頭頸部起源之全身廣泛壞死性筋膜炎：病例報告

Extensive Necrotizing Fasciitis of the Head and Neck-Report of a Case

蔡鴻明(Frank Tsai) ； 李正喆(Jang-Jaer Lee) ； 郭生興(Sen-Shin Kok) ； 郭英雄(Ying-Shiung Kuo) ； 韓良俊(Liang-Jiunn Hahn) ； 楊博正(Puo-Jen Yang)

《中華民國口腔顎面外科學會雜誌》 8卷2期 (1997/09) Pp. 86-93

https://doi.org/10.7104/CJOMS.199709.0086

摘要

壞死性筋膜炎是一種在頭頸部少見的猛暴性且具致死能力的軟組織細菌感染。在1980年代晚期以前發生在頭頸部的壞死性筋膜炎是相當罕見的，但是在近幾年，發生於頭頸部的壞死性筋膜炎發生率卻大幅的提高，較常見的原因中，齒源性感染佔了近8成，而早期致死率即有近三成，延遲治療的結果會使得死亡率大幅的增加。治療的方針包含儘早診斷、儘早積極性的手術清創、強力廣效性抗生素的給予等；其中尤其以儘早的診斷對於預後的影響最大，本文報告一位有糖尿病與長期服用類固醇的病史之54歲女性，起初因為右下大臼齒的疼病而就醫，繼之在右臉部出現紅腫，在症狀出現三天後轉診到台大醫院，此時發展為右側臉部及頸部廣泛壓痛性腫脹，在電腦斷層攝影中發現頸部右側與右頜下三角出現皮下氣腫，心跳加速且血壓降低，意識已呈嗜睡狀態，初步臨床診斷為壞死性筋膜炎。在經過緊急手術清創與引流後，雖然術後原感染區域獲得初步的控制，但是感染的範圍隨後又逐漸擴展到了全身，菌血症不易控制，終因多重器官衰竭而導致死亡。本報告對此病例之療程做一檢討，並對於相關文獻作簡要回顧。

關鍵字

壞死性筋膜炎 ； 頭頸部感染 ； 齒源性感染

並列摘要

Necrotizing fasciitis is a fulminant and fatal soft tissue infection in the head and neck area. It is a soft-tissue infection causing extensive necrosis of superficial fasciae and subcutaneous tissues with secondary involvement of muscle and skin. In the 1990swe are now experiencing enhanced expession of the virulence of necrotizing fasciitis. The foundation for successful treatment of this lesion is early diagnosis in conjunction with aggressive surgical intervention, antibiotics, and supportive therapy. We report a54-year-old female with DM and long-term steroid medication history. She visited a local dentist at first due to spontaneous toothache and received endodontic therapy then. But her symptom didn't imporve and she was transferred to our hospital for furthertreatment after 3 days. When reaching our hospital, her consciousness has become drowsy with tachycardia and hypotension. Her right cheek and upper neck was erythe-matous swelling with a ill-defined border. The computed tomography revealed some gasgathered within right submandibular space and anterior neck. The preliminary diagnosis was necrotizing fasciitis and she was arranged emergent surgical debridement immediately. Although the involved area was controlled at first, but the necrotic skin extended to her right leg and frank several days later in spite of aggressive surgical intervention and broad spectrum antibiotics. Ten days after surgery the patient was expire because of multiple systemic organ failure. We report this case and review some articles briefly in the wishness of some help to the dentist in the clinic.