Facial Swelling and Infection

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Description

Facial swelling can either be due to odontogenic causes (e.g. caries, retained roots, periodontitis) or non- odontogenic causes (e.g. soft tissue infection, fractures, osteomyelitis, sialoadenitis, foreign body). Infections can spread to the soft tissue around jaws, neck and cause cellulitis and suppuration. This can easily be life- threatening. In the absence of systemic signs and symptoms, odontogenic causes can be usually treated by local dental care, such as removal of the infected pulp tissue.

Signs and Symptoms

  • Fever
  • Lymphadenopathy
  • Pain
  • Suppuration
  • Redness

Treatment

  • Oral amoxicillin 500mg tds and metronidazole 400 tds for 5 days
  • Patients hypersensitive to penicillin should be given either erythromycin or cephalexin
  • If progressive trismus arises and airway is compromised, admit case and give: o Benzyl Penicillin 1 MIU-2MIU (600mg – 1200mg) IV 6 hourly

OR

  • Cloxacillin 500mg Po 6 hourly PLUS
  • Metronidazole 500mg IV 8 hourly

PLUS

  • Gentamicin 3-5mg/kg/day IV (ideally not exceeding 48 hours; in patients with poor renal function serious damage to the vestibular apparatus may result from gentamicin. Get an estimate of renal function before prescribing)
  • Pus must be drained surgically by the dentist