Multiple space infection of the floor of the mouth
Introduction
Introduction to multiple gap infections at the bottom of the mouth The multi-gap infection at the bottom of the mouth, also known as cellulitis of the floor of the mouth, was once considered to be one of the most severe and difficult to treat inflammations in the maxillofacial region. With the level of diagnosis and treatment and the rational use of effective antibacterial drugs, this disease has become extremely rare in recent years. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: sepsis
Cause
Causes of multiple interstitial infections
Disease factors (55%):
Multi-gap infection at the base of the mouth can be derived from periapical periodontitis of the mandibular teeth, periodontal abscess, subperiosteal abscess, pericoronitis, osteomyelitis of the jaw, submandibular gland inflammation, lymphadenitis, acute tonsillitis, soft tissue of the mouth and jaw Damage, etc.
Bacterial infection (35%):
Pathogenic bacteria causing purulent cellulitis, mainly Staphylococcus, Streptococcus; pathogens of spoiled necrotic orbital cellulitis, mainly anaerobic, spoilage and necrotic bacteria, pathogens of multiple interstitial infections Mixed bacteria, in addition to Staphylococcus, Streptococcus, can also be found in Clostridium perfringens, anaerobic streptococci, Clostridium septicum, Phytophthora sphaeroides, Bacillus thuringiensis, and dissolution fusiform Bacillus and the like.
Body factor (10%):
Below the mandible, there are multiple muscles between the tongue and the hyoid bone. The walking and interlacing are intertwined. Between the muscle and the muscle, the muscle and the jaw are filled with loose connective tissue and lymph nodes. Therefore, between the gaps between the mouth and the bottom There is a mutual energy relationship. Once cellulitis occurs due to odontogenic and other reasons, it is easy to spread to each gap and cause extensive cellulitis. The multi-gap infection at the bottom of the mouth is generally referred to as bilateral submandibular and sublingual. And the subtalar space is involved at the same time, the infection may be Staphylococcus aureus as the main suppurative mouth cellulitis; it may also be caused by anaerobic bacteria or spoiled necrotic bacteria, spoiled necrotic cellulitis, the latter Also known as Ludwig angina, clinical and local reactions are severe.
Prevention
Prevention of multiple gap infection at the bottom of the mouth
Active treatment of apical periodontitis of the mandibular teeth, periodontal abscess, subperiosteal abscess, pericoronitis, osteomyelitis of the jaw, submandibular gland inflammation, lymphadenitis, acute tonsillitis, soft tissue of the mouth and jaw and injury of the jaw.
Prevent all kinds of bacterial infections that cause suppuration, spoilage and necrotic cellulitis.
The pathogen causing purulent cellulitis, mainly Staphylococcus, Streptococcus, spoilage necrotic cellulitis, mainly anaerobic, spoilage and necrotic bacteria, pathogens with multiple interstitial infections are often Mixed bacteria, in addition to Staphylococcus, Streptococcus, can also be found in Clostridium perfringens, anaerobic streptococci, Clostridium septicum, Phytophthora sphaeroides, Bacillus thuringiensis, and dissolution fusiform Bacillus and the like.
Complication
Complications of multiple interstitial infections Complications sepsis
Serious complications such as sepsis, sepsis, mediastinal inflammation, etc. may occur.
Symptom
Symptoms of multiple interstitial infections at the mouth of the mouth Common symptoms Difficulty in breathing Difficulty swallowing
Sputum pathogen caused by purulent pathogens, the initial swelling of the lesion is mostly in one submandibular space or sublingual space. Therefore, the local features are similar to the submandibular space or the subgingival space cellulitis, such as inflammation continues to spread to At the time of the entire mouth and the mouth of the jaw, there were diffuse swellings in the submandibular, sublingual and ankle.
