1. 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

2. Introduction Introduction Microbiology Microbiology Applied anatomy Applied anatomy Management Management Summary Summary

3. 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 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

4. 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

5. 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

7. Applied anatomy

8. 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)

15. 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

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

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

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

22. Management--5

25. 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

26. Referral or not ?

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

28. Thanks for your attention