64 - Infections of the Oral Cavity, Neck, and Head

Abstract

Infections of the oral cavity are diverse in etiology and clinical presentation. They are most commonly odontogenic in origin, less commonly from rhinogenic or other causes. Odontogenic orofacial infections include dental caries, pulpitis, periapical abscess, gingivitis, periodontal disease, and infections in the deep fascial spaces. These are typically polymicrobial, involving both strict anaerobes and facultative bacteria, reflecting the indigenous oral microbiota. Nonodontogenic infections of the oral cavity include ulcerative mucositis, which complicates radiation and chemotherapy; noma (gangrenous stomatitis); and infection of the major salivary glands. Suppurative orofacial infections can also arise from the oronasopharynx, tonsils, middle ear and mastoids, and paranasal sinuses. Complications such as intracranial, retropharyngeal, or pleuropulmonary extension and hematogenous dissemination to heart valves, prosthetic devices, and other metastatic foci clearly indicate the potentially serious nature of these infections. Microbiologic investigation requires proper specimen collection, taking care to minimize contamination by the resident commensal microflora. Imaging studies, including computed tomography, magnetic resonance imaging, and radionuclide scanning are invaluable for localization and assessing the extent of these infections. Surgical drainage of loculated infection and removal of necrotic tissue are keys to management of deep fascial space infections of the oral cavity, head, and neck. Antimicrobial therapy is important in halting local spread of infection and in preventing hematogenous dissemination. Prevention of dental caries and advanced periodontal disease require meticulous oral hygiene and dental care, including dietary counseling; behavioral modification of risk factors, such as tobacco smoking; and application of topical cariostatic agents, such as fluorides and chlorhexidine oral rinses.