口腔科學炎癥

1、Infraorbital space （眶下間隙感染）,解剖:,感染來源 1- 4 根尖周炎 上頜骨骨髓炎 軟組織感染,,,,,臨床特點:,Treatment,(1)Local management with Chinese Herbs in primary stage of infection;(2)Abscess incision and drainage;(3)Incision at maxillary

2、sulci near the canine and first bicuspid.,,Buccal space infection（頰間隙感染）,Anatomical border:,Sources of infection (1) Molar periapicitis or alveolar abscess; (2) Injury or ulcer of buccal skin or mucosa; (3) Infect

3、ion spreading from buccal or supramandibular lymphadenitis.,,Masseteric space（咬肌間隙感染 ）,Anatomical border,Sources of infection,PericoronitisMolar periapititisSpreading from adjacent spacesPyogenic parotitis,臨

4、床特點,1- 紅、 腫 、以下頜角為中心病變區(qū); 2- 張口受限 3- 無波動感;4- 1周后穿刺可抽出膿液;5- 頜骨邊緣性骨髓炎,,,,B,M,并發(fā)癥及擴散途徑,Buccal spacePterygomandibular spaceInfratemporal spaceTemporal space,Treatment,Intraoral incision,Extraoral incision,Removal of fo

5、ci,Treatment of marginal osteomyelitis,,下頜緣下2cm3-5cm長切口,Pterygomandibular space (翼下頜間隙),Anatomical border,,Infection sources,PericoronitisMolar periapititisBlock anesthesia of inferior dental nerveSpreading from ad

6、jacent spaces,臨床特點,1- 牙痛史及開口困難 2- 腫脹不明顯; 3- 無明顯的波動感;4- 1周左右可穿刺抽出膿液;5- 邊緣性骨髓炎,擴散途徑,,顳下間隙顳間隙 咽旁間隙頜下間隙咬肌間隙,Treatment,Intraoral incisionExtraoral incision,Temporal space （顳間隙）,Anatomical border,(1) Other space infe

7、ction diffusion;(2) Ear infection;(3) Infection in the temporal region;,Sources of infection,Superficial space,,Deep space,Osteomyelitis,Multispace,,Treatment,Infection spreading;Maxillary molars;Deep anesthesia;,,,I

8、nfratemporal space (顳下間隙感染）,Anatomical space,Sources of infection,并發(fā)癥及擴散途徑,Temporal spacePterygomandibular spaceMasseteric spaceBuccal spaceOrbital cellulitisEncephalic infectionCavernous sinus thrombosis,,,Parapha

9、ryngeal space (咽旁間隙),Anatomical border,The space may be described in terms of an inverted cone or triangle with a superior limit formed by the skull base and its inferior apex by the hyoid bone. The medial limit is the v

10、isceral layer of the deep cervical fascia that covers the superior pharyngeal constrictor muscle. Laterally the space is bounded by fascia covering the pterygoid muscles and parotid gland. The posterior limit is the prev

11、ertebral fascia, whereas its anterior limit is predominantly the pterygomandibular raphe.,,,,Sublingual space （舌下間隙感染）,Anatomical border,Sources of infection,,(1) Infection from inferior teeth;(2) Infection spreading fr

12、om adjacent spaces;(3) Infection from sublingual and submandibular glands duct.,,,,Submandibular space (頜下間隙）,Anatomical border,Sources of infection,(1) Pericoronitis;(2) Infection of the second and third molars

13、;(3) Sialoadenitis of the submandibular gland; (4) Infection of sunmandibular lymphonode.,,Submental space (頦下間隙),Anatomical border,Sources of infection,,(1) Commonly secondary to lymphadenitis in this region;(2) Infe

14、ction of the skin, mucosa and teeth.,,,Cellulitis of the floor of the mouth口底蜂窩織炎,Cellulitis of the floor of the mouth, or called Ludwig`s angina, is an acute, potentially life-threatening cellulitis that involves the s

15、ubmandibular and sublingual space bilaterally as well as the submental space.,,Although Ludwig`s angina has a low incidence, it has been a devastating infection historically. The disease had a 50% mortality rate in the p

16、reantibiotic era; contemporary rates of mortality from the infection are difficult to estimate from the literature but appear to be less than 10% in well-managed patients.,The microbiology of this cellulitis has been tra

17、ditionally ascribed to the gram-positive sreptococci. However, contemporary reports have demonstrated staphylococci, mixed oral flora, and anaerobes such as gram-negative enteric organisms in cultures obtained from surgi

18、cal drainage of the infection.,Treatment principle,(1) Aggressive and timely systemic therapy with border spectrum antibiotics such as penicillin or clindamycin, augmented with metronidazole.(2) Supportive management (