口腔科学：炎症2

Pericoronitis Molar periapititis Block anesthesia of inferior dental nerve Spreading from adjacent spaces

临床特点
1- 牙痛史及开口困难 2- 肿胀不明显; 3- 无明显的波动感; 4- 1周左右可穿刺抽出脓液; 5- 边缘性骨髓炎

The microbiology of this cellulitis has been traditionally ascribed to the grampositive sreptococci. However, contemporary reports have demonstrated staphylococci, mixed oral flora, and anaerobes such as gramnegative enteric organisms in cultures obtained from surgical drainage of the infection.
Buccal space infection（颊间隙感染）

Anatomical border: Sources of infection (1) Molar periapicitis or alveolar abscess; (2) Injury or ulcer of buccal skin or mucosa; (3) Infection spreading from buccal or supramandibular lymphadenitis.

Although Ludwig`s angina has a low incidence, it has been a devastating infection historically. The disease had a 50% mortality rate in the preantibiotic 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.

Treatment
Intraoral incision
Extraoral incision
Removal of foci
Treatment of marginal osteomyelitis
Pterygomandibular space (翼下颌间隙) Anatomical border Infection sources
Cellulitis of the floor of the mouth
口底蜂窝织炎

Cellulitis of the floor of the mouth, or called Ludwig`s angina, is an acute, potentially life-threatening cellulitis that involves the submandibular and sublingual space bilaterally as well as the submental space.

临床特点
1- 红、 肿 、以下颌角为中心病变区; 2- 张口受限 3- 无波动感; 4- 1周后穿刺可抽出脓液; 5- 颌骨边缘性骨髓炎

并发症及扩散途径
Buccal space Pterygomandibular space Infratemporal space Temporal space
a
b
Parapharyngeal space (咽旁间隙)

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 visceral 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 prevertebral fascia, whereas its anterior limit is predominantly the pterygomandibular raphe.
Infraorbital space （眶下间隙感染）

解剖:

感染来源 1- 4 根尖周炎

Treatment
(1)Local management with Chinese Herbs in primary stage of infection; (2)Abscess incision and drainage; (3)Incision at maxillary sulci near the canine and first bicuspid.
Submandibular space (颌下间隙）

Anatomical border
Sources of infection
(1) Pericoronitis; (2) Infection of the second and third molars; (3) Sialoadenitis of the submandibular gland; (4) Infection of sunmandibular lymphonode.

扩散途径
颞下间隙 颞间隙
咽旁间隙
颌下间隙 咬肌间隙

Treatment
Intraoral incision Extraoral incision
Temporal space （颞间隙）

Anatomical border Sources of infection
(1) Other space infection diffusion; (2) Ear infection; (3) Infection in the temporal region;
a
b
Sublingual space （舌下间隙感染）

Anatomical border
Sources of infection
(1) Infection from inferior teeth; (2) Infection spreading from adjacent spaces; (3) Infection from sublingual and submandibular glands duct.

Masseteric space（咬肌间隙感染 ）

Anatomical border
Sources of infection
Pericoronitis Molar periapititis Spreading from adjacent spaces Pyogenic parotitis

Treatment principle
(1) Aggressive and timely systemic therapy with border spectrum antibiotics such as penicillin or clindamycin, augmented with metronidazole. (2) Supportive management (支持治疗）; (3) Airway compromise management by endotracheal intubation or tracheostomy; (4) Early surgical drainage.
Submental space (颏下间隙)

Anatomical border
Sources of infection
(1) Commonly secondary to lymphadenitis in this region; (2) Infection of the skin, mucosa and teeth.
Infection
Maxillary Deep
anesthesia;

并发症及扩散途径
Temporal space
Pterygomandibular space
Masseteric space Buccal space
Orbital cellulitis Encephalic infection Cavernous sinus thrombosis


Treatment
Superficial space
Deep space Osteomyelitis Multispace
Infratemporal space (颞下间隙感染）

Anatomical space Sources of infection spreading; molars;