Head, Neck, and Orofacial Infections: An Interdisciplinary Approach James R. Hupp, DMD, MD, JD, MBA, FACS Founding Dean and Professor of Oral-Maxillofacial Surgery School of Dental Medicine Professor of Surgery School of Medicine East Carolina University Greenville, North Carolina Elie M. Ferneini, DMD, MD, MHS, MBA, FACS Assistant Clinical Professor Oral and Maxillofacial Surgery Division, Department of Craniofacial Sciences University of Connecticut Medical Director, Beau Visage Med Spa Private Practice, Greater Waterbury OMS Waterbury, Connecticut 3251 Riverport Lane St. Louis, Missouri 63043 HEAD, NECK, AND OROFACIAL INFECTIONS: AN INTERDISCIPLINARY APPROACH ISBN: 978-0-323-28945-0 Copyright © 2016 by Elsevier, Inc. All rights reserved. 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Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a profes- sional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. International Standard Book Number: 978-0-323-28945-0 Executive Content Strategist: Kathy Falk Professional Content Development Manager: Jolynn Gower Senior Content Development Specialist: Courtney Sprehe Publishing Services Manager: Julie Eddy Design Direction: Julia Dummitt Printed in Canada Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contributors Matthew Anderson, BS R. Bryan Bell, MD, DDS, FACS School of Medicine Medical Director University of Connecticut Oral, Head and Neck Cancer Program and Clinic Storrs, Connecticut Providence Cancer Center The Earle A. Chiles Research Institute Amir F. Azari, DMD, MD Providence Portland Medical Center Department of Oral and Maxillofacial Surgery Attending Surgeon School of Dentistry Trauma Service/Oral and Maxillofacial Surgery Service Oregon Health and Science University Legacy Emanuel Medical Center Portland, Oregon Consultant Head and Neck Institute Ali Banki, DO Portland, Oregon Private Practice Glastonbury, Connecticut; Jeffrey D. Bennett, DMD Clinical Associate Professor and Chair Department of Dermatology Department of Oral Surgery and Hospital Dentistry University of Connecticut Indiana University Attending Dermatologist School of Dentistry Saint Francis Hospital and Medical Center Indianapolis, Indiana Hartford, Connecticut Tyler T. Boynton, DMD Mohammad Banki, MD, DMD, FACS Sonoma Valley Oral Surgery (Private Practice) Artistic Contours (Private Practice) Sonoma, California Warwick, Rhode Island; Clinical Faculty Grishondra Branch-Mays, DDS, MS Department of Surgery Associate Professor Warren Alpert Medical School Division of Periodontics Brown University Department of Developmental and Surgical Sciences Providence, Rhode Island; School of Dentistry Clinical Faculty University of Minnesota Division of Oral and Maxillofacial Surgery Minneapolis, Minnesota Department of Craniofacial Sciences School of Dental Medicine Joseph V. Califano, DDS, PhD University of Connecticut Professor Farmington, Connecticut Department of Periodontology School of Dentistry Lydia Aoun Barakat, MD Oregon Health and Science University Assistant Professor of Medicine Portland, Oregon Section of Infectious Disease Department of Internal Medicine Yale School of Medicine Medical Director of the YNHH Nathan Smith Clinic Program Director of the Yale HIV Primary Care Track New Haven, Connecticut v vi Contributors Todd Cassese, MD Susan L. Fink, MD, PhD Director Instructor Phase 1 of the Clinical Arts and Sciences Course Department of Laboratory Medicine and Immunobiology Associate Professor Yale School of Medicine Department of Medical Sciences New Haven, Connecticut Frank H. Netter MD School of Medicine Quinnipiac University Thomas R. Flynn, DMD North Haven, Connecticut Private Practice Reno, Nevada; Charles L. Castiglione, MD, MBA, FACS Former Associate Professor of Oral and Maxillofacial Associate Clinical Professor of Surgery Surgery School of Medicine Harvard School of Dental Medicine University of Connecticut Boston, Massachusetts Chief of Plastic Surgery Hartford Hospital Ashraf F. Fouad, DDS, MS Connecticut Children’s Medical Center Professor and Interim Chair of Endodontics, Periodontics Hartford, Connecticut and Prosthodontics School of Dentistry Frank M. Castiglione Jr., MD University of Maryland Associate Clinical Professor Baltimore, Maryland Department of Dermatology Yale School of Medicine Jacob Gady, DMD, MD Associate Clinical Instructor Yale New Haven Hospital and West Haven VA Hospital Division of Oral and Maxillofacial Surgery New Haven, Connecticut; University of Connecticut Private Practice Private Practice Hamden, Connecticut West Hartford, Connecticut Jason A. Chin, MD Morton H. Goldberg, DMD, MD Section of Vascular Surgery Clinical Professor Yale School of Medicine Division of Oral and Maxillofacial Surgery New Haven, Connecticut School of Dental