Dental Infection Recurrent Inadequate Drainage, CT
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This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
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Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0156-Dental Infection Recurrent Inadequate Drainage, CT
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CA0156-Dental Infection Recurrent Inadequate Drainage, CT
Case ReportHistory
Exam
Prior Study
Findings
Oral cavity, floor of the mouth, maxilla and mandible
There is severe edema in all the soft tissues within the buccal space, masticator space, floor of the mouth, submandibular space and the adjacent superficial fascia, subcutaneous fat and skin and the fat of the adjacent parapharyngeal space on both sides. The oral tongue is edematous. All of these changes produce severe oral cavity and oropharyngeal airway compromise.
There is a spread of purulent material in the floor of the mouth, freely across the midline between the geniohyoid/genioglossus and the mylohyoid muscle as well as into both submandibular spaces, probably over the back edge of the mylohyoid muscle.
A drain has been placed in the left submandibular space and it is no longer in connection with purulent material; the residual purulent material is surrounding the submandibular gland.
There is evidence of extensive endodontal and periodontal disease with caries. The first mandibular molar on the right has been extracted with a buccal cortical plate defect. There is evidence of periapical disease in the third right mandibular molar. The third mandibular molar on the left and both second maxillary premolars have been extracted.
Oropharynx and Nasopharynx
There is secondary generalized edema involving the parapharyngeal spaces predominately at the level of the oropharynx which appears to have narrow the airway of the oropharyngeal level to the extent that are required intubation. It is uncertain whether some of the purulent material is confined to the masticator space is on both sides or might also be present within the adjacent prestyloid parapharyngeal space on both sides.
Cervical and Retropharyngeal Lymph Node
There is reactive cervical lymphadenopathy throughout the neck.
There is no suppurative cervical lymphadenopathy.
Major Salivary Glands
Both submandibular and parotid glands are edematous, secondary to the inflammation as described above.
Hypopharynx, larynx, deep neck and entire retropharyngeal space
Due to the intubation, the hypopharynx, larynx and trachea are difficult to adequately assess.
There is no edema or other abnormalities within the adjacent deep neck, retropharyngeal or prevertebral spaces.
Vascular findings
There is no evidence of thrombus, thrombophlebitis or other occlusive or inflammatory process of visualized vascular structures.
Other findings:
There is mild non-aggressive mucoperiosteal thickening throughout the paranasal sinuses, most pronounced in the ethmoid.
Impression
Please note that a single drain that has been placed in the left submandibular space is not in contact with any purulent material that lies in several independent spaces of the floor of the mouth, masticator space parapharyngeal space and submandibular spaces. There are no drains in the other extensive purulent collections described above.
