1 / 42

Deep neck infections

Deep neck infections. 가천의과대학 길병원 구강악안면외과 김 현민. 차례. 1) facial spaces 2) each spaces ; buccal masticator sublingual & submandibular parapharyngeal retropharyngeal 3) case report 1.2

orenda
Télécharger la présentation

Deep neck infections

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Deep neck infections 가천의과대학 길병원 구강악안면외과 김 현민

  2. 차례 1) facial spaces 2) each spaces ; buccal masticator sublingual & submandibular parapharyngeal retropharyngeal 3) case report 1.2 4) summary 5) references

  3. Fascial spaces of clinical significance Face ; buccal canine masticator – masseter , pterygoid , zygomaticotemporal parotid Suprahyoid ; sublingual submandibular – submaxillary , submental lateral pharyngeal(pharyngomaxillary) peritonsillar Infrahyoid ; pretracheal (anterovisceral) Spaces of total neck ; retropharyngeal danger space space of carotid sheath by Topazian & Goldberg

  4. Fascial anatomy

  5. Fascial anatomy 1

  6. Fascial anatomy 2

  7. Fascial anatomy 3

  8. Fascial anatomy 4

  9. Fascial anatomy 5

  10. Fascial anatomy 6

  11. Cellulitis versus abscess on CT imagies • Abscess ; single or multilocated low density masses, peripheral irregular rim enhancement, fluid collections contrast injections (a)before (b)after on RPA/PPA • Cellulitis ; without a low density collection, no fluid collections hypodensity with(a),without(b) complete ring enhancement

  12. Buccal space infections • Symptoms ; round dome shape swelling, trismus, 원인치의 동요 및 타진 반응, 상하안검 swelling • Anatomy ;

  13. Masticator space infections • Symptoms; trismus, painful swelling, dysphagia etc • Anatomy ;

  14. Masticator space infections • * Mn 에서 야기된 odontogenic infections은 upward 되며 masseter m 감염은 PS , temporalis, lat.pterygoid m로 spread , med. Pterygoid m 감염은 PPS , lat. Pterygoid m로 spread된다. Downward 되어 sublingual, submn spaces로 spread 된다. • * Mx에서 야기된 inf 은 downward 되지 않고 superficially temporal, MS, deeply lat. / med. Pterygoid m을 involve 한다. • MS 는 mn inf. 의 primary site 이고 PS & pharyngeal space는 MS의 2nd site 이며 mn inf. 은 sublingual & submn으로 직접 전파된다. By Koichi Yonetsu

  15. Submandibular space infections • Symptoms ; neck rigidity, trismus, dysphagia, respiratory distress, sialorrhea, pyrexia, • Anatomy ;

  16. Submandibular space infections *Schematic drawing of the 3 types of pathways type 1; beyond mylohyoid ridge & posterioly from adjacent sublingual space ; with mylohyoid m enlarge type 2 ; from inflammatory periostitis of mn ; no or rare PPS,MS involvement mild symptoms without trismus & dysphagia

  17. Submandibular space infections • * 만약 감염이 PPS로 spread 되면 dysphagia 발생되며 PPS는 med. Pterygoid m 같은 MS 감염시 자주 spread 된다. 그런데,Submn space inf 시 PPS 사이에 fasciaL barrier 가 얇아서 전이가 용이하다. 이는 med. Pterygoid m involvment 없이도 동시에 감염이 일어나는 것으로 확인 될 수 있다. • type 3 ; downward from MS • Type1(57.6%) > type2(15.2%) > type3(12.1%) by Y.Ariji et al

  18. Parapharyngeal space infections • Symptoms ; fever(38.5), chill, throat swelling, odynophagia, dysphagia, neck pain & stiffness, respiratory distress, sialorrhea, trismus ( PPS swelling+ & trismus- = peritonsillar abscess) • Cause ; most common cause - peritonsillar abscess odontogenic sourse(20-39%) by Larry J. Peterson • Anatomy ; ant prestyloid compartment- fat filled post retrostyloid compartment-major neurovascular bundle (hard palate- upper PPS, lower PPS)

  19. Parapharyngeal space infections • Anatomy – MS,PS(lateral) , CS(post) , RPS(posteromedial) • PPS의 displacement direction 은 origin of lesion 을 suggest 한다. By VFH Chong et al

  20. Parapharyngeal space infections imagies

  21. Retropharyngeal space infections • Symptoms ; fever, decrease oral intake, odynophagia, malaise, torticollis, neck pain, trismus, otalgia, headache, neck swelling, • Anatomy ;

