Garré's Sclerosing Osteomyelitis with Perimandibular Soft Tissue Inflammation and Fistula

Garré's sclerosing osteomyelitis is a form of chronic osteomyelitis that commonly affects children and young adults. Here, we report one such case of Garré's sclerosing osteomyelitis in a 20-year-old female who presented with facial asymmetry and inability to open mouth. On clinical examination, it was bony hard swelling with trismus. History of infected second molar tooth extraction was present. Computed tomography scan showed thickening and sclerosis of the ramus and condylar process of mandible, on right side, with proliferative periostitis. Magnetic resonance imaging showed soft tissue edema and inflammation, in the form of enlargement of right masseter and pterygoid muscles with intramuscular fluid collection. On the basis of history, clinical signs, and imaging features, diagnosis of Garré's osteomyelitis with fascial space infection was made. To our knowledge, very few cases of Garré's osteomyelitis present with superimposed fascial space infection, as it is otherwise a nonsuppurative condition. Fistula formation is a very rare incidence as it is seen in our case.

Endovascular Management of Internal Carotid Artery Pseudoaneurysm Secondary to Pediatric Deep Neck Space Infection: A Case Report and Review of Literature

Pseudoaneurysms of extracranial internal carotid artery (ICA) are rare in children. Main causes include trauma, iatrogenic causes, and neck space infection. Prompt diagnosis and management is vital, in view of life-threatening complications like fatal airway hemorrhage and stroke. Endovascular management has currently become the preferred treatment strategy due to its minimally invasive nature and lower complication rates. We report a rare case of mycotic pseudoaneurysm of extracranial ICA in a 4-year-old child as a complication of neck space infection, which was successfully managed with endovascular parent artery occlusion.

Conservative Management of Submandibular Space Infection in a 5-Year-Old Child: A Case Report

Submandibular space infection is a potentially fatal infection that could arise as a result of odontogenic or non-odontogenic infections. The management should be prompt as the infection can spread rapidly leading to airway obstruction. A 5-year-old child reported with a complaint of swelling on the left side of the face for four days. On examination, patient had a diffuse swelling involving the left submandibular region with decreased mouth opening secondary to carious 75. The patient was administered intravenous (i.v) fluids, antibiotics and analgesics. Incision and drainage of the abscess was done extraorally under i.v sedation using midazolam with local anaesthesia followed by rubber drain placement. Patient responded to the treatment with progressive decrease in the swelling. Pulpectomy of 75 was performed followed by stainless-steel crown placement. This case highlights the importance of prompt appropriate treatment supplemented by salvage treatment to overcome the associated morbidity at this very young age.

Deep neck space infections in Adolescents

Adolescent deep neck space infection is an important pathology that often requires hospitalization for antimicrobial therapy. The aim of the study was to identify the inciting organisms and their resistance profiles in the adolescent population of patients with deep neck space infection. We performed a single-center cross-sectional retrospective analysis of patients between 10 and 16 years of age, with deep neck space infections. From the 319 cases of deep neck space infections that presented over the study period, nine patients met the criteria to be included in the study. The mean age being 11.8 years. The microbiology of the specimens revealed mainly Staphylococcus and Streptococcus species and in some patients microscopy and culture showed no predominant bacteria. There was an overall 86% resistance of organisms to penicillin and ampicillin but most organisms were sensitive to amoxicillin-clavulanic acid Deep neck space infections in adolescents can initially be managed with amoxicillin-clavulanic acid, source control and surgical drainage if required. Culture directed therapy can be initiated after microbiology results. The spaces involved are similar to adults with 44% of patients having deep neck abscess secondary odontogenic infection. The microbiology however is similar to that of children with Streptococcus and staphylococcus species being the most predominant.

Surgical Management of Pleural Space Infection

Pleural space infections are a common clinical entity affecting a large number of patients. These are associated with considerable morbidity and mortality rate and they require significant healthcare resources. In this chapter, we discuss the disease characteristics with regards to the etiology (primary and secondary), clinical presentation, radiological findings, different stages of the condition and treatment options according to stage at presentation. Conservative management (medical treatment, pleural drainage, with or without intrapleural fibrinolytic) may be effective in management of simple pleural space infections, but surgical management may be required in loculated complex empyema to prevent acute sepsis, deterioration and trapped lung. Surgical treatment of complicated pleural infections either by VATS or thoracotomy will be discussed in order to understand when to perform debridement/decortication of the pleural cavity or less frequently a thoracostomy.

