拔除阻生齒術後感染造成魯特維格氏咽峽炎—病例報告

Ludwig's Angina after Extraction of the Impacted Tooth- A Case Report

林彥宏(Yen-Hung Lin) ； 吳契聰(Chi-Tsung Wu) ； 許博智(Po-Chih Hsu) ； 鄭仁昌(Jen-Chan Cheng) ； 施嘉霖(Jia-Lin Shih) ； 李曉屏(Shiao-Pieng Lee) ； 謝志明(Chin-Ming Hsieh) ； 陳元武(Yuan-Wu Chen)

《臺灣口腔顎面外科學會雜誌》 22卷4期 (2011/12) Pp. 266-274

https://doi.org/10.7104/TJOMS.201112.0021

摘要

頭頸部齒源性感染常因齲齒或牙髓炎等原因造成，因拔牙而造成嚴重頭頸部感染（如魯特維格氏咽峽炎）相對少見，其最嚴重與致命的併發症為呼吸道阻塞而呼吸困難。本病例為一26歲年輕男性，主訴右側臉頰腫脹疼痛及張口困難，初期診斷為拔牙術後感染造成右下顎蜂窩性組織炎。經支持療法與經驗性抗生素治療後，症狀無明顯改善且加劇，於第三天腫脹擴展至對側，包括頦下間隙、雙側顎下間隙、舌下間隙及咽旁間隙均有腫脹情形，並嚴重影響呼吸與危及生命，診斷為致命的魯特維格氏咽峽炎。治療期間，呼吸道維持因美觀考量，接受鼻道氣管內管插管，取代傳統氣切維持氣道。期間共經歷六次清創手術，並於加護病房以靜脈投與第三線抗生素、積極清創換藥及追蹤胸部x光片，於第十六天拔除氣管內管，第二十二天出院。本病例以氣管內管插管之方式而取代氣管切開手術之方式以維持呼吸道，提供臨床醫師作為參考。

關鍵字

魯特維格氏咽峽炎 ； 齒源性感染 ； 呼吸道阻塞

並列摘要

Ludwig's angina was one of life-threatening infections disease, the most severe complication is dyspnea due to the obstructed airway. This is a 26-year-old male who complained about painful swelling over right face and month 40 opening restriction. He was suffered from swelling of the submental, submandibular and sublingual spaces bilaterally and with subsequent of airway compromised. Due to the esthetic reason by himself, he had received nasotracheal intubation in stead of tracheostomy. This uasotracheal tube which maintained the airway during post-operative days and weaning on thirteenth day. The successful treatment depended on appropriate antibiotic control, aggressive surgical intervention, airway maintenance and supporting care. This life-threatening case provided some experience about maintaining airway by nasotracheal tube.

並列關鍵字

Ludwig's angina ； odontogenic infections ； airway obstruction