Hospital Dentistry Report

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BY:

SARAH JOYCE R. PADILLA

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A cavernous sinus thrombosis is a blood

clot within the cavernous sinus, a largechannel of venous blood in a cavitybordered by the sphenoid bone and the

temporal bone of the skull. A thrombosis (clot) in this key crossroadscauses the cavernous sinus syndrome

which is characterized by edema (swelling)of the eyelids and the conjunctivae of theeyes and paralysis of the cranial nerveswhich course through the cavernous sinus.

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Oblique section through the cavernous sinus

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Symptoms  Causative agent 

Bulging eyeballs Cannot move the eye

in a particular direction

Drooping eyelids

Headaches Vision loss

Staphylococcus aureus  and Streptococcus areoften the associatedbacteria

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Recognizing the primary source of infection (i.e., facial cellulitis, middle ear,

and sinus infections) and treating theprimary source expeditiously is the bestway to prevent cavernous sinusthrombosis.

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Broad-spectrum intravenous antibiotics areused until a definite pathogen is found.

Nafcillin 1.5 g IV q4h

Cefotaxime 1.5 to 2 g IV q4h Metronidazole 15 mg/kg load followed by 7.5

mg/kg IV q6h

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Vancomycin may be substituted for nafcillin if 

significant concern exists for infection bymethicillin-resistant Staphylococcus aureus orresistant Streptococcus pneumoniae . Appropriatetherapy should take into account the primary

source of infection as well as possible associatedcomplications such as brain abscess, meningitis, orsubdural empyema.

Anticoagulation with heparin is controversial.

Retrospective studies show conflicting data. Thisdecision should be made with subspecialtyconsultation.

Steroid therapy is also controversial and is not

recommended by many sources.

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Surgical drainage with sphenoidotomy is indicatedif the primary site of infection is thought to be thesphenoidal sinuses.

All patients with CST are usually treated with

prolonged courses (3–4 weeks) of IV antibiotics. If 

there is evidence of complications such asintracranial suppuration, 6–8 weeks of totaltherapy may be warranted.

All patients should be monitored for signs of complicated infection, continued sepsis, or septicemboli while antibiotic therapy is beingadministered.

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Otherwise known as angina

ludovici, is a serious,potentially life-threateningcellulitis, or connectivetissue infection, of the floorof the mouth, usually

occurring in adults withconcomitant dentalinfections. It is named afterthe German physician, Wilhelm Friedrich von

Ludwig who first describedthis condition in 1836.Other names include"angina Maligna" and"Morbus Strangularis".

Ludwig's angina shouldnot be confused withangina pectoris , which is

also otherwise commonlyknown as "angina ". Theword "angina " comes fromthe Greek word ankhon ,meaning "strangling", soin this case, Ludwig'sangina refers to thefeeling of strangling, notthe feeling of chest pain,

though there may bechest pain in Ludwig'sangina if the infectionspreads into the

retrosternal space.

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Symptoms include Other symptoms that mayoccur with this disease

Breathing difficulty

Confusion or othermental changes

Fever Neck pain

Neck swelling

Redness of the neck

Weakness, fatigue,excess tiredness

Difficulty swallowing Drooling Earache 

Speech that is unusualand sounds like theperson has a "hotpotato" in the mouth

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Treatment involves appropriate antibiotic

medications, monitoring and protection of theairway in severe cases, and, where appropriate,urgent maxillo-facial surgery and/or dental consultation to incise and drain the collections. A

nasotracheal tube is sometimes warranted forventilation if the tissues of the mouth makeinsertion of an oral airway difficult or impossible.In cases where the patency of the airway is

compromised, skilled airway management ismandatory. This entails management of the airwayaccording to the American Society of Anesthesiologists' "Difficult Airway Algorithm" and

necessitates fiberoptic intubation

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The cause is usually an infection withStreptococcal bacteria, although otherbacteria can cause the condition. Since theadvent of antibiotics, Ludwig's angina has

become a rare disease.

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A tonic contraction of the muscles of mastication.In the past, this word was often used to describe theeffects of tetanus, also called 'lock-jaw'. Morerecently, the term 'trismus' has been used todescribe any restriction to mouth opening,including restrictions caused by trauma, surgery orradiation. This limitation in the ability to open themouth can have serious health implications,including reduced nutrition due to impaired

mastication, difficulty in speaking, andcompromised oral hygiene. In persons who havereceived radiation to the head and neck, thecondition is often observed in conjunction with

difficulty in swallowing.

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The most obvious effect of trismus is difficulty in

opening the mouth. In cancer patients this frequentlyresults from scar tissue from radiation or surgery, nervedamage, or a combination of factors. In stroke patients,the general cause is central nervous system dysfunction.Difficulty in speech and swallowing often accompany thelimitation in mouth opening, and create a combination of 

symptoms that may be difficult to treat. In cases of trismus caused by radiation treatment,

patients also frequently present with Xerostomia,mucusitis, and pain as a result of radiation burns. Theremay also be associated symptoms such as headache, jaw

pain, ear ache, deafness, or pain on moving the jaw. Incases of Temporomandibular tightness, the joint itself may become fibrotic, or even (in rare cases) ankylotic.Each of these factors may affect the treatment providedto the patient.

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Pericoronitis 

Inflammation of muscles of mastication 

Peritonsillar abscess 

Temporomandibular

 joint disorder (TMD)

temporary side effectof many stimulants of the sympathetic

nervous system likebruxism as a side-effect

Submucousfibrosis.

Acute osteomyelitis  Ankylosis of the TMJ (fibrous or bony) Condylar fracture or other trauma. Gaucher disease which is caused by

deficiency of the enzymeglucocerebrosidase.

Giant cell arteritis  Infection Local anesthesia 

Needle prick to the medial pterygoidmuscle  Oral submucous f ibrosis. Radiation therapy to the head and

neck. Tetanus  Malignant hyperthermia  Malaria severa  Secondary to neuroleptic drug use Malignant otitis externa  Retropharyngeal or parapharyngeal

abscess 

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Treatment requires treating the underlyingcondition with dental treatments, physicaltherapy, and passive range of motion devices.Additionally, control of symptoms with pain

medications (NSAIDs), muscle relaxants, andwarm compresses may be used.

Splints have been used

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