Chapter 6 Infection in Oral and Maxillofacial Regions

第六章 口腔颌面部感染 Chapter 6 Infection in Oral and Maxillofacial Regions

感染（Infection）： Invasion by and multiplication of pathogenic microorganisms in a bodily part or tissue, which may produce subsequent tissue injury and progress to overt disease through a variety of cellular or toxic mechanisms. （美国传统词典） 炎症（Inflammation）： A localized protective reaction of tissue to irritation, injury, or infection, characterized by pain, redness, swelling, and sometimes loss of function. （美国传统词典）

一、口腔颌面部感染的途径及病原菌 Pathways and Pathogens of Infection in Oral and Maxillofacial Regions （一）口腔颌面部感染的途径 1. 牙源性（Dental genetic） 2. 腺源性（Adenoid genetic） 3. 损伤性（Injury genetic） 4. 血源性（Hemal genetic） 5. 医源性（Iatrogenic）

Pathogenic microorganisms Tooth Periodontium Pulp Root apex Alveolus Maxillary / Mandible Cellular spaces in oral and maxillofacial regions

Progression of Odontogenic Infections

Fascial Space Infections

Progression of Odontogenic Infections

Progression of Odontogenic Infections

（二）病原菌（Pathogens）： 1. 需氧菌（Aerobic bacteria）： Ø 金黄色葡萄球菌（Staphylococci aureus） Ø 溶血性链球菌（Haemolytic chain cocci） Ø 大肠杆菌（Escherichia coli ，E coli） 2. 厌氧菌（Anaerobic bacteria）： Ø 类杆菌属（Bacteroides） Ø 梭杆菌属（Fusobacteria） Ø 消化链球菌（Peptostreptococci ）

Progression of Odontogenic Infections Periapical Ø Periodontal Ø Soft tissue involvement l Determined by perforation of the cortical bone in relation to the muscle attachments Ø Cellulitis- acute, painful, diffuse borders Ø Abscess- chronic, localized pain, fluctuant. Ø

Microbiologic Considerations Ø Identification of bacteria l l Representative specimen collected Examine specimen Submit for culture and sensitivity Gram Stain

Surgical Treatment Provide drainage Ø Remove the cause of infection Ø l l Ø Pulpectomy Extraction Remove foreign body Debride non-viable bone Culture and sensitivity

Surgical Treatment

（三）全身治疗（General treatment）： 1. 抗菌药物治疗（antibacterial therapy) ①应用抗菌药物指征： • 感染病原为细菌（the infection is of bacterial origin） • 有明显的局部淋巴结肿痛或发热等全身反应（there is significant regional lymph node or systemic reactions, ie. body temperature is raised） • 感染扩散迅速（spread is significant) • 局部治疗无效（appropriate local treatment has not been succesful) • 患者抵抗力下降（resistance is reduced)

Principles of Antibiotic Therapy Administer the antibiotic properly Ø Proper route of administration Ø Proper dose Ø Proper time interval Ø Adequate period of administration Ø