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目的:研究牙源性下行性坏死性纵膈炎的临床表现、发病机理,提高早期的诊断率及治愈率。方法:分析5例牙源性坏死性纵膈炎的临床资料。5例中冠周炎3例,根尖脓肿2例。经X线、CT、B超以及引流脓液细菌培养等检查明确诊断,采用手术引流联合抗生素治疗。结果:5例均表现为下颌、颈部肿胀,其中胸闷气急4例,胸痛2例,皮下可扪及捻发音3例;影像学阳性表现多在出现临床症状之后,表现为上纵膈增宽,可有胸腔及心包积液、皮下及纵膈气肿等。治疗后本组4例痊愈,1例死亡。结论:牙源性下行性坏死性纵膈炎的病情发展迅速且病死率高。早期确诊,及时切开引流是治疗成功的关键。
Objective: To study the clinical manifestations and pathogenesis of odontogenic necrotizing mediastinitis and to improve the early diagnosis rate and cure rate. Methods: Five cases of odontogenic necrotizing mediastinitis were analyzed. 5 cases of pericoronitis in 3 cases, apical abscess in 2 cases. The X-ray, CT, B ultrasonography and drainage of pus bacterial culture and other tests to confirm the diagnosis, the use of surgical drainage combined with antibiotics. Results: 5 cases showed mandibular and neck swelling, of which chest tightness and irritability in 4 cases, chest pain in 2 cases, subcutaneous palpable and twisted voice in 3 cases; imaging findings were more clinical symptoms, the performance of the mediastinum widening , May have pleural and pericardial effusion, subcutaneous and mediastinal emphysema. After treatment, 4 patients recovered and 1 died. Conclusions: The condition of dental descending necrotic mediastinitis develops rapidly and the mortality rate is high. Early diagnosis, timely drainage is the key to successful treatment.