Oral tuberculosis debridement

Adapt to the cervical spine 1 ~ 2 tuberculosis and the symptoms of posterior pharyngeal abscess, remove the lesion. Treatment of diseases: retropharyngeal abscess Indication Cervical vertebrae 1 to 2 tuberculosis and posterior pharyngeal wall abscess. Contraindications Older, combined with severe heart, liver, kidney and other diseases and difficult to tolerate surgery. Preoperative preparation 1. Apply antibiotics for 1 to 2 weeks before surgery to control infection. It is best to do a pus bacterial culture and antibiotic susceptibility test first. The general condition should be improved. Local acute inflammation should cause it to completely resolve. 2. If the scope of surgery is large, a certain amount of blood should be prepared for intraoperative application. 3. Conventional preoperative examination of the bone and lateral x-ray films to examine the condition of dead bone, dead space and new bone to correctly determine the timing and exposure of the operation. If necessary, the secondary layer should be taken or the sinus angiography should be used as a reference. 4. Preoperative skin preparation must be prepared to reduce the chance of secondary infection and cannot be ignored because it is infected with the wound. 5. If there are oral sinusitis, dental caries and other oral lesions, the operation should be actively treated. 6. Disinfect the mouth with tincture on the 3rd day before surgery, and spray the oral cavity and nasal cavity with antibiotic solution. 7. Systemic application of antibiotics. 8. Skull traction on the day of surgery to stabilize the spinal cord and prevent spinal cord injury. Traction is more important when the atlas is severely damaged, dislocated, or paralyzed. For children or inconvenienced patients with skull traction, the lead gypsum bed should be prepared in advance (the neck is overstretched). Surgical procedure 1. Position: supine position, shoulder pad soft pillow, neck overstretched, head tilted back. 2. Open the mouth and expose the lesion (see the anterior side of the cervical spine). 3. Cut the abscess: Open the uvula of the suture traction line and reveal the abscess of the posterior pharyngeal wall. Plug the gauze around it to prevent pus from flowing into the trachea. A light tongue depressor and a suction device are built into the mouth. After the puncture confirmed the abscess, the wall of the abscess was cut longitudinally along the midline of the posterior pharyngeal wall, that is, the pus emerged and was exhausted. 4. Reveal the diseased vertebrae: use the hemostatic forceps to explore the abscess, sometimes the abscess is a dumbbell type, a small hole can be seen on the anterior vertebral fascia, the anterior fascia is cut through the hole, and the anterior fascia is sutured with 4 silk threads. The side edges are pulled apart to reveal the diseased vertebrae. 5. Clear the lesion: use a hemostatic forceps or curette to remove dead bone, tuberculous granulation and necrotic tissue under direct vision. If there is bleeding, the gauze ball can be used to stop bleeding, and then the lesion is washed. The wound is embedded in the blue and streptomycin powder, and the anterior fascia and the abscess wall are sutured with the gut line respectively, and no drainage is performed. 6. Replace the tracheal cannula: After the operation, insert the trachea into the trachea and aspirate the blood and pus that may have entered the upper end of the trachea. After the patient recovers and the cough reflex is restored, the tracheal intubation is withdrawn and the tracheal cannula is placed. complication 1. The wound failed to heal in the first stage. 2. The lesion recurred.