraction.

(omplications of different dental treatments !iatrogenic factors

also#


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Pathogenic mechanisms of infectious agents spreading:

$rans-osseous way usually met in inflammatory process of

periodontal tissues. Infectious agents spread along the )awers

channels !in the bone# to the periosteal !endo-osseous phase#.

*ub-mucosal way usually met in inflammatory process of

periodontal pockets.

+ymphatic and %enous ways !lead to phlebitis and

lymphadenitis#.

Direct way !septic puncture and others#.


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Mild Infection

$ri%ial - Inflammatory sign

Dolor (alor

ubor

$umor

+oss of function +ymphadenopathy

/yrexia !fe%er#

ODONTOGENI IN!ETION "GENE#$% &T'D()

linical !eatures "&igns and &ymptoms)

&e*ere Infection

$ri%al 0 signs of toxicity

/aleness apid respiration

apid thrombing pulse

*hi%ering

'e%er +ethargy

Diaphoresis !se%ere sweating#


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$cute and chronic apical periodontitis

Etiology 1dontogenic, traumatic

!orm of disease

2. 3cute *erosal4 &uppurati*e

5. (hronic 'ibrotic, 6ranulating,

6ranulomatous, (hronic in

recrudescence


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$cute periodontitis

$he pain intensity grows, becomes acute, pulsatile

Irradiate in temple, ear, eye or cer%ix.$ouching the affected tooth causes acute pain.

/atient cannot occlude tooth and therefore often keeps his

mouth a little opened.

$he surrounding gum is hyperemic./alpation of the transitory fold and gingi%al along the all

root becomes more painful.egional lymphadenitits

7ecause of pains the ingestion is hampered, the sleep isdisturbed, appears the discomfort, general weakness

'e%er

8-ray changes can be obser%ed after approx. 29-52 days.


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Differential diagnostics

Pulpitis

#adicular cyst


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acute odontogenic maxillary sinusitis "for posterior

maxillary teeth)+ periostitis and osteomyelitis,

Periostitis


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Treatment

endodontic drainage

Endodontic treatment

In case of bad treatment conditions, after the regression of

inflammatory process, a tooth extraction must be performed.

In case of periostitis signs, or bad drainage conditions, an

antibacterial, anti-inflammatory and antifungal treatment is

re"uired.


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Periostitis

Periostitis: Inflammation of the periosteum !a dense

membrane composed of fibrous connecti%e tissue that closely

wraps all bones, except the bone of articulating surfaces injoints which are co%ered by syno%ial membranes#.

Etiology: in most cases a non treated acute or

recrudescence apical periodontitis

linical picture: $cute periostitis

3fter the spreading of inflammatory process through the

bone, the infiltrate is being localized between the cortical

plate and the periosteum. Due to a good adherence ofperiosteum to it:s cortical plate, the presence of suppuration

under it is %ery painful. $his is described as intra-osseous

phase.


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General signs: /ain !local as well as headache#

'e%er !in most cases, especially in the e%ening#. 3sthenia *leep disturbance

%ocal signs:

*ymptoms of acute apical periodontitits are present /ain senses in the tooth region irradiate in temporal fossa,

ear, eye, neck !cer%ix#. $ooth percussion is %ery painful

*welling of surrounding mucosa is poor /alpation of mucosa and underling bone is %ery painful egional lymph glands increase and become more painful.


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Differential diagnosis.

2. 3cute periodontitis,

5. 1steomyelitis,

;. /hlegmon and lymphadenitis, supra-infected cysts.


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Treatment

(onser%ati%e treatmentantibiotics !determination of the antibiotic sensiti%ity, use

ofspecific, narrow- spectrum antibiotics if it is possible#,

anti-inflammatory,anti-fungal,

anti-septic medications.

*urgical main remedial measures during the acute purulent

periostitis consist in surgical prosection of suppurati%e

colection and creation of free outflow of formed exudate.


