顎口腔領域の重症感染症への対応

• Published in: 日本口腔外科学会雑誌 Vol. 64; no. 7; pp. 394 - 403
• Main Authors: 古森, 孝英, 古土井, 春吾
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.07.2018
• Subjects: 壊死性筋膜炎; 外科的ドレナージ; 歯性感染症; 蜂窩織炎
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.64.394

The infection in the oral and maxillofacial regions is frequently observed on a daily basis, and most of them are odontogenic. Odontogenic infections are commonly the result of carious teeth with pulpal exposure, periodontitis, pericoronitis, or complications of dental procedures. They respond well to current medical and surgical treatments. However, they can sometimes extend beyond the oral cavity, with serious consequences. Cellulitis in the oral and maxillofacial region can spread to deep neck spaces and possibly to the mediastinum. Computerized tomography play the important role in diagnosis of cellulitis. Fulminating infection in the head and neck may present as a rapidly progressive, potentially fatal condition characterized by extensive necrosis along the fascia of the neck. One form of such infection is necrotizing fasciitis. Early diagnosis and treatment is critical. The laboratory risk indicator for necrotizing fasciitis (LRINEC) score was a valuable assisted diagnosis tool. The keys to successful management of these infections are protection and control of the airway, intravenous antibiotic therapy and aggressive incision and surgical drainage. It is usually preferable to drain multi-space infections involving the sublingual, submental, submandibular, masseteric, pterygomandibular, and/or lateral pharyngeal spaces, as early as possible from an extraoral approach.