Dental Abscess Airway Ntɛmntɛm, Ludwig Angina, ne Submandibular Swelling¶

Ludwig angina yɛ polymicrobial cellulitis a ɛkɔ so ntɛmntɛm, a ɛde nkwa to asiane mu a ɛwɔ ano fam ne kɔn mu mmeae abien a ɛwɔ anom, a ɛba bɛboro ɔha biara mu nkyem 80 kosi 90 mu denam sẽ a ɛwɔ ase a ɛwɔ ase (titiriw no, anom a ɛto so abien anaa abiɛsa a ɛwɔ fam) a wɔansa no yare so. Esiane sɛ nnompe a ɛwɔ ase anom (manible) no mma ɔfe no ntrɛw nkɔ abɔnten anaasɛ nkɔ fam nti, edema a ɛreyɛ kɛse ntɛmntɛm no pia ano no fam ne tɛkrɛma no ase kɔ soro tẽẽ kɔ ano no atifi na ɛsan kɔ menewa no mu, na ɛde mfiri a ɛyɛ hu koraa to asiane mu wɔ nnɔnhwerew kakraa bi mu. Sɛ obi a ne sẽ yɛ no yaw anaasɛ ne sẽ a wɔayiyi no hohoro denneennen wɔ n'afã abien no nyinaa wɔ ne hwene ase ("nantwi kɔn"), ne tɛkrɛma a ɛkɔ soro, nsu a ɛtɔ, "ɛmo a ɛyɛ hyew" nne a ɛyɛ mmerɛw, anaasɛ ontumi mmue n'ano (trismus) a, frɛ wo mpɔtam hɔfo nɔma ahorow a egye ntɛmpɛ prɛko pɛ. Bere a woretwɛn nnuruyɛfo a wɔboa nkurɔfo no, hwɛ mframa kwan ho akwankyerɛ a ɛfa ho no mu wɔ peritonsillar abscess ne kɔn mu yare a emu dɔ, . epiglottitis, croup, ne mframa kwan a ɛwɔ soro no stridor, na nsensan ho nsɛm a egye ntɛmpɛ ne sẽ a wɔabɔ.

Esiane sɛ tumi a ɛtwe ade ba fam nkutoo ne tumi a ɛboa ɔyarefo no ma ɔkura ne tɛkrɛma a ahonhon no kɔ n’anim kakra fi ne menewa akyi nti, w’asɛyɛde biako pɛ a ɛho hia sen biara a ɛfa mmoa a edi kan ho ne sɛ wobɛma ɔyarefo no atra bolt no mu tẽẽ na wadan akɔ n’anim kakra, na worenhyɛ no da sɛ ɔntra n’akyi tratraa esiane biribiara nti.

Yɛ eyi mprempren¶

1. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma ntɛm ara na fa Airway Emergency a asiane kɛse wom to gua. Trɛ 911 wɔ United States ne Canada, 112 wɔ European Union nyinaa, 999 wɔ United Kingdom, 000 wɔ Australia, anaa hwɛ yɛn list of nɔma ahorow a egye ntɛmpɛ. Ka no pefee: "Wɔsusu sɛ Ludwig angina / dental airway emergency: afã abien a ɛho ahonhon wɔ anom ase, tɛkrɛma a ɛkɔ soro, nsu a ɛtɔ, nne a ɛyɛ mmerɛw, ne asiane a ɛwɔ hɔ sɛ mframa kwan no besiw mpofirim."
2. Ma ɔyarefo no ntra ase bolt tẽẽ na ɔmfa ne ho nkɔ n'anim kakra ("Tripod" anaa "Sniffing" gyinabea) bere nyinaa. Mfa ɔyarefo a ɔwɔ Ludwig angina anaasɛ submandibular dental swelling a emu yɛ den nto mpa, sofa, ambulance stretcher, anaa ayaresabea CT scanner pon so da. Sɛ obi da fam a, ɛma tɛkrɛma a emu yɛ duru a ɛho ayɛ kurukuruwa ne anom ntini a ahonhon no hwe ase tẽẽ kɔ akyi kɔ akyi berɛmo no fasu no so denam tumi a ɛtwe ade ba fam so, na ɛma mframa kwan no to mu wɔ sikɔne kakraa bi mu na ɛma koma no gyaee ntɛm ara.
3. Ma ɔyarefo no kwan ma ɔnteɛteɛ nsu mu ngu kuruwa anaa mpopaho mu, na MMFA nsateaa, tɛkrɛma a ɛtwetwe, anaa nkankyee nhyɛ ano DA. Esiane sɛ ano no fam ahonhon denneennen te sɛ nnua na anom ntini no atoto wɔ spasm (trismus) mu nti, sɛ wobɔ mmɔden sɛ wobɛtetew sẽ no mu anaasɛ wode nsenia bɛmia tɛkrɛma no ase a, ɛkanyan basabasa anom a ɛyɛ den, laryngospasm, anaa mogya a ebetumi ama mframa kwan no asiw koraa ntɛmntɛm.
4. Hyɛ NPO a ɛyɛ katee (biribiara nni ano: nsuo biara nni hɔ, nnuru a wɔde kum ɛyaw nni hɔ, nnuru a wɔde kum ɔyare mmoawa biara nni hɔ). Nea edi kan no, tɛkrɛma a ɛkɔ soro no de mfiri siw menewa ano, enti nsu anaa aduru biara bɛhwie agu mframa afiri (trachea) mu tẽẽ na ama obi amene. Nea ɛto so abien no, ɔyarefo no behia awake fibeoptic intubation anaa awake surgical tracheostomy / cricothyrotomy ntɛm ara wɔ oprehyɛn dan mu bere a wadu ayaresabea no.
5. Ma ɔyarefo no ho dwo, onwini, na onhinhim, na sansan atade no kɔla, krataa, ne kɔnmuade nyinaa. Dadwen, osu, anaa nipadua mu mmɔdenbɔ ma ɔhome ntɛmntɛm, na ɛdan mframa a ɛyɛ mmerɛw (laminar) a ɛfa menewa a ayɛ teateaa no mu ma ɛbɛyɛ mframa a ɛyɛ basabasa a ɛtwe mframa kwan afasu a ahonhon no to mu (the Bernoulli / Venturi nkɛntɛnso).
6. MMFA ɔhyew aduru anaa nsuo a ɛyɛ hyew nkotokuo nhyɛ kɔn anaa anom a ahonhon no akyi. Sɛ wode abɔnten ɔhyew gu anim anaa kɔn mu yareɛ a emu dɔ so a, ɛma mpɔtam hɔ ntini a ɛtrɛw ne ntini mu edema kɔ soro kɛse, ɛma mframa kwan a wɔto mu ntɛmntɛm na ɛtwetwe ɔyare mmoawa no kɔ honam ani anaasɛ ɛkɔ akyiri kɔ kɔn no mu kɔ koko no mu (descending necrotizing mediastinitis).

