1、Oral and maxillofacial infection,Liang Yu-jie Department of oral and maxillofacial surgeryGuanghua school of stomatology,Key points in clinical practice,AnatomyClinical manifestationAntibiotics,Basic knowledge,AnatomyImmunologySurgery,Logic,infection & inflammationinfection & contagionlocal & system
2、ic/genetalacute & chronic,Introduction, Infection： the pathological state resulting from the invasion of the body by pathogenic microorganisms, Inflammation: the reaction of body to the invasion of these microorganisms and the toxins generated by them. The reaction include: alteration, exudation, pr
3、oliferation,Immune response in the early stage of injury,Green antibody battles a red antigen!, existence of normal bacterial flora open, suitable moisture and temperature （ oral cavity and sinus, tooth, gingival, tonsillar ）,Characterisitcs of oral & maxillofacial region,Characterisitcs of oral & m
4、axillofacial region, fascia space, abundant blood circulation, and valveless veins,Characterisitcs of oral & maxillofacial region, abundant lymphaden,Characterisitcs of oral & maxillofacial region,Modes of Transmission,Reasons of infection, Odontogenic periapical periodontitis, pulpitis, periodontit
5、is Adenogenous lymphadenitis, parotitis Traumatic Hemogenic Iatrogenic infection,What causes infectious diseases?,MicroorganismsBacteriaVirusPrionFungusProtozoaHelminthProducts from microorganismstoxins,Pathogenic bacteria, staphylococcus, streptococcus, escherichia coli aerobic, anaerobic, mixed in
6、fections The general infection process are the mixed flora: early phase the aerobic bacteric consume the available oxygen, allows the overgrowth of anaerobes,Pathogenic bacteria,Anaerobic,Anaerobic,Are all bacteria bad?,No!Some bacteria perform essential functions in the body such as: skin: prevents
7、 more harmful bacteria from colonizing intestines: helps body break down and absorb certain nutrients; prevents more harmful bacteria from causing intestinal infections vagina: prevents yeasts from overgrowing and causing infectionsOther body areas are colonized and infections only occur in immunoco
8、mpromised people nasopharynx, oropharynx, esophagus, stomach,Why do people get sick?,Host Factors age gender ethnicity immune status nutritional status behaviorBalance is Key!,Host defenses, Local defenses: the first line of defense,Clinical manifestation, Acute inflammationrednessswelling heatpainl
9、oss of functionpurulent infection & putrescent cellulitis,Local symptom, Chronic inflammationinflammatory proliferationfistula recurrence,Local symptom, Chronic inflammation can result fromFailure to eliminate whatever was causing an acute inflammationAn autoimmune response to a self antigen - the i
10、mmune system attacks healthy tissue, mistaking it (them) for harmful pathogensA chronic irritant of low intensity that persists,Local symptom, Functions in oral and maxillofacial regionswallowingspeechrespirationmouth opening,Local symptom,General condition common presence chill, fever, headache, di
11、scomfort, tire, anorexia, WBC septicaemia, pyohemia dystrophy hepatic failure，kidney failure septic shock, Bacteremias refers to the transient presence in the blood of bacteria because of surgery, which are removed rapidly. oral surgery such as tooth extraction may, in certain conditions, result in
12、the establishment of an infection in a site distant from the site of surgery, that is metastatic spread Septicaemia refers to the chronic presence of bacteria in the blood, usually secondary to an established infection somewhere in the body,Diagnosis, easy to make a correct diagnosis according to th
13、e presence of redness, swelling, heat, pain fluctuance test bacterial culture and antibiotic susceptibility testing, Fluctuance test,The nature of the pain ?The duration of symptoms?Changes in the nature of the swelling and how fast this change is occurring. Did the swelling begin as a soft mass, or
14、 was it consistently firm?Is pain associated with the swelling?, historical data collection, cellulitis diffused firm, erythematous swelling, resulting from the spread of microorganisms through soft tissue abscess localized cavity lined by fibrous connective tissue that contains pus,Characteristic E
15、dema(inoculation) Cellulitis Abscess Duration 0-3 days 1-5 days 4-10 days Pain,borders mild,diffuse severe,diffuse localized Size variable large small Color normal red shiny center Consistency jellylike boardlike soft center Progression increasing increasing decreasing Pus absent absent present Seri
16、ousness low greater less, Comparison of Edema, Cellulitis, and Abscess, Laboratory diagnosisblood Rt, CRP, bacterial culture, antibiotic susceptibility testing Needle aspiration, ultrasonic, CT deeper abscess X-ray, CT, 3D-CTosteomylitis, other examination,Treatment, The treatment of infection must
17、be aimed at restoring the original balance. It is important to fully appreciate the concept that the host is primarily responsible for curing the infection. Surgical and antibiotic therapy are merely aids to help the patient., Local therapykeep local cleanliness, avoid stimulation and movement, herb
18、 dressing Surgeryincision and drainage, eliminate causative factors Systemic therapyantibiotics therapy, supporting therapy,Principle 1: Determine severity of infection complete history symptoms physical examination respiratory obstruction !,Principle 2: Evaluate patients host defense situation medi
