Anatomy and surgical therapy of oral and maxillofacial infections
1
Basic microanatomy, neurophysiology, and surgical principles provide the foundation for successful micro- neurosurgery. Experience is gained in fellowship train- ing, laboratory animal operations, and postgraduate courses. Methods for prevention of nerve injuries in everyday oral and maxillofacial surgery practice are em- phasized. An efficacious method of evaluation and doc- umentation of nerve injuries is used. Accepted guide- lines determine indications, timing, and prognosis of microsurgical repair of nerve injuries. After sensation begins to return, patients practice a daily regimen of “sensory re-education” exercises for at least 1 year, which enhances the quality of sensory function of the surgically repaired or reconstructed nerve. Documented results from microsurgical operations on more than 520 injured nerves followed for at least 12 months in the author’s practice are discussed and analyzed. Overall, 458 (88.1%) nerves regained “useful sensory function.” Of the 62 nerves that showed “no improvement” of pain or numbness after microneurosurgery, 36 were operated on more than 12 months after injury and 43 had intrac- table pain rather than numbness as their chief complaint. Currently, microneurosurgery offers selected nerve- injured patients an effective method of treatment and is part of the standard of care for such injuries. Some patients, especially those with long-standing painful nerve injuries, may benefit from nonsurgical manage- ment. References Meyer RA: Nerve harvesting procedures. Atlas Oral Maxillofac Surg Clin North Am 9:77, 2001 Meyer RA, Roth EM: Sensory rehabilitation after trigeminal nerve injury or nerve repair. Oral Maxillofac Surg Clin North Am 13:365, 2001 Meyer RA, Ruggiero SL: Guidelines for diagnosis and treatment of peripheral trigeminal nerve injuries. Oral Maxillofac Surg Clin North Am 13:383, 2001 M124 Anatomy and Surgical Therapy of Oral and Maxillofacial Infections Thomas Flynn, DMD, Boston, MA The principles of the management of deep space head and neck infections include early and rapid assessment of the severity of the infection by anatomic location, rate of progression, and the potential for airway compro- mise. After evaluation of host defenses, early definitive surgical management is a key to arresting further pro- gression of the infection. The use of drains, medical supportive care, and follow-up management of these infections are presented. Unusual and complicated infec- tions are illustrated with cases, including necrotizing fasciitis, brain abscess, mediastinitis, and cavernous si- nus thrombosis. Orofacial infections usually spread in a predictable fashion from one anatomic space into another, depend- ing on the site of origin and the causative organism. The ability of the oral and maxillofacial surgeon to predict the clinical behavior of deep space infections of the head and neck make this specialist the expert in the manage- ment of these conditions. That anatomic and surgical knowledge is summarized in this lecture, including the borders, contents, relations, and likely causes of infec- tions in the deep fascial spaces. The clinical presenta- tion, diagnosis, and surgical therapy of infections of each of these spaces are illustrated with several cases. Anesthetic and airway considerations in the manage- ment of orofacial infections are then discussed. The diagnosis of airway compromise is reviewed, and cur- rently available airway management techniques are com- pared. These considerations are supported by data resulting from a recently completed prospective study of 36 se- vere odontogenic infections recently completed at the Montefiore Medical Center, Bronx, NY. References Flynn TR: Anatomy of oral and maxillofacial infections, in Topazian RG, Goldberg MH, Hupp JR (eds): Oral and Maxillofacial Infections (ed 4). Philadelphia, PA, Saunders, 2002 Flynn TR: Timing of incision and drainage, in Piecuch JF (ed): Knowledge Update 2002. Rosemont, IL, American Association of Oral and Maxillofacial Surgeons, 2002 Bennett J, Flynn TR: Anesthetic and Airway considerations in oral and maxillofacial infections, in Topazian RG, Goldberg MH, Hupp JR (eds): Oral and Maxillofacial Infections (ed 4). Philadelphia, PA, Saun- ders, 2002 M221 Mandibular Block Autografts: Avoiding Functional and Aesthetic Pitfalls Michael Pikos, DDS, Palm Harbor, FL Autogenous block grafting must be integrated into treatment planning by today’s implant surgeon to effec- tively treat patients with compromised implant sites. This clinically oriented lecture will draw from the au- thor’s experience with more than 450 block grafts over an 11-year time frame and will include results of a 5-year retrospective study of 98 patients, 115 grafts, and 206 implants. The indications, contraindications, surgical protocol, histology, complications, and 5-year retrospec- Surgical Mini-Lectures AAOMS • 2003 99
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Transcript of Anatomy and surgical therapy of oral and maxillofacial infections
Basic microanatomy, neurophysiology, and surgicalprinciples provide the foundation for successful micro-neurosurgery. Experience is gained in fellowship train-ing, laboratory animal operations, and postgraduatecourses. Methods for prevention of nerve injuries ineveryday oral and maxillofacial surgery practice are em-phasized. An efficacious method of evaluation and doc-umentation of nerve injuries is used. Accepted guide-lines determine indications, timing, and prognosis ofmicrosurgical repair of nerve injuries. After sensationbegins to return, patients practice a daily regimen of“sensory re-education” exercises for at least 1 year,which enhances the quality of sensory function of thesurgically repaired or reconstructed nerve. Documentedresults from microsurgical operations on more than 520injured nerves followed for at least 12 months in theauthor’s practice are discussed and analyzed. Overall,458 (88.1%) nerves regained “useful sensory function.”Of the 62 nerves that showed “no improvement” of painor numbness after microneurosurgery, 36 were operatedon more than 12 months after injury and 43 had intrac-table pain rather than numbness as their chief complaint.
