Odontogenic infection pathway are caused by oral pathogens that inhabit the surface of the teeth and oral mucous membranes and are also found in the gingival sulcus and saliva Odontogenic infections Microorganisms involved in mixed bacterial infections of the oral cavity Nonodontogenic source (secondary infect.) § an infection surrounding the oral cavity as the skin, tonsils, ears or sinusitis Dental origin (primary infection) § progressive dental caries § extensive periodontal disease § trauma caused by dental procedures Infection in oral cavity can be: > Rubor - due to vasodilatation effect of inflammation Tumor - caused by pus accumulation and oedema Calor - caused by accelerated local metabolism Dolor - results from pressure on sensory nerve caused by edema or infection Functio laesa - problems with mastication, trismus, dysphagia, and respiratory impairment Dental infection normally produce the classic signs of infection: Spread of dental infection 1. per continuitatem The path of least resistance - by spaces in the head and neck 2. by vascular system 1. 3. by lymphatic system The various pathways of spread with odontogenic infections: 1. Spread of dental infection per continuitatem Spread of apical infection § periodontal gap § alveolar process § The type and virulence of the microorganisms involved and the immunological condition influence the degree of spread of infection § § Infection may be: - localized (abscess) - diffused (infection tends to spread rapidly through the tissues along the line of least resistence into the anatomically demarcated tissue spaces) Abscess Periapical - progressive carries, pathogens invade the pulp and spread apically Periodontal - caused by spread from an infected gum (usually in adults) Pericoronal - around an erupting third molar A closed tissue space with supuration from a dental infection Local abscess can spread along the anatomically demarcated tissue spaces An barrier is the fascia and the muscle attachments to the bones mylohyoid muscle buccinator muscle Vestibular Abscess § the roots of all teeth of upper and lower jaw § § if the roots are localized upon the muscle insertion (lower jaw) or below muscle insertion (upper jaw) § abscess perforate bone on the vestibular plate of the alveolar process Palatal Abscess § the roots of the upper lateral incisors or the first premolars and molars (roots often incline palatally) § § § usually no spraed over palatine raphe The submucosal portion of the hard palate contains neurovascular bundle, minor salivary glands a lymfoid tissue § § the rich innervation of the periosteum - painful ! § § the course of the palatine artery - bleeding ! Buccal Space § premolars and molars both jaws § if the roots are localized above the buccinator muscle insertion (upper jaw) or below insertion (lower jaw) § § infection spread into the soft tissues of the cheek → along anatomical planes toward the infratemporal or pterygopalatine fossa (pterygomandibular raphe!) § molars of upper jaws § § infection may ascend into the cavernous sinus (through venous plexus in the ovale and spinosum foramen), orbita, temporal fossa, pterygopalatine fossa Infratemporal Space Infratemporal space § between the temporal fascia and the temporal bone § § inferiorly communicate with infratemporal space Temporal Space Temporal space Infraorbital Space § between the levator anguli oris and the levator labii superioris muscles § § possible infection via the angular vein → opthalmic vein → spread into the cavernous sinus § § collateral oedema often includes the upper lip and lower eyelid § usually anterior superior teeth, less often the premolars Maxillary Sinus § occasionally of dental origin, more often by respiratory infection § § buccal and sometimes palatine root of first or second molar, second premolar that perforate the sinus floor § § the floor of nasal cavity is infected from the anterior teeth Submental Space § spread beneath the mylohyoid muscle into the submandibular area § mandibular anterior teeth § § the root of teeth lay below the muscles insertion (mental + depressor labii inf. muscles) Submandibular Space § the root of teeth lay root apices lay below the buccinator muscle insertion § mandibular posterior teeth § spread beneath the mylohyoid muscle into the submandibular area § mandibular posterior teeth Sublingual Space § spread to the sublingual space - between the mouth floor and mylohyoid muscle § CAVE! Ludwig´s angina § § spread along submandibular duct into submandibular space Ludwig´s angina = the right and left submandibular, sublingual and submental spaces are infected A fulminant infection can spread rapidly to pharyngeal and retropharyngeal space Figure 5 Submandibular space Submental space Sublingual space Masseteric Space l: parotideomasseteric fascia m: ramus of the mandible s: zygomatic arch i: insertio of the masseter muscle § posterior teeth of the lower jaw § expand laterally to the pterygomandib. space § oedema of the overlying masseter muscle Tento prostor v topografii neprobírali, proto je nutné ho vysvětlit zde ! Masseteric space Pterygomandibular Space § infection may spread into infratemporal space § carious, partially erupted mandibutal third molar or needle tract infection of anesthetize of inferior alveolar nerve Pterygomandibular space Alveolar inferior artery, vein and nerve ! Lateral Pharyngeal Space § peritonsillar infection penetrate the pharyngeal constrictor muscles → lateral pharyngeal space § shaped like an inverted pyramid, base at the base of the skull and its apex at the hyoid bone § by aponeurosis of Zuckerkandl is space divides into prestyloid and poststyloid compartments Lateral pharyngeal space Visceral space Visceral Paravisceral Retrovisceral Pretracheal space Prevertebral space The Neck Spaces between middle and profound cervical fascia § Subcutaneous - between the superficial cervical fascia and platysma § § Suprasternal - between the superficial and middle cervical fascia § § Pretracheal § § Parapharyngeal § § Retropharyngeal Abscess Retropharyngeal abscess 2. Spread of dental infection by blood system § Bacteremia - bacteria traveling in the blood § Infected thrombus - dislodge from the inner blood vessel wall and travel as an embolus → dural venous sinuses → brain or internal jugular vein → thrombophlebitis In general, veins of the head and neck lack valves, so blood can flow into and out of the cranial cavity ! Anterior pathway ophtalmic v. infraorb. v. deep facial v. Posterior pathway pterygoid plx. → oval or spinosum for. 3. Spread of dental infection by lymphatic system Repetition of the 2nd semester Palatal Sublingual Mylohyoid muscle Submandibular Buccal Vestibular Buccinator muscle Vestibular Buccal Vestibular g-hyo g-gl st-gl hy-gl Gl. s-li Gl.s-m Sublingual space Submandib. space Submental space Spatium basale intermusculare linguae a. lingualis n. lingualis dct. submand. n. XII. A. sublingualis může chybět, pak je nahrazena větví z a. submentalis. To má praktický význam, neboť krvácení v regio sublingualis se běžně staví ligaturou a. lingualis. V těchto případech je ligatura neúčinná. A. sublingualis anastomozuje s a. submentalis, drobné spojky pronikají skrze m. mylohyoideus. Skrze m. mylohyoideus prostupují ze sublinguálního lože i lymfatické cévy. Regio sublingualis je spojeno štěrbinami ve spodině jazyka a s regio submandibularis. Zdůraznit průběh m. mylohyoideus a vztah kořenů nad či pod ním.