Orofacial Infections
Orofacial Infections
This domain tests recognition of odontogenic infection spread, airway risk, source control, and antimicrobial stewardship. The exam expects anatomic reasoning about fascial spaces and when to operate.
Core rules
- Odontogenic infection spreads along fascial planes; submandibular, sublingual, buccal, canine, masticator, and pharyngeal spaces are key.
- Ludwig angina is a bilateral, board-like infection of the submandibular, sublingual, and mental spaces that threatens the airway.
- Assess voice change, drooling, dysphagia, trismus, floor-of-mouth elevation, and stridor; secure the airway before drainage if needed.
- Source control by extraction, pulpectomy, or incision and drainage is essential; antibiotics alone are insufficient.
- Obtain imaging for deep-space involvement and monitor for necrotizing fasciitis or osteomyelitis.
Worked example
A patient has bilateral submandibular swelling, elevated tongue, trismus, and dysphagia. Reasoning: this suggests Ludwig angina with airway compromise. Management begins with airway assessment, then urgent drainage and removal of the dental source, with intravenous antibiotics covering oral anaerobes and streptococci.
Traps
Waiting for fluctuance; relying on antibiotics without drainage; missing retropharyngeal spread; underestimating airway compromise; failing to obtain cultures in severe infection.