Diagnosis And Treatment Of Oral And Maxillofacial Space Infection

Objective:To investigate the law of occurrence,development and prognosis of Oral and Maxillofacial Space Infection(OMSI),in order to find the method to diagnose and treat the disease.To explore and formulate the clinical norms which provided a reference for the prevention and treatment of OMSI.Methods:A retrospective review of the medical charts of patients with OMSI treated at the Department of Oral and Maxillofacial Surgery,School of Stomatology,the Fourth Military Medical University from January to December 2016 was conducted.The etiological factors,illness judgment,the distribution of the pathogens and the use of antibiotic,surgical treatment were systematically analyzed.Results:A total of 119 patients were enrolled in this study with 61 males and 58 females.The age range was 1-82 years(median age 44.67±19.45 years).The most age of patients were?60 years group 29 patients(24.37%).The most occupations of patients were farmers 65cases(54.62%).The most common reasons of OMSI were odontogenic 93 cases(78.16%).Only 4 patients(3.36%)were seen within 2 days after onset,while the most admission time of patients were more than 9 days 57 cases(47.89%).In 119 patients of this study,11 cases(9.24%)had self-reported dyspnea and 75 cases(63.03%)had a clear history of toothache in the clinical inquiry.85 cases(71.43%)had obvious local swelling in inspection.There were 65 patients(54.62%)who had palpable fluctuation in palpation.In laboratory tests,the patients with white blood cells(WBC)?20×10~9/L were 18 cases(15.13%).The patients with c-reactive protein(CRP)?100mg/L were 13 cases(10.92%).The patients with procalcitonin(PCT)>10ng/ml were 6 cases(5.04%).76 cases(63.87%)selected computed tomography(CT)in auxiliary examination.A total of 93 patients performed pus bacterial culture and antimicrobial susceptibility test in this study.The patients with bacteria detected were 66 cases(70.97%),and a total of 71 bacterial strains were detected.The most commonly detected bacteria were 45strains of Gram-positive/aerobic bacteria.It accounted for 63.38%of the number of detected bacterial strains.Among them the most detected bacteria were oral streptococcus9 strains(12.68%).There were 15 strains of Gram-negative/aerobic bacteria,accounting for 21.13%.Gram-positive/anaerobic bacteria were 6 strains(8.45%).The antimicrobial susceptibility test results showed that the drug sensitivity of cefuroxime was 96.77%,and the cefoperazone sulbactam was 98.04%.Among the anti-aerobic bacteria drugs selected for the first clinical trial,36 cases(38.71%)selected cefuroxime and 34 cases(36.56%)selected cefoperazone sulbactam.The most commonly used anti-anaerobic drug were ornidazole 78 cases(83.87%).In this study,105 patients underwent surgical incision and drainage.There were 32patients with single-space infection and 73 patients with multi-space infections.The most common sites of infection were the masseteric space 14 cases(43.75%)in patients with single-space infection,followed by the submandibular space in 7 cases(21.88%).The most commonly involved were submandibular space in multi-space infections,a total of51 cases(69.86%).A total of 123 incisions were used in 105 patients.The most frequently selected operative incisions were the submandibular incision 85 times(69.11%).The most postoperative drainage method were"semi-closed irrigation and drainage"in 38 cases(36.19%).Conclusions:1.It was very important for the prevention of OMSI that strengthening the publicity and education of oral health care and raising the awareness of oral health care in the whole society,especially for the vast poor and backward areas.It was of great significance for reducing the incidence of OMSI that establishing an effective mechanism for prevention and treatment of dental diseases and raising the level of medical care for oral diseases in the whole society.2.Through the inquiry of history of present illness,past history and other information related to disease,the patient's condition was understood.The physical examination was mainly through inspection,palpation and olfactory examination to judge the patient's condition at preliminary and objective,and to find the serious patients and treat them as soon as possible.In laboratory tests WBC and N%reflected the degree of infection to some extent,and the effect of treatment can also be monitored in timely."CRP/hs-CRP+PCT"can be very objective and sensitive to judge the severity of OMSI and play a very important role in guiding clinical treatment of diseases."K~++HbA1c+Oxygenation Status"reflected the patient's general condition.It monitored patient's status in real time and accurately guided the clinical treatment and effectively improved the clinical treatment effect.Auxiliary examination was mainly through CT and ultrasound to examine the patient's local lesions accurately and detailed,and provided accurate and reliable diagnostic data for surgical incision and airway protection.3.OMSI commonly mixed infection with a variety of bacteria.The most were gram-positive bacteria.Although the detection rate of anaerobic bacteria was not high,but the pathogenic role of anaerobic bacteria can't be ignored."Cefuroxime+Ornidazole"was an ideal experienced antibiotics for clinical non-critically patients.Patients with severe space infection should use"Imipenem"or"Imipenem+Ornidazole"as early as possible to cover all pathogenic bacteria.After the infection was effectively controlled,the use of antibiotics should be adjusted.4.It should be promptly incision and drainage for the patients with abscess formed.For the infection caused by aerogenous bacteria,it was necessary to treat with preventive incision drainage.Submandibular incision can solve the vast majority of space infection.The length of the incision was preferably 3-5 cm.Only in the presence of Ludwig's angina,it was possible to incline inverse T or collar-shaped incision under the mandible.Intraoperative using a double-assisted procedure blunt dissected the abscess.The abscess flushing can be achieved by normal saline.The"semi-closed irrigation and drainage"program was suitable for most space infections.