Gyinaesi dua: ɛse a ɛyɛ yaw, anim a ɛho ahonhon, ne Ludwig angina mframa kwan a wɔayiyi¶

flowchart TD
    Start["Ɛse a Ɛyaw, Nsen a Abubu, Anaasɛ Nnansa Yi Nsesa a Wɔayiyi A Anim, Afono, anaa Asen ase Ahohoro"] --> AirwayScreen{"Anamɔn 1: Hwɛ Airway & Ludwig Angina Red Flags: Ɛhonhon wɔ abɔgyesɛ afã ABIEN NO ase, tɛkrɛma a wɔpia kɔ soro, nsu a ɛreworo so, ɛmo a ɛyɛ hyew nne a ɛyɛ mmerɛw, trismus, anaasɛ tripod gyinabea a ɛteɛ?"}

    AirwayScreen -->|"YIW ma Frɛko Kɔkɔɔ BIARA"| LudwigEmergency["MMƆDENBƆ A ƐFA NKWA HO NSƐM NTƐM (LUDWIG ANGINA): Frɛ Ntɛmntɛm Dwumadibea (911 / 112 / 999) Ntɛm ara"]

    AirwayScreen -->|"DABI: Ɔhonhon no anohyeto wɔ anom anaa afono biako nkutoo mu, mene ne nne a ɛfata, ano a ɛbue nyinaa"| LocalDental["Uncomplicated Localized Dental Abscess: Yɛ nhyehyɛe ma ntɛm ara da koro no ara nsensan ho oduruyɛfo nhwehwɛmu; fa nkyene nsu a ɛyɛ hyew hohoro mu brɛoo, MFA ɔhyew nhyɛ wo hwene so DA, na sɛ wo hwene ase hohoro anaa trismus fi ase a, kɔ ED"]

    LudwigEmergency --> UprightRule["1. STRICT UPRIGHT POSTURE (Tripod / Sniffing Position): MFA ɔyarefo no nna fam wɔ stretcher anaa CT pon so DA; ma nsu a ɛwɔ mu no nkɔ n’anim nkɔ kuruwa anaa mpopaho mu"]

    UprightRule --> HandsOff["2. BƆ MUM KWAN NO HO BAN: Fa NPO a ɛyɛ katee (nsu anaa nnuru a wɔde fa ano nni hɔ), MMFA nnuru a wɔde hyɛ tɛkrɛma ase anaasɛ pry jaw open, mfa abɔnten so ɔhyew a wɔde hyɛ mu nhyɛ mu, na nsan kɔ kɔla"]

    HandsOff --> HospitalOR["3. Ayaresabea Mframa-Nhyehyɛe Mmienu & Oprehyɛn Ho Dwumadi: Nyan Flexible Fiberoptic Nasotracheal Intubation te tẽẽ ne Simultaneous Prep ma Nyan Tracheostomy, IV Dexamethasone, Broad-Spectrum IV Antibiotics, ne Oprehyɛn Decompression"]

Anatomy ne pathophysiology: "Mylohyoid Line" mmara ne nea enti a ntini a ɛwɔ fam no ma Ludwig angina ba¶

