![Page 1: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/1.jpg)
Semmelweis University
Department of Oral- and Maxillofacial Surgery
Dr. Barabás Péter
ODONTOGENIC PURULENT INFLAMMATION,
CELLULITIS (PHLEGMONE), SPACES OF THE
MAXILLOFACIAL REGION
![Page 2: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/2.jpg)
OUTLINE
Types and reasons of inflammations
Symptomes and diagnostic possibilities
Conservative treatment methods
Surgical treatment methods
Cellulitis (symptomes and treatment)
Osteomyelitis
Bisphosphonate related osteonecrosis of the jaw (BRONJ)
![Page 3: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/3.jpg)
TYPES OF INFLAMMATIONS
Acute soft tissue inflammations: abscess, cellulitis (acute
exacerbation of chr. inflammations)
Chronic inflammations: remain bacteriums among granuloma
Bone inflammations: osteomyelitis
![Page 4: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/4.jpg)
THE ORIGIN OF INFLAMMATIONS
Dental origin (~95%):
caries→pulpitis (gangrene pulp)→acute periapical periodontitis (chr. periapical
lesions) → ostitis → abscess → cellulitis
postoperative period, parodontopathies(periodontitis), cysts, non erupted teeth
Other reasons:
Sialoadenitis
Lymphadenitis
neck cysts
injuries of the skin or the mucosa, furuncle, pyoderm,
untreated fractures
sinusitis (mycotic infection-aspergillosis, mucor mycosis)
surgical interventions
![Page 5: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/5.jpg)
PATHWAYS OF INFECTION caries
pulpitis
periap.periodontitis
ostitis
subperiosteal abscess
submucosal/subepith.
abscess/cellulitis
![Page 6: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/6.jpg)
PERIMANDIBULAR ABSCESS
![Page 7: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/7.jpg)
![Page 8: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/8.jpg)
Buccal
abscess
![Page 9: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/9.jpg)
CAUSATIVE AGENTS
Mainly monoinfections, in most cases: Staphylo-, Streptococcus
Sometimes Gram negative: Enterobacter, Pseudomonas aeruginosa, E. coli, anaerobics
In the case of severe infections, specimen for bacteriology, antibiogramm is absolutely neccessary
![Page 10: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/10.jpg)
SYMPTOMES
Swelling /fluctuation?/
Angry red coloured skin/mucosa
Fever/in the case of abscess „septic ~” kind of fever/
Pain
Mouth closure, swallow problems, speach problems, breath
problems
Bad general condition
Deviation of blood test, CRP↑- in cellulitis
![Page 11: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/11.jpg)
DIAGNOSTIC POSSIBILITIES
Anamnesis: (~48-72h abscess formation) tooth, salivary gland, lymph node
Clinical examination: swollen, deep caries, tooth sensitivity to
temperature and pressure change
Punction (purulent?) – microbiological exam.
X-rays
Ultrasound! – localization, extension, salivary galands? stones?
(CT, MR) – in serious cases (parapharyngeal expansion)
![Page 12: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/12.jpg)
TREATMENT POSSIBILITIES
Conservative treatment: (if no pus gathering): antibiotics, steam
dressing, painkillers, mouth gymnastics
Surgical treatment:
acute: (if pus gathering): intraoral/extraoral incision,
drainage
definitive surgery: tooth extr., periapical surg., decortication,
sequestrectomy
![Page 13: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/13.jpg)
ANTIBIOTICS
Amoxycillin (+clavulanic acid - Augmentin Duo 1000 mg 2x1 p.os,
2x1.2 g iv., 375 mg, 625 mg - just for children)
Clindamycin (Dalacin 300 mg 4x1 p.os or iv., 3x300mg or 3-4x
150mg – just for children )
Cefalosporins (Ceclor, Zinnat 250 mg, 500 mg 2x1)
Fluorokinolons (levofloxacin-Tavanic 1x500mg, moxifloxacin-Avelox
1x400mg - in bad cellulitis )
Metronidazoles (Klion, Supplin 2x500mg) –for anaerobics
![Page 14: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/14.jpg)
STEAM DRESSING
Dry cotton wool
Nylon
Wet cotton wool
Dry gauze
Fat cream
![Page 15: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/15.jpg)
ASPECTS OF INCISION
Possibility of complete outflow of purulent discharge (bigger
swell/deepest point)
Saving important anatomical specimens ( nerv- and wessel
branches)
Esthetic aspects (avoiding disadvantageous scars)
![Page 16: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/16.jpg)
![Page 17: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/17.jpg)
![Page 18: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/18.jpg)
![Page 19: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/19.jpg)
![Page 20: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/20.jpg)
![Page 21: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/21.jpg)
![Page 22: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/22.jpg)
![Page 23: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/23.jpg)
![Page 24: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/24.jpg)
![Page 25: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/25.jpg)
![Page 26: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/26.jpg)
![Page 27: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/27.jpg)
CELLULITIS I.