19、cal conditions that compromise host defense uncontrolled metablolic diseases systemic disease AIDS pregnancy,Principle 3: Treat infection surgically, drain the abscess (if present)remove bacteriarelieve tissue tension antimicrobial therapy (if necessary),Objective vent abscess or putrescence release
20、 of pain and tension causing by swelling prevent the occurrence of complication, incision and drainage,Indication pain aggravation, obvious swell, palpation to fluctuance, pain palpation point, pus extract by aspiration antibiotic-uncontrolled infection, obvious systemic toxicosis multispace infecti
21、on, dyspnea, swallow difficulty tuberculosis of lymphonodus, inefficacy to anti-tubercolosis treatment and abscess formation, incision and drainage,Guidelines for successful incision and drainage Local anesthesia,Guidelines for successful incision and drainage hide the Incisions,Guidelines for succe
22、ssful incision and drainage make all incisions through skin or mucosa into connective tissue,Guidelines for successful incision and drainage use a blunt hemostat to open and explore any compartments within the abscess pocket, Establish drainage，the insertion of drain made from rubber dam material or
23、 iodoform gauze should permit continuous drainage and provide adequate analgesia. Patients with a drain in place should be examined daily, replacing for every 24-48 h., Irrigate the drain daily with normal saline or an antibiotic solution.,Principle 4: Support patient medically Patient care is impor
24、tantDehydration alone can account for an increase in temperature Adequate nourishment is essential，in liquid or soft form if necessary A laxative can be suggested if neededComplete rest is necessary. Analgesics and sedatives will relieve pain and anxiety,Principle 5: Choose appropriate antibioticMec
25、hanism inhibit the synthesize of cellular wall of bacteria Injury the cytoplasmic membrane Inhibit the synthesize of protein Inhibit the metabolism of nucleic acid,Principle 6: Evaluate patients responseA variety of situations can cause failure of treatment Failure to drain abscess Depressed host de
26、fenses Presence of a foreign body Failure of antibiotic to reach bacteria, osteomyelitis Inadequate antibiotic dose Wrong bacteriologic diagnosis and antibiotic selection,Penicillin group (青霉素类） low toxicity for action against bacterial cell wall that mammalian tissue does not have inexpensive class
27、ic antimicrobial spectrum : streptococcus, staphylococcus, many anaerobes, neisseria, treponema(螺旋体). drug allergy,The variety antibiotic available,Cephalosporin group （头孢类） broad-spectrum antibiotics, bactericidal, against both gram-positive and gram-negative initial treatment of infection where th
28、e specific organism is unknown first generation, effective to gram-positive second and third generation, enhanced antibacterial activity,Clindamycin （克林霉素） bacteriostatic antibactetial spectrum including streptococcus, staphylococcus and anaerobic,Metronidazole (甲硝唑） occasionally an old drug finds a
29、 new use treatment for trichomonas bactericidal for obligate anaerobes, peptococcus adverse reaction disulfiram, cause severe abdominal cramping, nausea, vomiting, allergy side effects are those expected problems that arise in many patients who taking normal doses of the drug for short periods of ti
30、me Toxicity reactions are those that usually occur as a result of excessive dose or duration of therapy but can occur in individual patients at normal doses The most common toxicities are neural, renal, hepatic, and hematological injury,Adverse reactions of antibiotics, Narrow-spectrum fewest advers
31、e reactions well-established but still effective antibiotic Bactericidal rather than bacteriostatic less expensive,Choice of antibiotics,The principle of therapeutic antibiotic application, clearly established bacterial infection laboratory culture and antibiotic susceptibility studies indication of
32、 combination treatment: life-treatening infection， susceptibility tested not obtained , mix infection, long-term therapy Administer antibiotic properly: dose, dose interval, duration of therapy, route of delivery,The principle of therapeutic antibiotic application,Principle of prophylactic antibioti
33、cs use, the length of the surgery compromised host, poorly controlled metabolic disease, the olderlychemotherapeutic immunosuppressive or glucocorticoid drug implatation,Prevention of wound infection Class , incision Class incision with high risk of infection,Fast facts on inflammation,Inflammation
34、is the bodys attempt at self-protection to remove harmful stimuli and begin the healing process.Inflammation is part of the bodys response.Acute inflammation, starts rapidly and quickly becomes severe.Chronic inflammation, this means long-term inflammation, which can last for several months and even
35、 years.,Fast facts on inflammation,Our infections, wounds and any damage to tissue would never heal without inflammation tissue would become more and more damaged and the body, or any organism, would eventually perish.Chronic inflammation can eventually cause several diseases and conditions, includi
36、ng some cancers.Although scientists know that inflammation plays a key role in heart disease and several other illnesses, what drives inflammation in the first place is still a mystery.It should be remembered that inflammation is part of the healing process. Sometimes reducing inflammation is necessary, but not always.,Thank you for your attention!,April 11, 2016,