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$he incision and drainage

$ooth extraction

Osteomyelitis


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Osteomyelitis

It is a diffuse inflammation of the soft tissue and bone

in%ol%ing

the cancellous bone marrow and the periosteal component.1steomyelitis can also be defined as an inflammation of the

medullary portion of the bone.

1steomyelitis can be explained as an inflammatory condition

of

bone that begins as an infection of the medullary ca%ity and

ha%ersian systems and extends to in%ol%e the periosteum of the

affected area.


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lassification

&aws: 1steomyelitis can be non-specific- odontogenic

!stomatogenic#, traumatic, toxic, hematogenic and

specific,

$hree phases !periods# of disease course acute, su-acuteand chronic.

hronic form:producti%e hyperplastic processes or

destructi%e processes !arefying form or *e"uestrate

form# Depending on affected area +ocalized, Diffuse


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may appear as an acute or chronic form from the beginning.

!)ematogenous osteomyelitis in most cases has such a form - diffuse#.

"uick lunch

acute infectious local and general clinical picture

bone suppuration, diffuse swelling, shine skin and congestion, high local

temperature, may extend to a big area, e%en a part of neck surfaceprobing show a hard inflammatory infiltrate, painful, with bone and

periosteum swelling

trismus is present especially in posterior mandible osteomyelitis

the gum presents a significant swelling and congestion

teeth !group# pathological mobility and toothaches

)ypersali%ation

adiological picture has specific signs only after =-> days.

Diffuse Osteomyelitis


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General signs:Diffuse pain, pulsatile, irradiance'e%er !;?-


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hronic osteomyelitis -producti%e hyperplastic processes +ead to formation of hyperostosis are form 1ften appear in children, in the period of teeth eruption $he affected area has a thicker contour, a bigger %olume $he pain has an intermittent character, then a continue one

/eriods of recrudescence usually appears In mature patients the bone se"uestration is a sign of chronic

osteomyelitis !destructi%e process#


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Differential Diagnosis:

acute periodontitis acute periostitis abscesses, phlegmons cysts in maxilla-facial region

benign tumors and tumor-like diseases !cysts,osteoblastoclastoma, osteoid osteoma, eosinophilic granuloma

and so on#, and also malignant tumors.


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&pecific osteomyelitis

$ctinomycosis

During this disease it is generated a lot of fistulas with thecrumbly purulence. $he bone is swollen during the

actinomycosis. It has the look of dense fusiform tumor, inside

which become apparent cystic spaces with sings of serosal-

purulent exudate.$wo forms arefying form !from periphery to the center#

and pseudoneoplastic form !endo-osseous beginning#.


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'or Tuerculosisit is characteristic

6entle flow !months, years#

3ttenuate clinical picture, sharp morbidity

+ymphadenitis with a chronic e%olution

In the pathological process are in%ol%ed other bones

3ppears specific scar

/eriods of recrudescence may appear

*pecific radiological picture.


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&yphilis

Aaxilla syphilis appears as a result of gummous affection of

the bone or periostenium. In rare cases may appear as a resultof secondary stage of syphilis.may appear as a circumscribed !hyperostosis or gumma# or

diffuse formlymphadenitis without painDuring the suspicion for syphilis it is used serological

sedimental reactions.


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Treatment

The est treatment is the primary prophylaxis

Drug treatment: 3ntibacterial !large spectrum antibiotics#

Determination of the antibiotic sensiti%ity, use of specific,

narrow- spectrum antibiotics

3nti-inflammatory

3nti-fungal

Detoxification therapy

/roteolytic

3ntiseptic !local#


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&urgical treatment

$ooth extraction !causal#

Drainage of purulent collections !incisions and insertion ofdrains#

*e"uestrectomy must be performed only after a good

delimitation of se"uestrum !in chronic process, usually ;- weeks for lower one#

Pathology of maxillary


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Pathology of maxillarysinuses


