submandibular space infection
Introduction
Introduction to submandibular space infection Infection of the submandibular space is often secondary to inflammation of the oral tissues. The pathogens are mainly hemolytic streptococcus and Staphylococcus aureus. Early clinical manifestations include local pain in the oral tissue, swelling in the bottom of the mouth, and progressive difficulty in opening the mouth. Infection spreads along the fascia to the neck, causing serious complications such as mediastinal infection and laryngeal obstruction. Treatment requires the use of a sufficient amount of effective antibiotics to reduce tension and adequate drainage early. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: laryngeal obstruction secondary mediastinal infection aspiration pneumonia sepsis parapharyngeal abscess
Cause
Causes of submandibular space infection
(1) Causes of the disease
Common pathogens are hemolytic streptococcus and Staphylococcus aureus, and the common spirochetes and anaerobic bacteria of the oral cavity can also be the pathogen of primary or secondary infection.
(two) pathogenesis
80% of infections in the submandibular space (submandibular space) originate from infection of the teeth or periodontal, and can also be caused by infections at the base of the mouth, the base of the tongue, the tonsil, the salivary glands, etc., since the root of the second molar is located in the lower jaw. Above the skeletal muscle, the infection is usually confined to the sublingual gland; the roots of the second and third molars often extend below the attachment point of the entire mandibular ligament, so the infection can directly affect the submandibular gland.
Prevention
Prevention of submandibular space infection
Diet needs everyone's attention, pay attention to supplement a certain amount of nutrition, it is best not to eat spicy food.
Complication
Submandibular space infection complications Complications, laryngeal obstruction, secondary mediastinal infection, aspiration pneumonia, parapharyngeal abscess
1. Mediastinal infection In this area, the infection can spread along the styloidal ligament to the dorsal aspect of the larynx, and then invade the loose medial tissue of the posterior pharyngeal space to reach the superior mediastinum.
2. Laryngeal obstruction, suffocation of the tongue and the posterior movement of the tongue and inflammation of the throat can be caused, often requiring tracheotomy.
3. Aspiration pneumonia is caused by the saliva and mucus in the pharynx being inhaled into the respiratory tract.
4. Others include sepsis, parapharyngeal abscess, internal jugular vein embolism, and mandibular osteomyelitis.
Symptom
Symptoms of submandibular space infection Common symptoms Soft tissue swelling, severe pain, high fever, difficulty in opening the mouth, cold teeth, closed airway, obstruction, difficulty breathing
1. Sublingual space (portal space) infection usually occurs 3 to 4 days after tooth extraction, local pain and tenderness of the oral tissue near the primary lesion is obvious, and the bottom of the mouth gradually becomes swollen, the swelling can spread to the tongue, push the tongue Upward, there is a gradual difficulty in opening the mouth, and even the teeth are closed. The pharyngeal door is still visible. The pain is obvious when the sacral triangle is up and down, but the neck is not swollen. This limited abscess can be timely. Drainage from the mouth or alveolar process can be quickly restored. If the drainage is not timely, the infection will be aggravated. Once it penetrates the mandibular lingual muscle, involving the submandibular space and the neck, it becomes the Ludwigs angina.
2. Bottom cellulitis (mandibular interstitial cellulitis, Ludvi angina) Infection is caused by the sublingual space; or caused by the direct spread of infection of the second and third molars, which is characterized by very high infection development. Rapidly, the main manifestation is the plank-like cellulitis of the submandibular space, without abscess formation, the boundary of cellulitis is clear, often bilateral, cellulitis produces necrosis with serous purulent infiltration, little pus or Not obvious, cellulitis invades connective tissue, fascia and muscle, but does not invade glandular tissue, inflammation spreads directly, rather than through lymphatic channels.
On the basis of infection under the sublingual space, the condition develops rapidly, and the posterior part of the tongue is moved upwards and backwards, involving the ankle, causing the tongue to move ineffectively, the indentation of the teeth is visible in the tongue, and the bottom of the mouth is also swollen and congested, but the pharynx No obvious changes, the pharyngeal door can not be seen during the examination, the soft tissue outside the lower jaw arch is swollen and hard, and the lower jaw is almost inactive; any activity of the base of the tongue and the hyoid bone can cause severe pain, and the patient's mouth is slightly open, and cannot Swallowing, saliva and mucus accumulate in the pharynx and spill over. In severe cases, laryngeal edema, hoarseness and difficulty in breathing, and even obstruction of the airway may occur. When the infection spreads to the neck, the front and sides of the neck are diffusely swollen. Down to the clavicle, swelling is serious and spreads widely, the skin is dark red, the touch is very hard, the pressure is pressed, there is no fluctuation, the puncture is more without pus, the patient has chills, high fever, headache, general malaise, etc. Symptoms of systemic poisoning.
Examine
Examination of submandibular space infection
Peripheral blood test, when the symptoms of systemic poisoning are obvious, the white blood cell count is increased.
Diagnosis
Diagnosis and diagnosis of submandibular space infection
According to medical history and clinical manifestations, diagnosis is generally not difficult.
