Introduction to Maxillofacial Infections

I. Definition

Maxillofacial infection is a bacterial infection that occurs in the maxillofacial region, often a consequence of dental pathologies, but can also be caused by other factors.

II. Characteristics

– Urgency: Maxillofacial infections usually progress rapidly, causing pain and significantly affecting health, even threatening life.

– Affects all ages: However, young children, elderly individuals, and those with weakened immune systems are more susceptible.

– Challenging management: Due to complex anatomical structures and rich vascular systems, maxillofacial infections can spread easily, leading to dangerous complications. Improper initial treatment, patient exhaustion, or underlying diseases can further complicate management.

– Common areas: Under the jaw, earlobe, cheek, and some other areas.

III. Causes

1. Dental causes: The primary cause of maxillofacial infection.

– Dental caries complications: Bacteria invade deeply into the tooth pulp, causing inflammation that spreads to surrounding tissues.

– Dental trauma: Fractures, broken teeth, exposed tooth pulp create conditions for bacteria to enter.

– Tooth eruption complications: Misaligned or impacted teeth can cause gum inflammation, providing opportunities for bacterial invasion.

– Periapical abscess complications: Severe gingivitis, periapical periodontitis, chronic periodontitis left untreated can lead to widespread infection.

– Post-extraction infection: Due to inadequate sterilization techniques during tooth extraction, unsterilized instruments, or the patient’s weak immune system.

2. Treatment-related causes:

– Root canal treatment: Errors in treatment techniques, unsterilized instruments, leftover pulp, create conditions for bacterial invasion.

– Denture complications: Ill-fitting dentures can damage the mucous membrane, allowing bacteria to enter.

– Orthodontic complications: Strong traction during orthodontic treatment can cause tooth pulp death, providing opportunities for bacteria to enter.

– Periodontal surgery: Inadequate sterilization during tissue removal after tooth extraction, periodontal surgery.

– Orthognathic surgery: Bone exposure during surgery creates conditions for bacterial invasion.

– Maxillofacial surgery: Causes damage and death of the tooth pulp.

3. Other causes:

– Maxillary sinusitis: Maxillary sinus inflammation can spread to surrounding areas, especially the cheek and upper jaw.

– Accidental infection during anesthesia: Unsterilized anesthesia techniques allow bacteria to enter soft tissue.

– Salivary gland infection: Salivary gland inflammation, salivary gland stones create conditions for bacterial invasion.

– Skin and mucous membrane infection: Open wounds, abrasions, burns, dermatitis create conditions for bacterial invasion.

– Tonsillitis, lymphadenitis: Tonsillitis, lymph node inflammation in the neck can spread to the maxillofacial area.

– Osteomyelitis of the jaw: Osteomyelitis of the jaw with bacterial infection spreads to surrounding soft tissues.

– Cyst: Dental cysts, jaw bone cysts can become infected, causing abscesses.

– Trauma: Trauma to the maxillofacial area creates conditions for bacterial invasion.

IV. Predisposing Factors

1. Facial muscle system: The anatomical structure of the facial muscles forms interconnected compartments, creating conditions for infection to spread.

2. Dental system:

– Tooth position, posture: Misaligned or impacted teeth create conditions for bacterial invasion.

– Tooth apex location: The tooth apex is close to the attachment of the muscles, providing conditions for infection to spread.

3. Factors that help fight bacteria:

– Thick mucous membrane layer: The thick, strong mucous membrane layer forms a protective barrier against bacteria.

– Antibacterial enamel of saliva: Saliva has a cleaning and antibacterial effect, limiting the growth of bacteria.

– Blood circulation: White blood cells, phagocytes, and antibodies in the blood fight bacteria.

4. Diseases that reduce body resistance:

– Diabetes: Diabetics have weak immune systems and are susceptible to infections.

– Myelosuppression: Myelosuppression reduces the body’s ability to produce white blood cells, reducing resistance.

– Malnutrition: Malnutrition reduces the body’s resistance, making it susceptible to infections.

– Extensive use of corticosteroids: Extensive use of corticosteroids weakens the immune system, making it susceptible to infections.

V. Pathogens

1. Aerobic bacteria:

– Gram-positive: Staphylococcus, Streptococcus, bacillus.

– Gram-negative: Moraxella neisseria.

2. Anaerobic bacteria:

– Gram-positive: Ramibacterium, Streptococcus, coryne bacillus, micrococus, bifidobacterium, anaerobic staphylococcus, catenabacterium.

– Gram-negative: Rare.

VI. Routes of bacterial invasion

1. Bone-periosteal route: Bacteria invade directly into the bone, periosteum.

2. Lymphatic and venous routes: Bacteria enter the bloodstream, spread through the lymphatic and venous systems.

3. Direct route: Bacteria invade directly into soft tissues through open wounds, trauma.

VII. Mechanisms of defense against infection

1. General body immune system:

– Physicochemical barrier: Skin, mucous membrane, saliva, mucus prevent bacterial invasion.

– Humoral immune system: Antibodies, complement destroy bacteria.

– Phagocytosis: White blood cells phagocytize bacteria.

2. Specific immune system:

– T lymphocytes: T lymphocytes are produced in the bone marrow, regulated by the thymus gland, and play a role in activating macrophages.

– B lymphocytes: B lymphocytes are produced in the bone marrow and produce antibodies.

VIII. Examination

1. Examination rules: Look, feel, tap, listen (assess the whole body).

2. Local examination:

– Outside the mouth: Look: Symmetry, swelling, color. Feel: Swelling density.

– Lymph nodes: Examine lymph nodes under the jaw, along the neck, under the chin, earlobe, nape of the neck.

– Inside the mouth: Examine lips, oral mucosa, upper and lower gingival recesses, palate, tongue, floor of the mouth, teeth, gums, occlusion.

– Function: Examine ability to open and close the mouth, chew, swallow, speak, breathe.

3. Purpose of a full body examination: To detect systemic diseases related to the head, face, and neck, including:

– Head and neck: ENT, eye diseases.

– Circulatory system: Cardiovascular disease, blood pressure.

– Respiratory system: Lung disease.

– Urinary system: Kidney disease.

IX. Treatment

1. General treatment principles:

– Early detection and clinical diagnosis: Identify the cause and severity of the disease.

– Paraclinical investigations: Blood culture, bacteria, antibiogram.

– Antibiotic therapy: Choose antibiotics appropriate for the pathogen.

– Fluid and electrolyte replacement: Replenish fluids and electrolytes for the patient.

– Enhance physical condition: For elderly, weakened patients, or those with underlying diseases, it is necessary to enhance their physical condition before treatment.

– Local treatment: Drain pus, remove pulp, remove apical tissues, extract the causative tooth.

– Anesthesia: Use anesthetics, general anesthesia, pain relief for the patient.

Notes:

– Maxillofacial infection is a serious disease that requires prompt diagnosis and treatment.

– Self-treatment at home can lead to dangerous complications.

– It is recommended to consult a dentist or hospital for proper diagnosis and treatment.

Additional Information:

– Maxillofacial infection can lead to dangerous complications such as abscesses, cellulitis, cavernous sinus thrombosis, meningitis, and septic shock.

– Prevention of maxillofacial infections by:

– Proper oral hygiene: Brush your teeth twice a day, use dental floss, have regular dental checkups.

– Treat dental pathologies promptly.

– Maintain good health: Eat a balanced diet, exercise regularly, get enough sleep.

Sources:

– Dental Textbook – Ho Chi Minh City University of Medicine and Pharmacy

– Ministry of Health website

Note: The information in this article is for reference only and should not replace the advice of a qualified healthcare professional.