腮腺膿瘍

Parotid Abscess

鄭立享(Li-Hsiang Cheng) ； 王興萬(Hsing-Won Wang)

《台灣耳鼻喉頭頸外科雜誌》 46卷2期 (2011/04) Pp. 61-66

https://doi.org/10.6286/2011.46.2.61

摘要

背景：腮腺膿瘍在臨床並不多見，腮腺膿瘍可能續發嚴重深頸部感染而具有致命性，本文希望藉由本院的治療經驗及病例分析，探討正確的診斷方法及治療方針，以避免致命的併發症產生。方法：回溯本院自1998年11月至2008年11月間，11名腮腺膿瘍接受住院治療病患，分析探討其發生的原因、臨床徵狀、診斷方法、細菌學、抗生素治療原則及手術治療的時機。結果：11名病患中，8名爲男性，3名爲女性；7名爲左側，4名爲右側；年齡分佈自22歲至88歲，平均年齡48.3歲，平均住院天數15天；最常見臨床症狀爲耳下腫痛(100%)及發燒(91%)；常見致病原因爲牙齒感染或口腔衛生差，多發生于免疫力差的病人，特別是糖尿病和癌症；電腦斷層攝影是重要診斷工具並可判斷病兆範圍；10例膿瘍接受細菌培養，6例呈陽性反應，包含Klebsiella pneumoniac 3例，Staphylococcus aureus 2例，Mycobacterium tuberculosis 1例；1例僅接受抗生素治療，其餘10例(9%)除抗生素治療外，並接受外科切開引流(8/10)或針抽吸(2/10)治療。未接受引流病患因敗血症死亡，其餘接受引流病患均改口服抗生素或抗結核菌藥物出院，平均追蹤3.2年均無復發。結論：對腮腺膿瘍的病患，應注意併深頭部感染造成致命的併發症。治療除給予廣效性抗生素及充足水份外，應儘早加以外科引流。

關鍵字

腮腺膿瘍 ； 顏面神經麻痺 ； 敗血症

並列摘要

BACKGROUND: Parotid abscess is a potentially life-threatening disease which can spread deeply into neck spaces. It is uncommon in clinical practice. To minimize the occurrence of fatal complications, appropriate diagnostic and therapeutic modalities are suggested after reviewing the cases at our hospital.METHODS: Eleven patients were diagnosed with parotid abscess and were treated from November 1998 to November 2008. They were retrospectively reviewed. All patients' clinical symptoms and signs, etiology, diagnostic methods, bacteriology, medical antibiotic treatment and timing of surgical intervention were tabulated.RESULTS: Eleven patients were diagnosed with parotid abscess. Eight of them were male and the other three were female. The ages ranged between 22 and 88 years with a mean age of 48.3 years. Seven cases were having parotid abscess on the left side and the rest were on the right side. The most common symptoms at the time of presentation were painful swelling of infra-auricular region (100%) and fever (91%). Typical etiologies were odontogenic infections or poor oral hygiene. Immunocompromised patients such as diabetes mellitus and cancer were at a higher risk of having this disease. CT (Computed Tomography) scans provide important information regarding abscess size, location, and relative positions of the great vessels and airway. In the series, there were six positive finding of pus bacterial cultures. Three were Klebsiella pneumoniae, two were Staphylococcus aureus, and one was Mycobacterium tuberculosis. One patient received intravenous antibiotics alone. In addition to antibiotic treatment, eight patients underwent surgical incision and drainage, and two underwent needle aspiration of pus. The patient received intravenous antibiotics alone was dead due to sepsis while others had complete resolution of disease without recurrence or sequelae.CONCLUSION: Fatal complications of deep neck infection should always be ruled out if a patient is suspected of having parotid abscess. In the management of parotid abscess, parenteral broad spectrum antibiotics and adequate hydration should be given and surgical intervention should be initiated.

並列關鍵字

parotid abscess ； facial paralysis ； sepsis