Medicine University of Connecticut Scott T. Claiborne, DDS, MD Hartford Hospital Oncologic and Reconstructive Surgery Hartford, Connecticut North Memorial Medical Center Robbinsdale, Minnesota Michael T. Goupil, DDS, MEd, MBA Associate Dean for Student Affairs Marc D. Eisen, MD, PhD Associate Professor Assistant Clinical Professor, Otolaryngology Department of Oral and Maxillofacial Surgery Department of Surgery School of Dental Medicine University of Connecticut Medical Center University of Connecticut Farmington, Connecticut Farmington, Connecticut Lewis N. Estabrooks, DMD, MS Neil Haycocks, MD Associate Clinical Professor Community Based Clinical Faculty Department of Oral and Maxillofacial Surgery Frank H. Netter MD School of Medicine Tufts University School of Dental Medicine Quinnipiac University Board of OMSNIC and Fortress Professional Liability Hamden, Connecticut Companies Boston, Massachusetts Kyle Johnson, MD University of Connecticut Health Center Antoine M. Ferneini, MD, FACS Department of Otolaryngology Section Chief Head and Neck Surgery Division of Vascular Surgery Farmington, Connecticut Yale-New Haven Hospital/St. Raphael Campus Connecticut Vascular Center, PC North Haven, Connecticut Contributors vii Lewis C. Jones, DMD, MD Luke H. L’Heureux, DMD, MD Assistant Professor Division of Oral and Maxillofacial Surgery Department of Oral and Maxillofacial Surgery School of Dental Medicine School of Dentistry University of Connecticut University of Louisville Farmington, Connecticut Louisville, Kentucky Stuart E. Lieblich, DMD James A. Katancik, DDS, PhD Clinical Professor Department of Periodontology Division of Oral and Maxillofacial Surgery School of Dentistry School of Dental Medicine Oregon Health and Science University University of Connecticut Portland, Oregon Farmington, Connecticut; Avon Oral and Maxillofacial Surgery (Private Practice) Kristine Kelliher, MD Avon, Connecticut Department of Surgery, Hartford Hospital Hartford Healthcare Medical Group Maricar Malinis MD, FACP Emergency General Surgery Assistant Professor of Medicine Surgical Critical Care Section of Infectious Diseases Hartford, Connecticut; Yale University School of Medicine Instructor New Haven, Connecticut Department of Surgery University of Connecticut Michael Miloro, DMD, MD, FACS Farmington, Connecticut Professor and Head Department of Oral and Maxillofacial Surgery Orlando C. Kirton, MD, FACS, MCCM, FCCP University of Illinois Ludwig J. Pyrtek, MD Chair in Surgery Chicago, Illinois Chief, Department of Surgery Chief, Division of General Surgery Thomas S. Murray, MD, PhD Interim Director, Trauma Service Associate Professor Hartford Hospital Frank H. Netter MD School of Medicine Hartford, Connecticut; Quinnipiac University Professor and Vice Chair Hamden, Connecticut; Department of Surgery Attending Physician School of Medicine Pediatric Infectious Diseases University of Connecticut Connecticut Children’s Medical Center Farmington, Connecticut Hartford, Connecticut Antonia Kolokythas, DDS James Naples, MD Associate Professor School of Medicine Department of Oral and Maxillofacial Surgery University of Connecticut University of Illinois at Chicago Farmington, Connecticut Chicago, Illinois Timothy O’Brien, MD Akshay Kumarswamy, BDS, MS Connecticut Ear, Nose & Throat Associates Clinical Assistant Professor (Private Practice) School of Dental Medicine Hartford, Connecticut East Carolina University Greenville, North Carolina Kourosh Parham, MD, PhD, FACS Associate Professor Matthew E. Lawler, DMD, MD Division of Otolaryngology Harvard School of Dental Medicine Department of Surgery Harvard Medical School University of Connecticut Health Massachusetts General Hospital Farmington, Connecticut Boston, Massachusetts viii Contributors Zachary Peacock, DMD, MD, FACS Luis Suarez, MD Assistant Professor of Oral and Maxillofacial Surgery Vascular Fellow Harvard School of Dental Medicine Tufts Medical Center Attending Oral and Maxillofacial Surgeon Boston, Massachusetts Massachusetts General Hospital Boston, Massachusetts Stevan H. Thompson, DDS Clinical Assistant Professor Robert Piorkowski, MD, FACS Division Director, Oral and Maxillofacial Surgery Chief School of Dental Medicine Division of Surgical Oncology East Carolina University Department of Surgery Staff, Oral and Maxillofacial Pathology Hartford Hospital Vidant Medical Center Hartford, Connecticut Greenville, North Carolina Philip M. Preshaw, BDS, FDS RCSEd, PhD Alison Y. Yeung, DDS, MD Professor of Periodontology Clinical Assistant Professor School of Dental Sciences and Institute Division of Oral and Maxillofacial Surgery of Cellular Medicine School of Dental Medicine Newcastle University East Carolina University Newcastle Upon Tyne, United Kingdom Greenville, North