Bottom cellulitis caused by spoilage necrotic pathogens, soft paraffin edema is very extensive, edema can range from the cheek to the neck to the level of the clavicle; severely can reach the upper part of the chest, there is a spontaneous drama in the jaw Pain, burning sensation, the skin surface is slightly rough and red and swollen, the skin in the swollen area is purple-red, tender, obviously depressed edema, inelastic, with the development of the lesion, the deep muscle and other tissues are necrotic, dissolved, and there is fluid volume and flow Sense, the skin is produced by gas, can be sputum and sputum pronunciation, after cutting, there is a lot of brown, thin, stench, liquefied with bubbles, and the muscle tissue is brownish black, the connective tissue is grayish white, but no obvious bleeding, the condition During the development process, the mucosa of the mouth and mouth appears edema, the tongue is squeezed and raised, because the tongue is stiff and the movement is limited, the patient's language is unclear, the dysphagia is difficult, and the food cannot be eaten normally. If the swelling develops toward the tongue root, it appears. Difficulty breathing, so that the patient can not lie flat; severe irritability, shortness of breath, cyanosis, cyanosis, and even "three concave" sign, there is a hair Choking hazard, the individual patient's infection can spread to the mediastinum barrier, exhibit corresponding symptoms of mediastinitis or mediastinitis.
The systemic symptoms are often very serious, often accompanied by fever, chills, body temperature can reach 39 ~ 40 ° C or more, but in the case of spoilage necrosis in the peak fossa tissue inflammation, due to severe symptoms of systemic body poisoning, body temperature can not rise, the patient breathe short, pulse Frequent frequency, even blood pressure drops, and shock occurs.
Examine
Examination of multiple gap infections at the bottom of the mouth
Routine oral examination, visual, palpation, combined with medical history to check body temperature, blood, etc., if necessary, puncture pus for bacterial culture and drug sensitivity test.
Diagnosis
Diagnosis and identification of multiple interstitial infections at the mouth
Differential diagnosis
Mainly the identification of various types of oral cellulitis
Sputum pathogen caused by purulent pathogens, the initial swelling of the lesion is mostly in one submandibular space or sublingual space. Therefore, the local features are similar to the submandibular space or the subgingival space cellulitis, such as inflammation continues to spread to At the time of the entire mouth and the mouth of the jaw, there were diffuse swellings in the submandibular, sublingual and ankle.
Bottom cellulitis caused by spoilage necrotic pathogens, soft paraffin edema is very extensive, edema can range from the cheek to the neck to the level of the clavicle; severely can reach the upper part of the chest, there is a spontaneous drama in the jaw Pain, burning sensation, the skin surface is slightly rough and red and swollen, the skin in the swollen area is purple-red, tender, obviously depressed edema, inelastic, with the development of the lesion, the deep muscle and other tissues are necrotic, dissolved, and there is fluid volume and flow Sense, the skin is produced by gas, can be sputum and sputum pronunciation, after cutting, there is a lot of brown, thin, stench, liquefied with bubbles, and the muscle tissue is brownish black, the connective tissue is grayish white, but no obvious bleeding, the condition During the development process, the mucosa of the mouth and mouth appears edema, the tongue is squeezed and raised, because the tongue is stiff and the movement is limited, the patient's language is unclear, the dysphagia is difficult, and the food cannot be eaten normally. If the swelling develops toward the tongue root, it appears. Difficulty breathing, so that the patient can not lie flat, severe irritability, shortness of breath, cyanosis of the lips, cyanosis, and even "three concave" sign, there is a hair Choking hazard, the individual patient's infection can spread to the mediastinum barrier, exhibit corresponding symptoms of mediastinitis or mediastinitis.
The systemic symptoms are often very serious, often accompanied by fever, chills, body temperature can reach 39 ~ 40 ° C or more, but in the case of spoilage necrosis in the peak fossa tissue inflammation, due to severe symptoms of systemic body poisoning, body temperature can not rise, the patient breathe short, pulse Frequent frequency, even blood pressure drops, and shock occurs.