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$natomy of Maxillary &inus

Maxillary sinus is the largest of all the paranasal sinuses present withinthe body of maxilla. It is pyramidal in shape, with its base directed

medially towards the lateral wall of the nose, and its apex directedlaterally to the zygomatic process of the maxilla. The boundaries of themaxillary sinus are:

Medial wall or base = by lateral wall of the nasal cavity.

pex = !xtends into or beyond the zygomatic process of maxilla

nterior wall = by anterior or facial wall of maxilla

"osterior wall = by infra temporal surface of maxilla

Functions of Maxillary Sinus

#. Ma$es the cranium bone lighter in weight%. cts as a resonant bone

&. 'egulates the temperature of the inspired air

(. )rainage

*. "neumatization


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Maxillary Sinusitis

Inflammation of the mucous of the maxillary sinus is calledas maxillary sinusitis. If all sinuses !maxillary, frontal,

ethmoidal and sphenoidal# are in%ol%ed, it is called as /an

sinusitis.

Types2. 3cute maxillary sinusitis It is sudden in onset and persists

for less than < weeks. Ceeds only short term therapy. !in

rare cases surgical treatment as well#

5. *ubacute maxillary sinusitis 'eatures persists for


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Etiology 1dontogenic

hinogenous

)ematogenic

$raumatic

3llergic.


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Dental causes causing maxillary sinusitis:-

#. +roantral communication

%. pical osteitis

&. 'adicular cyst and residual cyst

(. "eriodontal poc$ets*. Impacted teeth

. -oreign body in sinus.


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Clinical Features

1. Continuous nagging pain over antral cavity and

headache2. Facial pain and swelling

3. Nasal blocage with continuous purulent

unilateral nasal

discharge

!. Fever" chill" fatigue" cough" snee#ing

$. Fetid odour and halitosis due to %stulous

discharge

&. 'enderness on percussion over maxillary tooth

Treatment


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Treatment3ntral regime should be followed, this includes

2. Nasal decongestants: 0.5 percent - 1 percent ephedrine sulfate, in

normal saline e%ery =th hourly or 9.2 percent 8ylometozolin

hydrochloride, can be used as nasal drops.

$incture 7enzoin or car%ol, can be used as inhalation.

5. Antibiotics: Procaine penicillin, Amoxicillin, cla%ulanic acid or

cephlosporine can be gi%en either by oral or parenteral route.

;. Mucolytics: amphor, chlorbutal, menthol or karrol capsules canbe used to pro%ide easy drainage of the mucous by making it into a

less %iscous secretion.


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Chronic Maxillary SinusitisEtiopathogenesisThe normal mucosal cilliary tissues become hypertrophic

polypoidal/ or atrophic sclerosed/ due to prolonged neglecteddental infection or other focus of infection.Clinical FeaturesMay be asymptomatic or with mild symptoms of fever, iredness,facial pain, headache, nasal obstruction with prolonged

mucopurulant discharge which does not subside despiteantibiotic therapy.


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omplication

Infection of eyelid

1rbital abscess

estricted eye mo%ement and %ision affected

1steomyelitis of bone

Intracranial complications like meningitis, encephalitis,

extradural abscess and ca%ernous sinus thrombosis

Descending infection like otitis media, pharyngitis, tonsillitis,

laryngitis and tracheobronchitis


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Management

3fter proper diagnosis an adju%ant pharmacologic regime is

recommended as in case of acute sinusitis to reduce the

symptoms. $he focus of infection - either long standing dentalinfection, foreign body in sinus or oroantral fistula should be

treated.

$he purulent content should be properly drained, either by

irrigating in with antiseptic saline solution or by surgicaldrainage using (aldwall +uc techni"ue or nasal antrostomy or

functional endoscopic sinus surgery!'E**#


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&oft tissue inflammatory process

uick spread of the purulent exudate is causedby such anatomical particularities of

maxillofacial region as presence of big

"uantity of adipose tissue, spaces, which formsa wide range of interlocking cellular spaces,

abundant blood- and ner%e-supply, well-

marked lymphatic system.