Carolina Thomas Schlieve, DDS, MD Katherine J. Zamecki, MD, FACS Oral/Head and Neck Oncologic Surgery Fellow Attending Ophthalmologist The Department of Oral and Maxillofacial Surgery Ophthalmic Plastic and Reconstructive Surgery University of Tennessee Medical Center Danbury Eye Physicians and Surgeons, PC Knoxville, Tennessee Danbury, Connecticut David Shafer, DMD Skye Zeller, PhD Chair and Associate Professor School of Dental Medicine Division of Oral and Maxillofacial Surgery University of Connecticut School of Dental Medicine Farmington, Connecticut University of Connecticut Farmington, Connecticut Ryan Zengou, MD Assistant Professor Rabie M. Shanti, DMD, MD Division of Neurosurgery Fellow in Oral, Head and Neck Oncologic Surgery/ School of Medicine Microvascular Reconstructive Surgery University of Connecticut Department of Oral and Maxillofacial/Head and Neck Farmington, Connecticut Surgery Louisiana State University Health Sciences Center Shreveport, Louisiana Julie Ann Smith, DDS, MD Associate Professor and Predoctoral Program Director Department of Oral and Maxillofacial Surgery Oregon Health and Science University Portland, Oregon To Carmen, the love of my life, best friend, and wife; our unbelievably special children, Jamie, Justin, Joelle, and Jordan (Maime, Joost, Welly, and Jordo); our wonderfully talented daughters-in-law and son- in-law, Natacha, Jordan, and Joe; and our delightful granddaughters, Peyton and Morgan. JRH I dedicate this book to my wife Moniek, whose love, support, and devotion have made completion of this book possible. I would also like to express my love to my children Michael, Isabella, and Anthony, who inspire me and give me the strength and the will to strive to be the best I can be. Above all, I would like to thank my parents and brothers, especially Tony, who have encouraged me and taught me the value of education and hard work. EMF Preface Head, Neck, and Orofacial Infections: An • S urgeons including general surgeons, head and neck surgeons, otolaryngologists, oral-maxillofacial surgeons, Interdisciplinary Approach plastic surgeons, neurosurgeons, ophthalmologists, der- matologists, pediatric surgeons, and trauma surgeons Head, neck, and orofacial infections are commonly seen • D ental professionals including general dentists, periodon- in medical and dental offices, and, in severe cases, in hos- tists, endodontists, pediatric dentists, oral-m axillofacial pital emergency departments. Head and neck anatomy is pathologists, and oral-maxillofacial radiologists complex, with many contiguous spaces, and thus infections • N ursing professionals including midlevel providers, in one anatomic region may easily spread to other regions, those working in hospital infection control, and nurses including the pharynx, eye, and brain. This can lead to dev- in emergency care facilities and operating rooms astating results, including airway obstruction, blindness, and altered mental status with cranial neuropathies. Early Key Features recognition and correct management of severe infections can be life-saving, especially in medically compromised • O ver 500 images (including photographs, radiographs, patients and in those who present late in the infectious dis- and illustrations) clearly demonstrate pathologies, proce- ease process. Knowledge of the surgical anatomy and the dures, and outcomes. path of spread of infections in the head and neck is funda- • E xperts in the field provide authoritative, state-of-the art mental in correct diagnosis and treatment. Head, Neck, and Orofacial Infections: An Interdisciplinary guidance. Approach is the first book of its kind to present this level • A variety of topics are covered such as the evolving prin- ciples of antibiotic therapy; odontogenic infections; the of in-depth information for those diagnosing and manag- pathophysiology and management of nasal and paranasal ing pathology due to infections of the head and neck and sinus infections; acute ear infections; orbital infections; orofacial complex. This comprehensive resource provides the infection issues surrounding dental implants; anes- both time-tested and cutting-edge approaches to patient thetic management of the patient with a head and neck management. infection; and much more! This book is designed to be of value to a wide range of health professionals: • P hysicians including family physicians, infectious dis- ease specialists, anesthesiologists, internists, hospitalists, critical care physicians, pediatricians, radiologists, and clinical pathologists x Acknowledgments I appreciate the skill and hard work of the publishing team I would like to acknowledge my mentors, colleagues, resi- at Elsevier who helped make this book possible, including dents, students, and staff who have, over