The Treatment Principle of Head & Neck Infection 報告者 : 于恩浩 指導醫師 : 雷文天大夫 高壽延主任 高壽延主任

Introduction Introduction Microbiology Microbiology Applied anatomy Applied anatomy Management Management Summary Summary

Introduction Pre-antibiotic era: high mortality rate Pre-antibiotic era: high mortality rate 31 case Ludwig’s angina, 54% died 31 case Ludwig’s angina, 54% died 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% 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

Microbiology Multiple bacteria Multiple bacteria anaerobic vs aerobic vs mixed anaerobic vs aerobic vs mixed 35% 5% 60% 35% 5% 60% Aerobic G(+) streptococci Anaerobic G(+) coci G(+) rods Aerobic first then Anaerobic

Applied anatomy

Primary vs Secondary fascial space Primary vs Secondary fascial space Lowe, moderated and high severity for life threaten ( airway obstruction) Lowe, moderated and high severity for life threaten ( airway obstruction)

Management--1  History taking When, where, how, why, duration When, where, how, why, duration S&S:dolor,swelling,warmth,redness,trismus S&S:dolor,swelling,warmth,redness,trismus  Physical exam. Vital sign,palpation,teeth,x-ray Vital sign,palpation,teeth,x-ray  Abscess vs Cellulites

Management--2 Local: anatomic barrier Local: anatomic barrier indigenous bacteria indigenous bacteria Humeral: immunoglobulin Humeral: immunoglobulin complement complement Cellular: phagocytes Cellular: phagocytes lymphocytes lymphocytes

Management--3  I & D : dependent part  Culture: culture tip, aspiration  Drainage : penrose drain, rubber dam  Goals: remove etiology

Management--4  Nutrition : adequate fluid nutrition intake nutrition intake rest rest  Pain control  OHI

Management--5

Symptom subside? Symptom subside? vital signs, trismus, swelling, p ’ t feeling vital signs, trismus, swelling, p ’ t feeling Failure reason? Failure reason? etiology, surgery, host immune, etiology, surgery, host immune, foreign body, antibiotics foreign body, antibiotics Adverse effect Adverse effect Secondary infections Secondary infections

Referral or not ?

Summary Overall Evaluation Overall Evaluation etiology etiology Proper Therapy Proper Therapy medication & surgery medication & surgery Anatomical Knowledge Anatomical Knowledge

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