The Treatment The Treatment Principle of Head & Principle of Head &

Neck InfectionNeck Infection

報告者報告者 : : 于恩浩于恩浩指導醫師指導醫師 : : 雷文天大夫雷文天大夫 高壽延主任高壽延主任

• IntroductionIntroduction

• MicrobiologyMicrobiology

• Applied anatomyApplied anatomy

• ManagementManagement

• SummarySummary

IntroductionIntroduction

• Pre-antibiotic era: high mortality rate Pre-antibiotic era: high mortality rate 31 case Ludwig’s angina, 54% died31 case Ludwig’s angina, 54% died 1940 1940 Ashbel Williams• The antibiotic era: with the use of antibiotics and advanced medical supportive care, the mortality of Ludwig’s angina has been further reduced to 4%.

1979 Hought RT

• In 1974, Dr. Guralnick applied the principles of the initial establishment of airway security, followed by early and aggressive surgical drainage of all anatomic spaces affected by cellulitis or abscess under adequate antibiotic control

MicrobiologyMicrobiology

• Multiple bacteriaMultiple bacteria

anaerobic vs aerobic vs mixedanaerobic vs aerobic vs mixed

35% 5% 60%35% 5% 60%

Aerobic G(+) streptococci Aerobic G(+) streptococci

Anaerobic G(+) coci G(+) rodsAnaerobic G(+) coci G(+) rods

Aerobic first then AnaerobicAerobic first then Anaerobic

Applied anatomyApplied anatomy

• Primary vs Secondary fascial spacePrimary vs Secondary fascial space• Lowe, moderated and high severity for liLowe, moderated and high severity for li

fe threaten ( airway obstruction)fe threaten ( airway obstruction)

Management--1Management--1

History takingHistory taking When, where, how, why, durationWhen, where, how, why, duration

S&S:dolor,swelling,warmth,redness,trismusS&S:dolor,swelling,warmth,redness,trismus

Physical exam.Physical exam. Vital sign,palpation,teeth,x-rayVital sign,palpation,teeth,x-ray

Abscess vs CellulitesAbscess vs Cellulites

Management--2Management--2

• Local: anatomic barrierLocal: anatomic barrier

indigenous bacteriaindigenous bacteria

• Humeral: immunoglobulinHumeral: immunoglobulin

complementcomplement

• Cellular: phagocytesCellular: phagocytes

lymphocyteslymphocytes

Management--3Management--3

I & D :I & D : dependent part dependent part

Culture: Culture: culture tip , aspirationculture tip , aspiration

DrainageDrainage: penrose drain , rubber dam: penrose drain , rubber dam

Goals: Goals: remove etiologyremove etiology

Management--4Management--4

NutritionNutrition: adequate fluid: adequate fluid

nutrition intakenutrition intake

restrest

Pain controlPain controlOHIOHI

Management--5Management--5

• Symptom subside?Symptom subside?

vital signs, trismus, swelling, p’t vital signs, trismus, swelling, p’t feelingfeeling

• Failure reason?Failure reason?

etiology, surgery, host immune,etiology, surgery, host immune,

foreign body, antibioticsforeign body, antibiotics

• Adverse effectAdverse effect

• Secondary infectionsSecondary infections

Referral or not ?Referral or not ?

SummarySummary

• Overall EvaluationOverall Evaluation

etiologyetiology

• Proper TherapyProper Therapy

medication & surgerymedication & surgery

• Anatomical KnowledgeAnatomical Knowledge

Thanks for Thanks for your attentionyour attention