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相關文獻
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題名 | Ludwig's Angina with Mediastinitis Resulting from Odontogenic Infection--Case Report=齒源性感染的魯特維格咽峽炎合併縱隔腔炎--病例報告 |
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作者 | 陳俊明; 楊家福; 陳中和; 周世華; 李惠娥; | 書刊名 | 中華牙醫學雜誌 |
卷期 | 20:1 2001.03[民90.03] |
頁次 | 頁47-54 |
分類號 | 416.94 |
關鍵詞 | 魯特維格式咽峽炎; 縱隔腔炎; Ludwig's angina; Mediastinitis; |
語文 | 英文(English) |
中文摘要 | 齒源性感染造成魯特維格式咽峽炎並且合併縱隔腔炎是相當罕見的,而且有潛在 的致命性。感染最常起源於下顎臼齒周圍根尖或牙周發炎,並經由頜下間隙侵犯到咀嚼間隙 以及頸部組織間隙,因此病人在頸部上舌骨區通常可見到顎下區的腫脹,質地硬且疼痛;在 口底及舌部也會有相當明顯的腫脹,並且向上向後位移,頂住上顎的�Z部,導致發音、吞嚥 和呼吸困難。胸部併發症主要是經由頸部肌膜間隙向下擴散,當感染蔓延至縱隔腔併發縱隔 腔炎時,其死亡率是相當高的。 本篇提出一例齒源性感染而後形成魯特維格式咽峽炎病例,感染沿著頸部的組織間隙蔓延而 侵犯至縱隔腔造成縱隔腔炎和雙側性胸膜積水的併發症,住院期間施行氣管切開術維持呼吸 道的通暢,並根據致病菌培養與抗生素敏感性試驗的結果,投與有效的抗生素,適時的頸部 及縱隔腔的清創,徹底引流膿瘍。本篇同時探討此症可能的病因、臨床症狀,早期診斷以及 立即清創和縱隔切開術的重要性。 |
英文摘要 | Ludwig's angina, complicated with mediastinitis, is a rare but potentially lethal infection of odontogenic origin. The most common source of infection is the mandibular molars. Swelling of the mouth floor with tongue elevation and brawny neck edema descending on the anterior chest wall are common symptoms. We report a case of Ludwig's angina of dental origin, progressing to mediastinitis and bilateral pleural effusion. The patient survived because of early diagnosis accompanied by aggressive management, including maintaining an open airway, high doses of antibiotics, prompt surgical intervention and continuing intensive care. Here we report an anatomic scenario of Ludwig's angina with associated clinical symptoms, a bacteriological pattern, imaging findings, and consequent treatment. An early diagnosis followed by prompt mediastinotomy is crucial in treating mediastinal complications resulting from odontogenic infection. |
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