Currently, microneurosurgery offers selected nerve-injured patients an effective method of treatment and ispart of the standard of care for such injuries. Somepatients, especially those with long-standing painfulnerve injuries, may benefit from nonsurgical manage-ment.
References
Meyer RA: Nerve harvesting procedures. Atlas Oral Maxillofac SurgClin North Am 9:77, 2001
Meyer RA, Roth EM: Sensory rehabilitation after trigeminal nerveinjury or nerve repair. Oral Maxillofac Surg Clin North Am 13:365,2001
Meyer RA, Ruggiero SL: Guidelines for diagnosis and treatment ofperipheral trigeminal nerve injuries. Oral Maxillofac Surg Clin NorthAm 13:383, 2001
M124Anatomy and Surgical Therapy of Oraland Maxillofacial InfectionsThomas Flynn, DMD, Boston, MA
The principles of the management of deep space headand neck infections include early and rapid assessmentof the severity of the infection by anatomic location, rateof progression, and the potential for airway compro-mise. After evaluation of host defenses, early definitivesurgical management is a key to arresting further pro-gression of the infection. The use of drains, medicalsupportive care, and follow-up management of these
infections are presented. Unusual and complicated infec-tions are illustrated with cases, including necrotizingfasciitis, brain abscess, mediastinitis, and cavernous si-nus thrombosis.
Orofacial infections usually spread in a predictablefashion from one anatomic space into another, depend-ing on the site of origin and the causative organism. Theability of the oral and maxillofacial surgeon to predictthe clinical behavior of deep space infections of the headand neck make this specialist the expert in the manage-ment of these conditions. That anatomic and surgicalknowledge is summarized in this lecture, including theborders, contents, relations, and likely causes of infec-tions in the deep fascial spaces. The clinical presenta-tion, diagnosis, and surgical therapy of infections of eachof these spaces are illustrated with several cases.
Anesthetic and airway considerations in the manage-ment of orofacial infections are then discussed. Thediagnosis of airway compromise is reviewed, and cur-rently available airway management techniques are com-pared.
These considerations are supported by data resultingfrom a recently completed prospective study of 36 se-vere odontogenic infections recently completed at theMontefiore Medical Center, Bronx, NY.
References
Flynn TR: Anatomy of oral and maxillofacial infections, in TopazianRG, Goldberg MH, Hupp JR (eds): Oral and Maxillofacial Infections (ed4). Philadelphia, PA, Saunders, 2002
Flynn TR: Timing of incision and drainage, in Piecuch JF (ed):Knowledge Update 2002. Rosemont, IL, American Association of Oraland Maxillofacial Surgeons, 2002
Bennett J, Flynn TR: Anesthetic and Airway considerations in oraland maxillofacial infections, in Topazian RG, Goldberg MH, Hupp JR(eds): Oral and Maxillofacial Infections (ed 4). Philadelphia, PA, Saun-ders, 2002
M221Mandibular Block Autografts: AvoidingFunctional and Aesthetic PitfallsMichael Pikos, DDS, Palm Harbor, FL
Autogenous block grafting must be integrated intotreatment planning by today’s implant surgeon to effec-tively treat patients with compromised implant sites.This clinically oriented lecture will draw from the au-thor’s experience with more than 450 block grafts overan 11-year time frame and will include results of a 5-yearretrospective study of 98 patients, 115 grafts, and 206implants. The indications, contraindications, surgicalprotocol, histology, complications, and 5-year retrospec-
Surgical Mini-Lectures
AAOMS • 2003 99
