Facial Infections

Major pathway for spread of infections from a primary area to other complicated areas

facial space infections

What are facial space infections?

  • Teeth related orofacial infections arise either from dental caries or periodontal infections that have extended beyond the alveolar bone to involve the facial spaces around the face and oral cavity. The infections range from simple superficial abscess to deep infections in the neck; some resolving with little consequences and some lead to life-threatening conditions.
  • Facial spaces do not exist in a normal healthy individual and these are latent spaces created by distention of the tissue secondary to the infection from the dental pulp, periodontal tissues and the bone where the infection perforates the cortical plate and discharge into the surrounding tissues.
  • Facial spaces are potential spaces between the layers of the facia in the skin and it represents the major pathway for spread of infections from a primary area to other complicated areas

Who is responsible for this condition and how does this happen?

  • The microbial culture showed microorganisms that has mixed aerobic and anaerobic gram positive cocci and anaerobic gram negative rods.
  • It happens mainly by the colonization of the microorganisms. When the host is immunocompromised the microorganism will have a tendency to migrate from the tooth to the underlying bone and muscles and once it traverses from the localized area due to the increase in the microorganisms and increase in the pressure of the areas there will be swelling seen on the area with/without accumulation of pus.
  • If not addressed at an early stage then these will spread to other areas which will make it compromised and lead to intense procedures to cure the condition.

What are the factors that are responsible for the cause?

  • Long standing grossly decayed tooth with mild infection tends to rise sudden leading to spread into the spaces.
  • Gum problems which lowers the entire oral hygiene and leads to wide spread of infections
  • lowered body resistance or immunocompromised
  • any history of trauma which is not properly addressed immediately leads to infection.

what are the signs and symptoms?

  • Redness
  • Localized swelling of the region
  • Rise in temperature
  • Fatigue
  • Tenderness of the area and pain
  • Fever and other associated changes

How do you know that it’s a space infection?

  • There will be an existing decayed tooth.
  • When the oral cavity is compromised periodontally leading to colonization of microorganisms
  • Poor oral hygiene
  • As a result of any secondary causes that triggers the underlying infection
  • When a small infection is seen in the oral cavity and if it’s not properly addressed it will move along the path of least resistance to other adjacent anatomical spaces,increase in the pressure and accumulation of microorganisms in the secondary areas will lead to complications including swelling,restricted mouth opening pain etc.
  • In most of the cases it occurs as a result of an existing dental cause resulting in the formation of swelling on the face which can be fatal even in the worst conditions. The most critical point in the facial space infections is the understanding of the common and uncommon signs and symptoms, choice of antibiotics, definitive treatment and a thorough knowledge about the sequelae if left unmanaged.

microorganisms in the secondary areas

Mode of Spread

  • The spread of the infections could be either through tissues, blood, or lymphatic’s leading to fatal consequences like Airway obstruction, Meningitis, and Septicaemia; however, various factors influence the spread of infection. They are as follows:
  • Virulence of the organism.
  • Pathogenicity of the organisms.
  • Immune status of the patient.
  • Thickness of bone adjacent to the offending tooth.
  • In establishing the presence of an infection interaction occurs among the host, environment and the microorganism. Infection occurs when either host is immunocompromised or when pathogenicity and number of microbes invading host is more.
  • Untreated infections may result in abscess formation that can spread through different levels in and between the facial spaces and result in life-threatening situations including mediastinitis, pericarditis, meningitis, septic shock, airway compromise, jugular vein thrombosis, and arterial erosion, Although the complications are rare, they are serious and life threatening.

The spread of the infections

How this condition is managed?

  • Remove the cause.
  • Establish drainage.
  • Institute antibiotic therapy.
  • Supportive care, including proper rest and nutrition.

Early decompression has the following benefits

  • Prevents the spread of infection.
  • Prevents ischemic necrosis of the tissues.
  • Prevents pressure in the tissues.
  • To get rid of toxic purulent discharge.
  • Improves the drainage, by opening the lymphatic and venous channels, which were blocked by the edema and congestion.
  • To allow better perfusion of blood thereby improving the delivery of antibiotics and defensive elements to the required site.
  • Prevents further complications.

Do antibiotics and analgesics alone help to cure this condition?

  • No, medical management will give an antibiotic coverage of the region and helps in stopping further colonization of the microorganisms.
  • To prevent the further spread of the infection the primary management is to relieve the pressure on the swollen area and to wash out all the infectious content.
  • Once the area is decompensated and the pressure is released then washing away the region with an antiseptic solution, placing a drain so that whatever remnants seen on this area will come out through the drain.
  • Primary management is done along with the combined therapy with medications and removing the main cause of infection will be the best goal to relieve.

What kind of anaesthesia analgesics alone help to cure this condition?

  • Local anaesthesia will be delivered to the area before draining the swelling as that is the primary management.
  • Around the area of the swelling topical anaesthesia will be given and local anaesthesia will be administered in a ring pattern around the swelling to reduce the pain.
  • Along with these infiltrations, nerve block will also be given to reduce the pain and the associated symptoms.

kind of anaesthesia is given

How we plan and appropriately manage the situation?

As mentioned earlier swelling and space infection with tooth related cause should be managed with utmost care and consideration and with sophisticated instruments in meticulous hands. Faulty hands and improper instruments with techniques could be fatal and bring up utmost complications.

AT FMS, we have an in house operation theatre,24*7 monitoring and with expert hands of the maxillofacial surgeons its done by(add ot pic and icu fms)

  • Prior face to face consultation with the patient understanding the cause and history of the condition.
  • Administration of necessary antibiotics and analgesics needful for the condition
  • Explanation of the procedure in depth to the patient and a stress free environment is assured.
  • Primary management of the situation if needed
  • Admission of the patient in the hospital if necessary depending upon the status of the patient and the severity of the condition.
  • Use of proper drains and antiseptic lotion wash after the primary management to cure and wash out the remnants
  • Closing the area and administration of medications orally/via injections to reduce the severity.

What is a drain and hows it placed?

Surgical drains are used for a variety of purposes with best intentions to decompress either fluid or air from the area of surgery. It is mainly done by placing one either intra orally or percutaneously. The primary goal to achieve for this situation is to relieve out the swelling and other associated symptoms, relieve the condition, reduce the pressure on the area, and administer antibiotics and analgesics which help in reducing the general signs and symptoms.

The drain will be placed in areas which ensure smooth outflow of the infectious content thereby relieves the pressure and will be removed in a couple of days.

drain and hows it placed

Possible life-threatening complications may be developed if the space infections of the jaws are not addressed adequately;

a. complications of the spaces in the lower jaw ludwigs angina.

b. complications of the spaces in the upper jaw cavernous sinus thrombosis

Possible life-threatening

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