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2. /rimary *paces

3. A38I++3F

- (anine space- 7uccal space-.Infratemporal space

7. A3CDI7G+3- *ubmental space-.*ubmandibular space-.*ublingual space-.7uccal space

5. *econdary *paces

*/3(E* ICH1+HED IC

1D1C$16ECI( IC'E($I1C*

&oft tissue inflammatory process


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(e%nitions

3bscess

a localized collection of pus in part of the

body, formed by tissue disintegration and

surrounded by an inflamed area.

/hlegmon

a spreading diffuse inflammatory process with

formation of suppurati%epurulent exudate or

pus.


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7uccal abscess


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*ubmandibular abscess *ublingual abscess


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*ubmental abscess


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)udwig*s angina

7ilateral sublingual, submandibular and submental spaces


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OMP%I$TION& O!

ODONTOGENI IN!ETION

., a*ernous &inus Thromosis

It is a septic thrombosis of ca%ernous sinus caused

due to an infection in the orofacial region, like

sinusitis, abscess or cellulitis of the orbit, upper lip,nose, maxilla or dental tissues. $he classical

dangerous area of the face !$riangular area ha%ing its

base as the upper lip and its apex as the root of nose#

has %al%eless %enous drainage which empty itselfinto the ca%ernous sinus thus making it easier for any

infection of the region to enter into the sinus.


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/, 0rain $scess

It is the second most common neurological

complication, after meningitis of head and

neck infections, occurring from bacterimia

accompanying odontogenic infections.

1, Meningitis

It is the most common neurologic complications

in orofacial infections whereby bacteria infect thearachnoid mater, pia mater and (*'.


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2, Mediastenitis

It is an extension of infection from deep neck

spaces into the mediastenum, which is causedas a %ery late complication thereby causing chest

pain, dyspnea, unremitting fe%er and characteristic

mediastenal widening in radiograph. $he

condition is treated by long term antibiotictherapy and surgical drainage of mediastenum.

3, &eptic pneumonia

/neumonia caused by hematogenic spreading of

infection

PERICORONITIS


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PERICORONITISIt is a infection of the operculum co%ering the partially

erupted permanent teeth specially the mandibular ;rd molar.

/redisposing factors of the condition

Improper oral hygiene,

1cclusal trauma,

6ingi%al infection,

'ood lodgment,

educed body resistance.


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Types of Pericoronitis

/ericoronitis can be classified into ; types depending upon

the features present

2. 3cute )ere all the classical features are present

5. *ubacute )ere the classical symptoms ha%e subsided but

certain signs are still present along with the presence of a

sinus tract.

;. (hronic )ere most of the features ha%e subsided but a

distinct fistulous tract is present.

Features


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Features Crypt lie area is formed between thetooth and

operculum which favours food and debrislodgement

and thus microbial proliferation. +evere locali#ed or radiating pain.

(istinct extraoral and,or intraoral swellingnear theangle of mandible of the a-ected side

and,or

opposite to 3rd molar respectively. +ubmandibular lymphadenopathy andlymphadenitis. Fever" malaise" increased pulse rate"

increased


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Treatment

In case of 3cute /ericoronitis, general management of an

odontogenic infection - complete bed rest, soft nutritious

diet and proper oral hygiene with use of mouth rinses, isad%ised.

/roper use of antibiotic and analgesic should be instituted

- /enicillin, Doxycycline, and Aetrinidazole is preferred.

$horough debridement of tissues with chlorhexidineirrigation and hot saline mouth wash.


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In certain cases, surgical excision of the operculum -

operculectomy or use of caustic agents or electrocauterywith or without extraction of the offending, opposing

maxillary tooth is adi%ised.

In case of chronic /ericoronitis, proper antibiotic and

analgesic with or without extraction of offending,opposing maxillary tooth is recommended.