Retrograde Spread of Buccal Space Infection into Temporal Space with Temporal Muscle Necrosis in a Medically Compromised Patient - A Case Report

Superficial temporal space lies between the temporal fasciae. Abscess in the temporal and infratemporal space is very rare. They develop as a result of the extraction of infected maxillary molars. Temporal space infections or abscesses can be seen in the superficial or deep temporal regions. A 65 - year - old male patient reported with a complaint of painful swelling over the right cheek and restricted mouth opening with a history of extraction of second mandibular molar before four weeks. On examination, an ill-defined diffuse swelling was seen. Treatment was started with IV empirical antibiotics and planned for surgical drainage. Surgical drainage of the abscess in the temporal space was done along with debridement of the necrosed temporalis muscle. Infections of the maxillofacial region are of great significance to general dentists and maxillofacial surgeons. They are of clinical importance as they are commonly encountered, and are also challenging as timely intervention is needed to prevent fatal complications. The infections arising from the tooth are initially confined to the alveolar bone and surrounding periosteum. They spread along the path of the least resistance to the cortical plates. Once the infection penetrates the cortical plates, they reach the muscle plane.1 If the infection perforated is above the muscle attachments, it’s confined to an intraoral abscess. If the cortical plates are perforated below the muscular attachments, extraoral swelling develops. The next barrier is the periosteum which is strong and elastic in nature. Once the periosteum is breached, infections reach the soft tissue planes, the fascia. Most of the infections are confined to a particular space and the surrounding fascia. Based on the toxins produced by the microorganisms, the infection can spread to adjacent spaces and even retrograde. Common deep space infections are Ludwig's angina followed by peritonsillar, submandibular, and parotid abscesses. 2 Infratemporal and temporal space infections are rarely compared to other deep space infections. Many etiological factors form the base for the infections of deep spaces, dental caries, extraction of infected, non-infected tooth maxillary sinusitis, tonsillitis, maxillary sinus fracture, temporomandibular arthroscopy, drug-induced infections. Infections of odontogenic origin, spreading along infratemporal and temporal space are most common with maxillary molars followed by mandibular molars. We report a case of retrograde spread of buccal space infection into temporal space secondary to mandibular tooth extraction.

Deep Neck Space Abscess – A Case Report

Deep neck spaces are regions of loose connective tissue present between three layers of deep cervical fascia, namely, superficial, middle, and deep layers. The investing layer is the superficial layer, the pre-tracheal layer is the intermediate layer, and the prevertebral layer is the deep layer. Deep neck space infection (DNI) is defined as an infection in the potential spaces and actual fascial planes of the neck. Spread of infection occurs along communicating fascial boundaries. These deep neck spaces may be further classified into 3 anatomic groups, relative to the hyoid bone: Those located above the level of the hyoid, those that involve the entire length of the neck, those located below the level of hyoid. The patterns of infection may include abscess formation, cellulitis, and necrotizing fasciitis. Antibiotics and surgical drainage form the mainstay of treatment. There are some spaces in the neck present between these layers of deep cervical fascia. These deep neck spaces are filled with loose connective tissue. Deep neck space infection involves the spaces and fascial planes of the neck. Spread of infection occurs along communicating fascial boundaries after overcoming the natural resistance of the fascial planes. With relation to the hyoid bone, these deep neck spaces are further classified as follows: 1. Spaces above the level of the hyoid bone (peritonsillar, submandibular, parapharyngeal, masticator, buccal, and parotid spaces). 2. Spaces that involve the entire length of the neck (retropharyngeal, prevertebral, and carotid spaces). 3. Spaces located below the level of hyoid bone (anterior visceral or pre - tracheal space). Infection may present either as abscess, cellulitis, or necrotizing fasciitis. The mainstay of the management are antibiotics and surgical drainage.