Infant maxillary osteomyelitis
Introduction
Introduction to maxillary osteomyelitis in infants and young children Infants and young children with maxillary osteomyelitis are more common in neonates and children aged 3 years. The infection mainly comes from blood-borne, traumatic and contact, rather than odontogenic suppurative infection, which has been rare in recent years. The upper jaw of infants and young children is rich in blood supply, the blood vessels are fine, the blood flow is slow, and the bacteria are easy to stay. Under the action of various pathogenic factors, bacteria invade the maxillary bone marrow cavity to breed and breed, and when the body's resistance declines, it causes suppurative inflammation. basic knowledge Proportion of the disease: the incidence of infants is about 0.3% Susceptible people: more common in newborns and children within 3 years of age. Mode of infection: non-infectious Complications: sepsis Bronchial pneumonia Lung abscess Meningitis Brain abscess
Cause
The cause of maxillary osteomyelitis in infants and young children
Cause:
The upper jaw of infants and young children is rich in blood supply, the blood vessels are fine, the blood flow is slow, the bacteria are easy to stay, the pyogenic bacteria, especially Staphylococcus aureus, are infected by umbilical cord (septicemia), mucosal wounds (artificial feeding nipple wounds, removal of "horse teeth", Purifying the oral cavity, etc., and swelling of the skin, etc., invading the bone marrow cavity of the maxilla, and causing suppurative inflammation when the body's resistance is reduced.
Infants and young children with maxillary osteomyelitis occur within 3 months after birth, especially in newborns. The main infections are as follows:
(1) Hematogenous infection: neonatal maxillary cortex is thin, bone marrow is rich, blood circulation is strong, infection of any part of the body, such as umbilical cord or skin infection, maternal birth canal, broken nipple or iatrogenic infection, bacteria can pass Blood circulation causes infection of the maxilla.
(2) Local infection: The development of the maxilla in the newborn is not complete, the shape is flat and wide, there are two rows of tooth germs, and the alveolar mucosa is damaged during childbirth. The bacteria in the birth canal can enter the maxilla through the injury and cause infection. Spoon, when feeding the bottle, damage the oral mucosa or tooth germ; or the mother with mastitis continues to breastfeed, the infection can spread directly to the maxilla and form osteomyelitis.
(3) nasal infection: infants with small maxillary sinus, relatively large sinus ostium, acute rhinitis or sinusitis caused by upper respiratory tract infection or other infectious diseases can spread to the maxilla, leading to maxillary osteomyelitis.
The pathogen causing maxillary osteomyelitis is most common with Staphylococcus aureus, and can also be caused by Streptococcus, Staphylococcus aureus and Escherichia coli.
Prevention
Infant and child maxillary osteomyelitis prevention
1. Avoid damage to the alveolar mucosa during childbirth, and prevent the bacteria in the birth canal from entering the maxilla through the injury;
2. When using a small spoon and bottle feeding, be careful to prevent damage to the oral mucosa or tooth germ;
3. The mother suffering from mastitis should stop breastfeeding and reduce the possibility of infection spreading directly to the maxilla to form osteomyelitis;
4. Ensure the nutritional supply of the baby, improve the body's resistance and reduce the risk of infection.
Complication
Infant and child maxillary osteomyelitis complications Complications sepsis bronchopneumonia lung abscess meningitis brain abscess
Infants and young children with osteomyelitis are critically ill and develop rapidly. If the diagnosis and treatment are delayed, various complications and even death may occur. Common complications include: intraorbital infection, sepsis, bronchial pneumonia, lung abscess, and nose. Internal infection, pericarditis, pleurisy, some may be complicated by meningitis, brain abscess, cavernous sinus thrombosis and blindness, or facial asymmetry, missing teeth, valgus valgus, uneven teeth, etc., individual children may Death due to sepsis, bronchial pneumonia, meningitis or brain abscess.
Symptom
Infants and young children with maxillary bone marrow symptoms Common symptoms Difficulty breathing High fever convulsions Purulent discharge coma paralysis
Mainly by medical history, clinical manifestations and local examination, and X-ray film does not help much, sometimes it needs to be differentiated from tumor and periorbital cellulitis.
Infants and young children with maxillary osteomyelitis have an acute onset, rapid development and severe symptoms. The main clinical manifestations are:
(1) systemic symptoms: high fever chills, body temperature can be as high as 40 ° C or more, children do not want to eat, irritability, crying, night uneasiness, severe convulsions, coma and other symptoms.
(2) examination: the affected side of the nasal mucosa is swollen, with purulent or purulent secretions, or with bloody secretions, a small number of children may have severe breathing difficulties, a child's cheeks, hard palate or alveolar Redness and swelling, accompanied by swelling of the eyelids, conjunctival edema, or eyeball protrusion, displacement, ophthalmoplegia, etc. After 2 to 3 days, the gums, hard palate, lower jaw and internal and external palate can form abscesses, and some can develop into eyelid honeycombs. Inflammation, an abscess in the palate or an abscess in the ankle, the abscess will rupture on its own and form a fistula.
(3) In most cases, the body temperature is normal after drainage, the symptoms are relieved, the fistula can heal, and the development continues. The maxilla has dead bone formation, and the tooth germ also necrosis, finally forming a persistent fistula or mouth, and deforming.
(4) The X-ray film has little value for the early diagnosis of this disease. The advanced stage can show osteoporosis, destruction and formation of dead bone in the maxilla.
Examine
Examination of maxillary osteomyelitis in infants and young children
1. Physical examination: a child's cheeks, hard palate or alveolar swelling, accompanied by swelling of the eyelids, conjunctival edema, or protruding eyeballs, displacement, ophthalmoplegia, etc., 2 to 3 days after the gums, hard palate, squat Abscess can be formed in the internal and external crotch, and some can develop into eyelid cellulitis, intraorbital abscess or ankle abscess, and the abscess will collapse by itself to form a fistula.
2. Blood routine.
3. Pus smear or bacterial culture.
Note: Because the X-ray film overlaps, the tooth germ is full of it, and it is not easy to find the bone destruction area, which is not helpful.
Diagnosis
Diagnosis and diagnosis of maxillary osteomyelitis in infants
The early stage of the disease should be associated with acute dacryocystitis, simple facial cellulitis or erysipelas, orbital cellulitis. These differentially diagnosed diseases are localized with soft tissue redness and are rarely found in infants within 3 months, especially rare in newborns. .
