S232: Management of Aggressive Infections of the Head and Neck

S232: Management of Aggressive Infections of the Head and Neck

Surgical Clinics tion. This session, presented by a surgeon and a speech language pathologist will seek to discuss all phases of cleft care and their ...

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Surgical Clinics tion. This session, presented by a surgeon and a speech language pathologist will seek to discuss all phases of cleft care and their impact of speech and language development of children with a cleft deformity. Recognition and diagnosis of the various speech pathologies will be demonstrated. The different phases of formal speech evaluation will be presented including instrumental techniques such as nasometry and nasendoscopy. We will also discuss how this information can be integrated into surgical treatment planning and outcome assessment. The various surgical techniques that can be applied will then be presented as part of the discussion.

S232 Management of Aggressive Infections of the Head and Neck Gary Warburton, DDS, MD, Baltimore, MD Jaime Brahim, DDS, MS, Baltimore, MD Oral and maxillofacial surgeons are frequently faced with the management of deep space neck infections from an odontogenic source, some of which are aggressive infections. The principles of management include removal of the source, draining the involved space(s), providing appropriate empiric and culture directed antibiotic coverage, along with supportive management. Despite the frequency with which these infections occur, evidence based prospective outcome studies for both the surgical and medical management of deep space infections are lacking. The adult literature supports surgical management as the mainstay of treatment for deep space infections, especially those involving the neck. Less common infections like necrotizing fasciitis are occasionally seen, and must be dealt with promptly and aggressively, lest significant morbidity and mortality result. Though much less common in the head and neck, one should thoroughly understand the concepts of surgical and critical care management. Infection patients account for significant utilization of operating room, intensive care unit, and hospital resources. It would then seem reasonable that aggressive early management may decrease the number of intensive care unit days and improve length of stay. This clinic will serve as an overview for the management of aggressive head and neck infections. Emphasis will be placed on risk factors, airway management, antibiotic therapy, the surgical treatment of various space infections, and necrotizing fasciitis and myositis. Secondary reconstruction will be discussed when appropriate. Objectives: 1. Review the bacteriology and medical therapy for conventional odontogenic and more aggressive head and neck infections. 122

2. Discuss surgical management as it pertains to incision and drainage of the various spaces and airway management. 3. Discuss necrotizing infections and how they impact the overall surgical and medical management of the patient. References Storoe W, Haug RH, Lillich TT. The changing face of odontogenic infections. J Oral Maxillofac Surg. 2001 Jul;59(7):739-48 Har-El G, Aroesty JH, Shaha A, Lucente FE. Changing trends in deep neck abscess. A retrospective study of 110 patients. Oral Surg Oral Med Oral Pathol. 1994 May;77(5):446-50. Potter JK, Herford AS, Ellis E 3rd. Tracheotomy versus endotracheal intubation for airway management in deep neck space infections. J Oral Maxillofac Surg. 2002 Apr;60(4):349-54

S233 HIV and AIDS in the Adolescent and Adult: An Update for Oral and Maxillofacial Surgeons Julie Ann Smith, DDS, MD, Portland, OR Initially recognized as a disease in 1981, AIDS has since been one of the leading causes of death worldwide and in the United States. Approximately 33.2 million people worldwide are living with HIV infection. Oral and maxillofacial surgeons and other care providers should have a good understanding of the myriad of systemic effects of this disease and its treatment. This disease affects every system in the body and in order to provide the best care to these patients, a basic knowledge of this disease process is mandatory. Oral and maxillofacial surgeons have the potential to assist in the initial diagnosis of HIV and to assist in recognition of worsening disease by being able to recognize the signs and symptoms. During this surgical clinic presentation, the pathogenesis of HIV/AIDS and systemic and oral manifestations will be reviewed. Additionally, a review of antiretroviral medications and their implications on oral surgery care will be provided. References Smith, JA. HIV and AIDS in the Adolescent and Adult: An Update for the Oral and Maxillofacial Surgeon. Oral and Maxillofacial Surgery Clinics of North America. 20: 535-565, 2008 Hoffman C, Rockstroh JK, Kamps BS, ed., HIV Medicine 2007, 15th ed, Flying Publisher, Paris, 2007. Accessible at: http://www. hivmedicine.com/hivmedicine2007.pdf Accessed on 3 February 2009 Hodgson TA, Greenspan D, Greenspan JS. Oral Lesions of HIV Disease and HAART in Industrialized Countries. Adv. Dent. Res. 19: 57-62, 2006 EC-Clearinghouse on Oral Problems Related to HIV Infection and WHO Collaborating Centre on Oral Manifestations of the Immunodeficiency Virus. Classification and Diagnostic Criteria for Oral Lesions in HIV Infection. J Oral Pathol Med. 22: 289-291, 1993

AAOMS • 2009