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Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy Methodical Instructions for independent work of students during the training for the practical studies Educational discipline Surgical stomatology Module № 6 The topic of the stadies General characteristic of inflammatory processes of №7 the maxillofacial area. Acute and chronic nonspecific sialadenitis (non-calculous and calculous). Diagnosis and comprehensive treatment of sialodenitis. Sialosis. Course V Faculty Stomatological Poltava -2020 1. Relevance of the topic: Your skin is a natural barrier against infection. Even with many precautions and protocols to prevent infection in place, any surgery that causes a break in the skin can lead to an infection. Doctors call these infections surgical site infections (SSIs) because they occur on the part of the body where the surgery took place. If you have surgery, the chances of developing an SSI are about 1% to 3%. Acute sialadenitis is defined as inflammation of the salivary glands arising from infectious or noninfectious causes. Common viral etiologies include Coxsackie A, paramyxovirus (mumps), and cytomegalovirus. Most bacterial suppurative infections of the salivary glands are associated with a decreased salivary flow or obstruction of the Stensen or Wharton ducts, allowing retrograde spread of bacteria. Staphylococcus aureus is most frequently the cause, which is often resistant to penicillin. Viridans streptococci, Streptococcus pyogenes, and anaerobic bacteria can also be involved. Acute bacterial sialadenitis is more prevalent in the parotid glands, with rates of bilateral involvement ranging from 15% to 25% of cases. 2. THE SPECIFIC AIMS: 2.1. To analyze the statistics of inflammatory and degenerative lesions of the salivary glands. 2.2. To explain to the causes of inflammatory and degenerative lesions of the salivary glands. 2.3. To offer new approaches in the diagnosis of inflammatory and degenerative lesions of the salivary glands. 2.4. To classify inflammatory and degenerative lesions of the salivary glands. 2.5. To interpret results of radiological investigation at inflammatory and degenerative lesions of the salivary glands. 2.6. To diagrammatize plan of examination of patients with various forms of inflammatory and degenerative lesions of the salivary glands. 2.7. To analyze complications, consequences and prognosis of different forms of inflammatory and degenerative lesions of the salivary glands. 2.8. To diagrammatize plan of treatment of patients with pathology of the salivary glands of different genesis. 3. BASIC KNOWLEDGE, ABILITIES, SKILLS, WHICH ARE NECESSARY FOR STUDY THEMES (intradisciplinary integration) Names of previous The received skills disciplines 1. Internal medicine. To know the relationship of pathological processes in the salivary glands diseases with different organs and systems of human. 2. Human Anatomy. To know the anatomy of the maxillofacial area, blood supply and innervations of the head and neck. To determine the localization of the major salivary glands. 4. Pathophysiology. To know the etiology and pathogenesis of diseases, metabolism of abnormal tissues. 4. Pathomorphology. To know the histological structure and morphological structure of pathologically altered tissue. 4. TASKS FOR INDIVIDUAL WORK DURING PREPARATION TO LESSON. 4.1. List of basic terms, parameters, characteristic, which a student must master at preparation to lesson: Term Definition 1. Sialoadenitis. Inflammatory process in salivary gland. 2. Sialolitiasis. Inflammation of salivary gland which develops because of stone. 3. Sialosis. Dystrophic process in salivary gland. 4.2. Theoretical questions for the lesson: 1. Etiology and pathogenesis of acute and chronic sialoadenitis. 2. Etiology and pathogenesis of sialosis. 3. Classification of acute and chronic sialoadenitis and sialosis. 4. The clinical picture of acute and chronic sialoadenitis. 5. The clinical picture of sialosis. 6. Diagnostics and differential diagnostics of inflammatory and dystrophic diseases of the salivary glands. 7. Complex treatment of inflammatory and dystrophic diseases of the salivary glands. 4.2. Practical works (task) which are executed on lesson: 1. To spend curation of patients with pathology of the salivary glands (role-playing and situational training, atypical clinical tasks). 2. To develop a plan for a comprehensive survey of patients with inflammatory diseases of the salivary glands and dystrophic (individual and team assignments). 