the years, directly Kathy Falk, Courtney Sprehe, and David Stein. I am also or indirectly, contributed to this work. Their never-ending deeply grateful to my oral-maxillofacial colleagues at ECU, assistance and constant support have made this book pos- Drs. Ali Yeung and Stevan Thompson for giving me the sup- sible. For that, I am eternally grateful. I also want to express port I needed to dedicate time to this endeavor. Finally, I my appreciation for the expertise of the entire publishing wish to acknowledge and thank Drs. Richard Topazian and team at Elsevier. Morton Goldberg for the important contributions they made to my education and for the original concept of a EMF book dedicated to the topic of maxillofacial infections. JRH xi 1 Immunobiology of Infectious Disease JOSEPH V. CALIFANO AND PHILIP M. PRESHAW Introduction within the host, and a productive infection ensues. Once this occurs, many of the elements of innate immunity are The human immune system is a biologic marvel designed still active, but an adaptive immune response occurs over to identify and destroy or alter pathogens, foreign material, time.2 This response may be dominated by a humoral and abnormal cells that threaten an individual. This chapter response in which opsonizing antibody specific to the presents a detailed discussion of the immune system as it pathogenic organism facilitates phagocytosis and clear- relates to infectious pathogens. ance of the microorganism and its toxins (typical for Throughout our lives we are constantly encountering extracellular pathogens such as bacteria), or it may be microorganisms capable of causing infectious disease. We dominated by a cellular response in which cytokines, have, through the evolutionary processes of natural selec- phagocytes, or cytolytic T cells eliminate infected host tion, developed a complex and highly organized immune cells to clear the pathogen (typical response for intracel- system composed of molecules, cells, and tissues that protect lular pathogens like viruses and some bacteria, such as us from agents of infection. Although infections clearly do Mycobacterium tuberculosis). Innate immunity is consti- occur, most interactions with potentially pathogenic bacte- tutive; it does not require prior exposure to the micro- ria, viruses, or fungi do not result in a productive infection. organism to respond to it. Adaptive immunity, on initial For infection to occur, the inoculum and virulence of the exposure to a pathogen, requires 3 to 7 days for a response organism must be of a magnitude sufficient to overwhelm to occur. With multiple exposures to the pathogen over the immune system. time, either naturally or through immunization, there is Our immune system has been divided, based on our a decrease in the lag time and an increase in the magni- understanding of function, into innate immunity and tude and efficacy of the adaptive immune response. adaptive immunity (Figure 1-1). It is important to note that these aspects of immune functioning do not operate Cells of the Immune System in isolation; indeed, there is close functional integration between the innate and adaptive arms of the immune The cells of the immune system are derived from pluripo- response.1 Innate immunity serves to provide the first tent stem cells in the bone marrow. The stem cells then dif- line of defense in preventing infection. It includes physi- ferentiate into lymphoid and myeloid progenitors. cal barriers such as the skin and mucosa, phagocytic cells The lymphoid progenitor ultimately differentiates into B (e.g., neutrophils, macrophages), specialized receptors lymphocytes (produced in the bone marrow), T lympho- that bind and detect classes of macromolecules associ- cytes (produced in the thymus), and natural killer (NK) ated with pathogens not found in eukaryotic cells (e.g., cells. NK cells are involved in early immune responses, and lipopolysaccharide, lipoteichoic acid, single-stranded they recognize virally infected cells and neoplastic cells. DNA, double-stranded RNA [dsRNA]), and molecules B lymphocytes, when activated further, differentiate into that promote inflammation, chemotaxis, and opsoniza- memory B cells and antibody-secreting plasma cells. T lym- tion (e.g., cytokines, complement, acute phase proteins, phocytes further differentiate into helper T cells, cytotoxic T arachidonic acid metabolites). In most cases, infectious cells, and regulatory T cells. These different subpopulations agents are eliminated by innate immunity. When the of T cells are distinguished from each other by the types of innate immunity is not sufficient to prevent infection, cytokines they produce and by the surface molecules that the invading microorganism is successful in replicating they display (Figure 1-2). 2