- 期刊
妊娠期孕婦因齒源性感染引發嚴重深頸感染之處置－病例報告
Management of Severe Deep Neck Infection from Odontogenic Origin for a Pregnant Patient-A Case Report
摘要
齒源性感染造成之頭頸部感染之案例並非少見，一般多以切開引流合併給予抗生素治療，而影像學檢查如電腦斷層或核磁共振上之發現常用來作為手術操作時解剖構造的指引。本病例報告提出一24歲懷孕25週之女性患者，因下顎左側第三大臼齒牙冠周圍炎所造成的蜂窩性組織炎迅速引起深頸部感染。患者於急診來診時左側臉頰合併顎下區域腫痛，體溫38.8°C，張口度只有0.5公分，因此先安排患者入院接受抗生素治療，但患者因懷孕之故，完全拒絕任何影像學檢查，因此並無任何環口X光片、電腦斷層或核磁共振等影像。不幸的是患者住院當晚即發生寒顫、高燒不退（39.5°C～40°C）、低血壓、虛弱、呼吸急促、心跳過速的情況，被診斷為高死亡率敗血症引發全身性炎性反應症候群，經緊急照會婦產科及麻醉科後，在全身麻醉下利用理學檢查判斷，將上頸部及顎面組織間隙切開相通，為患者進行清創手術並拔除下顎左側第三大臼齒，同時進行氣管切開術以維護呼吸道。手術後經加護病房與一般病房照護，患者恢復情況良好，胎兒也於出院後2個多月順利產下。有鑑於此類病例較為罕見，因此提出此報告，討論全身麻醉及術後用藥對孕婦之影響，如何於無影像輔助下依理學檢查判斷進行清創手術，以及深頸部感染時氣管切開術之重要性。
並列摘要
Odontogenic infection are one of the candidates of common Head-and-neck region infections. In some situation the infection could be life-threatening. Most of the treatments include empirical antibiotic therapy, surgical incision and drainage, and even tracheostomy for airway patency. This case was presented a woman with left facial swelling with trismus and fever up to 38.8˚C in 2nd trimester (25 weeks) but the patient rejected to take any radiography due to pregnancy. Cellulitis with deep neck infection was tentatively diagnosed with suspiciously involved submandibular, submental, pterygomandibular, parapharyngeal, buccal and sublingual space. She underwent empirical antibiotic therapy and was soon admitted for observation Progressively, the situation got worsening, with high fever around 40˚C and low blood pressure at the night she just admitted. Thereafter, general weakness, tachypnea and tachycardia were debilitately notable and sepsis with systemic inflammatory response syndrome (SIRS)was suspected. After emergent consultation of the anesthesiologist and obstetrician, extraoral incision and drainage, tracheotomy and extraction of left lower third molar were performed under general anesthesia without any obtainable image. The patient stood the whole procedure well and childbirth after 2 month later went smoothly without any complications. Base on the difficult management of severely infections on pregnant patient in head and neck region, the case was referred as reference for evaluating pregnant cellulitis victims.