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%ymphadenitis and phlegmonous adenitis

+ymphadenitis is an inflammatory process in the

lymph gland.$natomical data,

$he tonsillar, submaxilary, and submental nodes

drain portions of the mouth and throat as well as more

superficial tissues of the face.Jnowledge of the lymphatic system is important

to a sound clinical habit whene%er a malignant or

inflammatory lesion is obser%ed, look for in%ol%ement

of the regional lymph nodes that drain it whene%er anode is enlarged or tender, look for a source in the

area that it drains.


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$he reason of maxilla-facial region lymphadenitis can be an

odontogenic infection during acute periodontitis and

aggra%ation of this chronic process, suppuration of the rootcyst, odontogenic process in periosteum, jaws bone, soft

tissues. +ymphadenitis can also be otogenic, tonsilogenic,

stomatogenic, idiopatic.

lassification of the lymphadenitis


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lassification of the lymphadenitis

3ccording to etiology odontogenic and nonodontogenic,

rinogenic, tonsillogenic, infectious and traumatic,dermatogenic, tumoral, stomatogenic, specific and

nonspecific.

3ccording to pathogenesis lymphangitis, lymphadenitis,adeno-abscesses, adeno-flegmons.

3ccording to the clinical picture acute !serosal, purulent# and

chronic !purulent, proliferate#

Deep and superficial.


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Distinguish two types of lymphadenitis acute and chronic

lymphadenitis.

3cute lymphadenitis can proceed in serosaland purulent

forms. (hronic lymphadenitis proceeds in the hyperplastic

form, it can transfer in the purulent form.

T t t


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Treatment:

'irst of all treat the cause of lymphadenitis

!conser%ati%e or surgical#

(onser%ati%e 3ntibacterial !large spectrum antibiotics#

Determination of the antibiotic sensiti%ity, use of

specific, narrow- spectrum antibiotics

3nti-inflammatory 3nti-fungal

Detoxification therapy

3ntiseptic !local#

*urgical in case of purulent lymphadenitis or in

phlegmon-adenitis.


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Do not e*er crush an acne

!uruncle is ac te s pp rati e inflammation of hair follicle


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!uruncle is acute suppurati%e inflammation of hair follicle

and surrounding its tissues. In the following the inflammation

goes into surrounding connecti%e tissue.

Aultiple affections by furuncles are named furunculosis.

Ethiology It is caused oftener by aurococcus, rarer by white

staphylococcus, sometimes by other microorganisms !for

example streptococcus#.

$hree stage Infiltrati%e, abscess, and wound healing

'ace furuncles often are accompanied by the regional

lymphadenitis, but suppuration of the lymph nodes appearsseldom.

* h i h h d h hilli l


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*uch patients ha%e headache, chilling, general

indisposition, which ser%e as manifestation of the

organism:s intoxication.

Especially difficult clinical course is characteristic for

upper lip furuncles, in the nasolabial triangle. 7ecause

of relati%ely not fre"uent appearance of threatening

aggra%ations !thrombophlebitis of facial %eins andca%ernous sinus thrombosis , senses,

meningoencephalitis# such furuncles are named

KmalignantL.

aruncle is named acute purulent-necrotic inflammationof se%eral hair pouches and oil glands with the formation of

the general infiltrate and %ast skin necrosis and subdermal

cellulose.


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Treatment

Gncomplicated furuncles in the first stage are treated

ambulatory as a rule. 'irst of all should be eliminate any

external irritator sha%ing, a small tissue trauma in the

furuncle region, o%erlapping on the focus and surrounding

tissues of the semi-spirituous bandage at one hour !to donot cause skin irritation# during ;-B days.

'uruncles of the II stage and carbuncles are treated only in

the hospital.

+ocal treatment in the disease acute phase is performed for

creation of pus outflow and exudate from the suppurati%e

focus


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3ntibacterial therapy

Disintoxication therapy

Desensibilization therapy

3nticoagulant !direct action - )eparin#

*urgical treatment

inflammatory process short for students

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