_inoral maxillofacial region口腔及颌面部感染地区（ppt37）课件

Infection in Oral & Maxillofacial Region Yu Chuang-Qi Pandect Infection- in oral & maxillofacial region nInfectionConception nTraitAnatomy nArisingRoute nMutationInfluence factors nDiagnosisPrinciples nTreatmentPrinciples Pandect Infection-conception Infectious agent(bacteria)Host Inflammatory reaction Elimination the infectious pathogen Repair tissue injury Hypersensitivity Autoimmune disease Beneficial Harmful protective and defensive Trait of anatomy nOral and nasal cavity nTooth nSpace nBlood and Lymphoid system nBacteria Trait of anatomy nOral and nasal cavity nMaxillary sinus(上颌窦) Temperature + Moisture (Beneficial) Reproduction + Developing Bacteria-Exist Alveolar bone Soft tissue Fascial space Trait of anatomy ToothTooth Caries Pulpitis Apical infection Trait of anatomy Fascial space(间隙)-loose connective tissue Among skin, maxillary and muscle Purulent- spreading way Do not exist in healthy state Become filling during infection Trait of anatomy Blood and lymphoid system Beneficial Abundance Harmful Dangerous triangle Lacking valves Cavernous sinus Cavernous sinus thrombosis Encephalic infection Trait of pathogenic bacterium nVaried nNumerous nStreptococcus hemolyticus (溶血性链球菌) nStaphylococcus aureus (金黄色葡萄球菌) nEscherichia coli (大肠杆菌) nAnaerobe (厌氧菌) Sterile Simple Complex Flora(Flora(菌丛菌丛) ) Route of infection nOdontogenic infection nAdenogenous(腺源性) infection nTraumatic infection nHematogenous(血源性) infection nIatrogenic(医源性) infection Odontogenic infection Periapical infection Pericoronitis(冠周炎) Periapical infection Acute-chronic Periapical infection Fistular(瘘) Cellulitis (蜂窝织炎) Intraoral soft tissue abscess (脓肿) Osteomyelitis (骨髓炎) Septicemia(败血症) Deep fascial space infection Ascending facial- cerebral infection Pathways of Periapical infection Pericoronitis (冠周炎) Lower third molar Infection-Arising nHost- defense system nMicrobe-virulence quantity nLocal circumstance Balance Imbalance Scale Mutation nInfluence factors nChanging directions Influence factors nHost- defense system nMicrobe-virulence quantity nTreatment strategy Changing directions nLocalization and recovery nAcute chronic nDiffusion Blood system-Septicemia lymphoid system-Lymphadenopathy From submandible space infection to chest region How to diagnose? nLocal Signs and Symptoms nSystemical Signs and Symptoms Signs and Symptoms Local Signs and Symptoms nPain nSwelling nSurface erythema nPus formation nLimitation of motion LocallyLocally Systemical Signs and Symptoms n Fever n Lymphadenopathy n Malaise n Toxic appearance n Elevated white blood cell count How to treat? nAcute stage nChronic stage Acute stage nHost nAntibiotic therapy nSurgical drainage and incision Host nMigration of white blood cell nProduction of antibodies nMost important factor - final outcome nThe infections- cured by the host, not by antibiotics Critical Principles Defense Mechanisms Principles for choosing appropriate antibiotic ncausative organism(致病菌) nsensitivity nspecific, narrow-spectrum antibiotic nleast toxic antibiotic ndrug history(success, allergic and toxic) Antibiotic era Principles of antibiotic administration nProper dose nProper time interval nProper route of administration(oral, parenteral) nCombination antibiotic therapy Surgical drainage and incision nHow to judge the pus formation? nPurposes of surgical drainage and incision nPrinciples of surgical drainage and incision How to judge the pus formation? Three stages Inoculation Cellulitis Abscess n Duration- 5 days n Palpation-Fluctuant n Appearance-Reddened n Needle aspiration n B-ultrasound n CT CharacteristicCharacteristic Fluctuant examination Purposes of surgical drainage & incision nRid the body of toxic purulent material nDecompress the tissues nAllowing better perfusion of blood containing antibiotics and defensive elements nIncreased oxygenation of the infected area Infection in masseteric space Infection in multi-space Ludwigs angina Principles of surgical drainage & incision nPlace the incision in an esthetically acceptable nPlace the incision in a dependent position to encourage drainage by gravity nDissect bluntly through deeper tissues and explore all portions of the abscess nPlace a drain and stabilize it with sutures Principles of surgical drainage & incision n n Lesion tooth-Impacted toothLesion tooth-Impacted tooth n n OsteomyelitisOsteomyelitis Chronic stage Chronic stage Surgical removal of the focus(Surgical removal of the focus(病灶病灶