3. To plan complex treatment of patients with inflammatory and degenerative diseases of the salivary glands (individual and team assignments). THE CONTENT OF THE TOPIC: The knowledge of the anatomy of fascial spaces is essential for the correct diagnosis and treatment of head and neck infections, because both facial and cervical fasciae work as an effective barrier against the spread of infections in this region. Once these infections occur, they are often difficult to assess accurately by clinical examinations and conventional radiographic techniques, and the outcome may be serious and potentially life-threatening. The fasciae of the neck are glossy and divided into two separated layers: the superficial fascia and the deep fascia. The superficial fascia is actually a component of the fatty subcutaneous tissue while the deep cervical fascia is divided into three layers: the superficial layer, the visceral or middle layer, and the pre vertebral or deep layer. The deep cervical fascia plays an important role in determining the location and course of spread of infections within the soft tissues of the neck. The infections that commonly affect head and cervical areas are frequently from odontogenic origin and to a lesser frequency, proceeding from foreign bodies or trauma to this region. An impacted mandibular third molar is one of the most frequent causes of odontogenic infection. Moreover, an semi-impacted third molar results in odontogenic infection more commonly than fully erupted or completely impacted molars. Odontogenic infections occasionally spread beyond the barriers of the fascial spaces, which are formed, as seen, by the deep cervical fascia of the suprahyoid regions of the neck. Among various spaces, the submandibular space is one of the first to be involved in odontogenic infections, similar to the masticatory space. As infection may spread along deep cervical facial planes and neck cavities, widespread cellulitis, necrosis, abscess formation, and sepsis may occur in these cases. Therefore, it is important to understand the anatomy, rate of progression and potential for airway compromise of an infection.spontaneous dissemination of an odontogenic infection is however, very rare in immunocompetent patients. In patients with anatomical abnormalities, systemic diseases or immunosuppression, bacteremia caused by dental procedures may lead to generalized or metastatic systemic infection complications leading to hospital care. In particular, patients with poorly controlled diabetes mellitus are more susceptible to bacterial infections. However, death from odontogenic infection is quite rare. Despite being rare, facial and neck fasciae spaces involved by infections from odontogenic origin may lead to a very morbid condition. The diagnosis delay and late or wrong therapeutic approachs to deep infections in these areas are the main causes of high mortality rate in this life-threatening situation. Dentistry has made great progress in prevention and early intervention of odontogenic infection. The introduction of antibiotics reduced significantly the mortality and morbidity of these infections, however, even in this contemporary postantibiotic era, serious infections such as a descending necrotizing mediastinitis still have a high mortality rate with a fulminating course, leading frequently to death. Anatomy of the fascial spaces in axial (A) and coronal (B) images. SMS: submandibular space; SLS: sublingual space; PPS: parapharyngeal space; CS: carotid space; MS: masticatory space. SMG: submandibular gland; GGM: genioglossus muscle; MHM: mylohyoid muscle; MM: masseter muscle; MPM: medial pterygoid muscle; LPM: lateral pterygoid muscle; TM: temporal muscle. What is surgical infection? A surgical site infection (SSI) is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. How does a surgical wound get infected? Causes and risk factors of surgical site infections Germs can infect a surgical wound through various forms of contact, such as from the touch of a contaminated caregiver or surgical instrument, through germs in the air, or through germs that are already on or in your body and then spread into the wound. How long after surgery can you get an infection? A surgical wound infection can develop at any time from 2-3 days after surgery until the wound has visibly healed (usually 2-3 weeks after the operation). Very occasionally, an infection can occur several months after an operation. What antibiotic is used for surgical site infection? Antibiotic Prophylaxis Operation Expected Pathogens Recommended Antibiotic Vascular S aureus, Staphylococcusepidermidis, Cefazolin 1-2 g surgery gram-negative bacilli S aureus, streptococci, anaerobes and Head and streptococci present in an oropharyngeal Cefazolin 1-2 g neck surgery approach Types of surgical site infections An surgical site infections (SSIs) typically occurs within 30 days after surgery. The CDC describes
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