口腔科学：炎症.ppt

Infraorbital space （眶下间隙感染）,解剖:,感染来源 1- 4 根尖周炎 上颌骨骨髓炎 软组织感染,临床特点:,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.,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.,Masseteric space（咬肌间隙感染 ）,Anatomical border,Sources of infection,Pericoronitis Molar periapititis Spreading from adjacent spaces Pyogenic parotitis,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,B,M,并发症及扩散途径,Buccal space Pterygomandibular space Infratemporal space Temporal space,Treatment,Intraoral incision,Extraoral incision,Removal of foci,Treatment of marginal osteomyelitis,下颌缘下2cm 3-5cm长切口,Pterygomandibular space (翼下颌间隙),Anatomical border,Infection sources,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,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,(1) Other space infection 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;,Infratemporal space (颞下间隙感染）,Anatomical space,Sources of infection,并发症及扩散途径,Temporal space Pterygomandibular space Masseteric space Buccal space Orbital cellulitis Encephalic infection Cavernous sinus thrombosis,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.,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.,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.,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.,Cellulitis of the floor of the mouth 口底蜂窝织炎,Cellulitis of the floor of the mouth, or called Ludwigs angina, is an acute, potentially life-threatening cellulitis that involves the submandibular and sublingual space bilaterally as well as the submental space.,Although Ludwigs 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.,The microbiology of this cellulitis has been traditionally 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 surgical drainage of the infection.,Treatment principle,(1) Aggressive and timely systemic therapy with border spectrum antibiotics such a