  22. Retrppharyngeal space infections • Lateral neck x-ray 는 first imaging test 되어야 한다. Air sign이 보이는 경우 specific하다. CT scan은 RPS abscess manage 시 중요하지만 cellulitis 와 abscess를 구분하는 데 한계가 있다. by Carl Boucher • RPS abscess – lat. Neck x-ray – air sign+- drainage (with CT) air sign—IV anti –no improvement-CT scan improvement-IV continue • Young children에서 neck plain films는 true lat, orientation(neck extension, full inspiration, swallowing& expiratory crying 을 avoid 하여야 RPS thicken 을 방지할 수 있다.by P.Bradley Brechtelsbauer • Lat. Neck x-ray diagnosis ; 1)smooth lordotic curve of cervical vertebra-C2,C3 7mm wide적어야, 평균3mm, C6 14mm소아, 22mm성인 soft tissue shadow가 정상

  23. Retropharyngeal space infections • 2) presence of gas • 3) straight cervical spine or reversed kyphotic curve • loss of the lordotic curve by Larry J. Peterson

  24. Retropharyngeal space infections

  25. Case report 1 Pt ; 38/F • CC ; 내원 5일 전 개인치과 발치 후 우측 swelling으로 내원 • PI ; mouth opening limitation, dysphagia, Rt buccal & sub mn swelling / Td/ redness • Dx ; masticatory spce, lat. Pharyngeal space abscess • Tx ; I & D X 2 • (submn & submental, deep neck carotid sheath area) • anti theraphy ( aug + micronomycin + flagyl) • fluid etc supplementary tx (O2 etc) • 초진 lab ; WBC 30260, segmental neutrophil 85.9%, CRP 36.5

  26. 초진 모습

  27. 치료 임상 사진 • 1) 초기 I&D (02.9.13), 2차 I&D(02.9.14) • 2)3차 I&D(02,9.17)

  28. 치료 후 사진 • 02. 9.27

  29. 초진 CT (02.9.14)

  30. 2회 CT(02.9.17)

  31. 3회 CT(02.9.19)

  32. 4회 CT(02.9.25)

  33. Case report 2 • Pt ; 30/M • CC ;transfer from ENT d/t deep neck infection from dental origin • Hx ; 02.5.20 #38 ext 후 ENT로 입원 • PI ; both submn swelling & Td mouth opening limit, dysphagia, dyspnea, neck Td & redness, #38 area pus • DX ; submn & mental space abscess pretracheal space abscess descending necrotizing mediastinitis • Tx ; I & D 3회 (local 1, general 2 with TS)

  34. 초진모습 • 초진 lab ; WBC 16120, segmental neut92.7%, ESR119, CRP25.1

  35. 치료 임상 사진

  36. 치료 후 사진

  37. 초진 CT(02.5.25)

  38. 2회 CT(02.5.29)

  39. 3회 CT(02.6.3)

  40. 4회 CT(02.6.12)

  41. Summary • Deep neck infections 의 치료는 early radiologic Dx, medical management(effective antitherapy), intensive surgical management & airway control 등 요소가 필수적이다. • Culture를 시행하는 것이 중요하지만 감수성검사가 시행되기 전까지 penicillin derivatives & clindamycin과 같은 항생제로 early intervention을 시행하여야 하고 cellulitic stage에서는 항생제만으로도 가능하지만 abscess가 확진 되면 surgical intervention이 시행되어야 한다. CT 및 MRI 등의 이용은 임상증상의 한계를 보이는 deep neck infection 시 고려되어야 한다. • 만약 초기 항생제 치료 48시간내 증상의 호전이 보이지 않거나 abscess가 임상적으로 확인가능 하다면 I & D는 충분히 고려되어야 한다. • AIR way 확보는 RPA, Submn A 시 tracheostomy가 필요로 하는 경우도 있으므로 충분한 환자의 monitoring이 중요하다고 하겠다.

  42. References • 1.Y.Ariji et al.odontogenic inf. Pathway to the submn space; imaging assessment.Int.J.Oral Maxillofac.Surg.2002;31;165 • 2.VHF Chong & YF Fan. Radiology of the PPS.Australasian radiology.1998;42;278 • 3.Larry J. Peterson.L.contemporary management of deep infections of the neck.J.Oral Maxillofac.Surg.1993;51;226-231 • 4.Carl Boucher et al.RPS abscess; a clinical & radiologic correction;J.of Otolaryngology,1999;28;134 • 5. Per-Lennart Westesson; contemporary maxillofacial imaging OMFS clinics of noth america,1992 • 6. Topazian & Goldberg; oral & maxillofacial infections, 3rd edition • 7. 김여갑; 임상구강악안면감염학,1995 • 8. Koichi Yonetsu et al; deep fascial inf. Of odontogenic origin: CT assessment of pathways of space involvment. AM J Neuroradiology,1998;19;123

More Related