Pteromandibular space infection
Introduction
Brief introduction of pterygopalatine infection Wing mandibular space infection is an acute suppurative infection of the pterygopalatine space. The main clinical manifestations are limited mouth opening and chewing and swallowing pain. Often there is a history of toothache, followed by limited mouth opening, chewing food, swallowing pain; oral examination revealed mucosal edema at the pterygopalatine fold, and the inside of the posterior margin of the mandibular branch may have mild swelling and deep tenderness. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: difficulty swallowing
Cause
Wing mandibular space infection etiology
The pterygomandihular space is located between the medial wall of the mandibular branch and the lateral aspect of the pterygoid muscle. The anterior boundary is the diaphragm and the buccal muscle; the posterior is the parotid sheath; the upper is the lower edge of the pterygoid muscle; the lower is the pterygoid muscle. Attached to the mandibular branch; a bottom-up, pointed-down triangle with a cranial nerve branch and a lower alveolar motion from the foramen ovale in the gap, the vein passing through, and the honeycomb tissue and adjacent Under the armpits, sputum, cheeks, submandibular, sublingual, parapharyngeal, masseter muscles, the gaps are connected; through the skull base blood vessels, the nerves can also pass into the skull.
Commonly caused by periapical periodontitis of the mandibular wisdom teeth and periapical inflammation of the mandibular molars; inferior disinfection of the inferior alveolar nerve block can also cause infection of the pterygopalatine space; in addition, adjacent gaps, such as the infraorbital space, parapharyngeal space Inflammation can also spread.
Prevention
Wing mandibular space infection prevention
Pay attention to strengthen the whole body nutrition, pay attention to local quiet, avoid bad stimulation, and minimize local activities such as chewing and speaking.
Complication
Wing mandibular space infection complications Complications, difficulty swallowing
The inflammation spreads to the adjacent space, which can form multiple infections such as underarm, parapharyngeal, submandibular, and posterior jaw, which complicates the condition.
Symptom
Wing mandibular space infection symptoms common symptoms jaw joint pain toothache fever
History
There is a history of pericarditis of acute mandibular wisdom teeth, or a history of anesthesia injection of inferior alveolar nerve block.
2. Clinical manifestations
The swelling and tenderness of the temporomandibular ligament area is very obvious; the medial mandibular angle, the medial posterior mandibular branch is swollen and the pressure is obvious; the lower part of the zygomatic arch is swollen, the patient has fever and the white blood cells are increased.
Puncture through the lateral side of the ligament of the sacral ligament into the gap along the inside of the mandibular branch, or puncture from the back of the jaw into the gap can be clearly diagnosed.
Often there is a history of toothache, followed by limited mouth opening, chewing food, swallowing pain; oral examination of mucosal edema at the pterygopalatine fold, mild swelling of the inside of the posterior margin of the mandibular branch, deep tenderness, due to the pterygopalatine space The position is deep, even if the abscess has formed, it is difficult to be directly contacted and fluctuated by the clinical, and it is often necessary to determine the puncture. Therefore, it is often easy to delay the diagnosis, causing the inflammation to spread to the adjacent space, which can form the underarm, the parapharyngeal, the submandibular, and the jaw. After waiting for multiple gap infections, the condition is complicated.
Examine
Examination of pterygopalatine infection
Intraoral examination showed swelling and tenderness of the pterygopalatine folds, and the posterior margin of the mandibular branch and the inside of the mandibular angle were full and tender.
Puncture: The puncture is inserted into the gap along the lateral side of the mandibular ligament after penetrating outside the ligament of the pterygopalatine, or the pus can be diagnosed by puncture from the back of the jaw.
Diagnosis
Diagnosis and diagnosis of pterygomatic space infection
It is distinguished from pericoronitis of the maxillary third molar and periapical periodontitis.
The initial manifestation of pericoronitis is only the pain and swelling of the gums. It is aggravated during chewing and swallowing. The pain in the mouth can be aggravated. When the infection affects the chewing muscles and the pterygoid muscles, the teeth can be closed tightly, the local swelling can occur, and the lymph nodes can be enlarged and tender. At this time, systemic symptoms such as general malaise, fever and white blood cell increase may occur. The onset of symptoms is 2 to 3 days, such as pain, and the fever does not retreat. It may be considered that the inflammation develops into the suppuration phase, and the drainage is gradually removed in this period, and the inflammation gradually subsides.
Patients with apical periodontitis have mild pain in the early stage. At this time, the teeth are bitten, and the pain can be relieved temporarily. As the inflammation is aggravated, the patient's teeth are elongated and have a sense of floating. The pain of the tooth is painful, and the pain of the periapical periodontitis For spontaneous, persistent pain, and limited scope, patients can clearly indicate the tooth, if acute apical periodontitis is not treated, inflammation continues to develop, forming an acute apical abscess, then the pain is increased, the pain is obvious, and there is Persistent jumping pain, pus spread to the periosteum, pain, swelling are very obvious, once the perfusal penetrates the periosteum to the submucosal, due to the weakened pressure, the submucosal tissue is loose, the pain is less than before.