The inflammation is spreading along connective tissue spaces
without any border
General diseases in the background/immunodeficiency?
Life threatening because of spreading into the mediastinum or the
skull, (sepsis also)
![Page 28: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/28.jpg)
![Page 29: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/29.jpg)
![Page 30: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/30.jpg)
CONNECTIVE TISSUE SPACES I.
SPACES OF THE MASTICATORY MUSCLES
Spatium submasseterica
Spatium pterygomandibulare
Spatium temporalis superficialis
Spatium temporalis profunda
Fossa pterygopalatina
Fossa infratemporalis
![Page 31: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/31.jpg)
![Page 32: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/32.jpg)
CONNECTIVE TISSUE SPACES II.
SPACES OF THE FLOOR OF THE MOUTH
Spatium sublinguale
Spatium submandibulare
Angina Ludowici (bilateral cellulitis which involves both the
sublingual and the submandibular spaces)
![Page 33: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/33.jpg)
CONNECTIVE TISSUE SPACES III.
OTHER SPREADING DIRECTIONS
Perimandibular cellulitis
Spatium buccale
Fossa retromandibularis
Spatium para-, retropharyngeale
Spatium praevertebrale
![Page 34: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/34.jpg)
![Page 35: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/35.jpg)
CELLULITIS II.
TREATMENT
Wide, multiple incisions, drainage, cleaning with Betadine
Massive antibiotic treatment (broad spectrum -Avelox)
Intensive care (if necessary)
Consultation with chest surgeons and neurologists
![Page 36: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/36.jpg)
![Page 37: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/37.jpg)
![Page 38: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/38.jpg)
![Page 39: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/39.jpg)
OSTEOMYELITIS
Osteomyelitis acuta
Osteomyelitis chronica purulenta
Osteomyelitis sclerotisans focalis
Osteomyelitis sclerotisans diffusa
Osteoradionecrosis
BRONJ
![Page 40: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/40.jpg)
SIGNS
Swelling
Fever
Pain
Mouth closure
Fistule
Seqestration
X-ray
![Page 41: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/41.jpg)
TREATMENT
Conservative: antibiotics (Clindamycin!) in high dose, for a long
time (6 weeks), or by antibiogramms
Surgical: removal of bone sequesters, decortication, bone
resection, local antibiotic teratment (Gentamycin chain)
![Page 42: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/42.jpg)
BRONJ (BISPHOSPHONATE RELATED
OSTEONECROSIS OF THE JAW) I.
• Bisphosphonates:
• Pamidronate (Aredia)
• Alendronate (Fosamax)
• Ibandronate (Boniva)
• Risedronate (Actonel) inhibit: osteoclasts, remodelling
• Zoledronate (Zometa, Aclasta)
• Clodronate (Bonefos)
• Others: denosumab, bevacizumab
• Medical uses:
• Osteoporosis
• Bone metastasis (prostata cancer, breast cancer)
• Myeloma multiple
![Page 43: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/43.jpg)
BRONJ (BISPHOSPHONATE RELATED
OSTEONECROSIS OF THE JAW) II.
Clinical staging of BRONJ.
• At risk category:No apparent exposed/necrotic bone in patients who
have been treated with either oral or intravenous
bisphosphonates
• Stage 1: Exposed/necrotic bone in patients who are asymptomatic and
have no evidence of infection
• Stage 2: Exposed/necrotic bone associated with infection as
evidenced by pain and erythema in the region of the exposed
bone with or without purulent drainage
• Stage 3: Exposed/necrotic bone in patients with pain, infection, and
one or more of the following: pathologic fracture, extra-oral
fistula, or osteolysis extending to the inferior border
![Page 44: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/44.jpg)
BRONJ (BISPHOSPHONATE RELATED
OSTEONECROSIS OF THE JAW) III.
• Treatment:
• Antibiotics:
• 3 days before surgery and after further 2 weeks
• penicillin > quinolones > clindamycin >
metronidazole
• Surgery:
• atraumatic tooth extraction
• sequestrectomy
• mucoperiosteal cover of the bone
![Page 45: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/45.jpg)
![Page 46: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/46.jpg)
![Page 47: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/47.jpg)
![Page 48: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/48.jpg)
![Page 49: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/49.jpg)
![Page 50: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/50.jpg)
![Page 51: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/51.jpg)
THANK YOU FOR YOUR ATTENTION !
![Page 52: ODONTOGENIC PURULENT INFLAMMATION, CELLULITIS (PHLEGMONE), SPACES … · 2017. 2. 15. · Semmelweis University Department of Oral- and Maxillofacial Surgery Dr. Barabás Péter ODONTOGENIC](https://reader035.vdocuments.site/reader035/viewer/2022071414/610cf1fc36385a2825067235/html5/thumbnails/52.jpg)
WORK SAFETY PROTECTION TRAINING