评论
打印
Ludwig's Angina
脓性颌下炎也称路德维希咽峡炎
Where did the name come from?
这个名字是怎么来的？
Ludwig was a scientist and "angina" means "strangling" or "feeling of strangling".
路德维希是一位科学家，“angina”的意思是“窒息”或“窒息的感觉”。
Definition
定义
It is life threatening cellulitis, meaning inflammation of cells.
这是一种威胁生命的蜂窝组织炎，也就是细胞发炎。
Its location is the infection of submandibular space, which is divided into two compartments by mylohyloid muscle, sublingual compartment (above muscle), submaxillary and submental compartment (below muscle).
其位置为颌下腔感染，颌下腔被下颌舌骨肌、舌下腔室（肌上）、上颌下腔室和颏下腔室（肌下）分为两个腔室。
Causes
病因
It is caused by dental infection or tooth abscess, involving molars and premolars, as well as submandibular sialadenitis, injuries to oral mucosa and mandibular fracture.
原因是牙齿感染或牙齿脓肿，累及磨牙和前磨牙，同时伴有下颌下涎腺炎、口腔黏膜损伤和下颌骨折。
Commonly involved organisms
涉及的感染菌
Organisms mostly involved are Alpha-hemolytic Streptococci, Staphylococci, and bacteroides.
主要涉及的微生物是溶血性链球菌、葡萄球菌和拟杆菌。
Signs
体征
External Signs
外部体征
External signs include bilateral lower facial oedema or swelling around mandible (jaw bone in upper neck).
外部体征包括双侧下面部水肿或下颌周围肿胀（上颈部的颚骨）。
All compartments become swollen, tender and in part woody hard feel when touching them.
触摸时，会感觉到所有的隔间都变得肿胀、柔软，扪之硬如木板。
Intra oral sign include raised floor of mouth due to sublingual space involvement and posterior displacement of tongue.
口内体征包括舌下间隙发病引起的口底隆起和舌后移位。
Symptoms
症状
Patient complain of dysphagia (difficulty swallowing), odynophagia (painful swallowing), drooling and trismus, reduced opening of jaw.
患者主诉吞咽困难、吞咽疼痛、流口水和牙关紧闭，下巴开口变小。
Treatment
治疗
Give IV fluids, systemic antibiotics covering Gram + and Metronidazole.
静脉输液，全身使用抗生素，包括革兰氏阳性和甲硝唑。
Incision and drainage of abcess and localize.
脓肿切开引流及定位。
Intra oral incision is given if localized to sublingual space.
如果定位于舌下间隙，则采用口内切口。
External Incision if involving submaxillary space.
如涉及颌下间隙，则采用外切口。
Tracheostomy if airways is in danger.
如果气道有危险，就做气管切开术。
Complications
并发症
The abscess or post-collection in Ludwig's angina can spread to nearby structures causing parapharyngeal and retropharyngeal abscess:
脓性颌下炎的脓肿或脓肿后残留可扩散到附近结构，导致咽旁和咽后脓肿:
airway obstruction as it causes laryngeal oedema, causing larynx to swell up and obstructing the air flow;
气道阻塞，因为它会导致喉部水肿，导致喉部肿胀，阻碍呼吸的顺畅性;
septycemia: the infecting can spread through blood to all parts of body.
败血症，感染后可通过血液传播至身体各个部位。