German oduruyɛfo Wilhelm Friedrich von Ludwig (a ɔtoo din angina fii Latin kasa mu angere, a ɛkyerɛ "sɛ wobɛbɔ anaasɛ wobɛmene obi," na ɛnyɛ koma yaw) na odii kan kaa ho asɛm wɔ 1836 mu, Ludwig angina no, wɔde mmara pɔtee bi na ɛkyerɛkyerɛ nipadua mu: ɛyɛ gangrenous-serosanguinous cellulitis a ɛtrɛw ntɛmntɛm, ɛte sɛ board, a ɛka ho submandibular triangle no ntam kwan abiɛsa no nyinaa wɔ afã abien:

1. The Sublingual Space (wɔ ano fam, tẽẽ atifi mylohyoid ntini no).
2. The Submylohyoid / Submaxillary Space ((wɔ ase tẽẽ wɔ mylohyoid ntini a ɛwɔ benkum ne nifa so).
3. The Submental Space (wɔ abɔgyesɛ no mfinimfini ase).

Nea enti a ntini a ɛwɔ fam a ɛto so abien ne abiɛsa (nyansa sẽ) na ɛyɛ bɔne¶

Dɛn nti na abura a ɛnyɛ den anaasɛ akisikuru a ɛwɔ anim sẽ anaa premolar a edi kan mu no taa ma anom a ɛyɛ beae bi bow wɔ ano no mu ara kwa, bere a anom sẽ a ɛwɔ fam anaa anom a ɛto so abiɛsa (nyansa sẽ) a ɔyare no wɔ mu no de Ludwig angina a ɛde ne nkwa to asiane mu ba? Mmuae no wɔ ntini biako a wɔfrɛ no mylohyoid ntini a ɛtrɛw te sɛ hammock fa anom dompe a ɛwɔ fam no mu ma ɛyɛ ano no fam ntini a ɛyɛ ntini no mu:

• Nse a ɛwɔ anom a ɛtɔ so mmienu no anim (incisors, canines, premolars, na mpɛn pii no ɛyɛ anom a ɛdi kan): Nsõ a ɛwɔ anim sẽ yi ntini no ano (apices) te atifi (ɛkorɔn sen) mylohyoid ntini no attachment ridge a ɛwɔ anom dompe no mu. Sɛ akisikuru bi ba saa sẽ yi ntini ano a, akisikuru no to dompe a ɛwɔ ntini a ɛwɔ ntini no atifi no mu na ɛtra ano no mu (sublingual anaa buccal space).
• Ase a ɛto so abien ne abiɛsa (Ludwig angina nsɛm no mu 70% kosi 90%)): Ntini a emu dɔ a ɛwɔ ase a ɛto so abien ne abiɛsa no du fam ase (a ɛba fam sen) mylohyoid ntini a ɛbata ho no, baabi a mandible no mu cortical bone no yɛ teateaa te sɛ krataa. Sɛ ntini mu akisikuru bi a ɛwɔ anom a ɛto so abien anaa abiɛsa a ɛwɔ fam no mu pae fa saa mu dompe a ɛyɛ tratraa no mu a, mmoawa ne awuduru tow tẽẽ wɔ mylohyoid ntini no ase kɔ submandibular space no mu.
• Apɔnkɔ nan a ɛbɔ ntini no akyi ho hyia: Esiane sɛ mylohyoid ntini no akyi ano sɛn hɔ kwa te sɛ ntama a fascial akwanside biara nni mu a ɛtetew submandibular space a ɛwɔ ase no ne sublingual space a ɛwɔ soro no mu nti, ntɛm ara na ɔyare mmoawa no twa mylohyoid ntini no akyi hye ho hyia kɔ sublingual space no mu na ɛtwa mfinimfini kwan no kɔ kɔn no fã a ɛne no bɔ abira, na ɛkyere ano no fam nyinaa wɔ vise a ɛte sɛ pɔnkɔ nan mu.

[Sagittal / Cross-Section Anatomy of Ludwig's Angina]

     ROOF OF MOUTH (HARD & SOFT PALATE)
              |   |   |
   (Tongue is pushed UP and BACK into airway)
   [====== SWOLLEN TONGUE ======]
   [Sublingual Space (Above Mylohyoid)]  <-- Wraps around free posterior edge
   ------------------------------------  <-- MYLOHYOID MUSCLE SLING
   [Submandibular Space (Below Mylohyoid)] <-- Root of Lower 2nd/3rd Molar dumps here
   ====================================  <-- Unyielding Deep Cervical Fascia & Mandible

Nea enti a Ludwig angina yɛ "nnua cellulitis" sen sɛ ɛbɛyɛ pus kotoku a ɛnyɛ den ntɛm¶

Nea ɛnte sɛ nsensan a ɛyɛ mmerɛw a ɛyɛ kotoku a ɛyɛ mmerɛw na ɛyɛ squishy a ɛyɛ akisikuru wɔ nna pii mu no, Ludwig angina a edi kan no yɛ necrotizing-style cellulitis a ɛtrɛw ntɛmntɛm a ɛnam anom streptococci (Streptococcus viridans, Streptococcus anginosus/milleri kuw) ne anerobes a wɔde ano yɛ hu a ɛyɛ hu (Prevotella, Porphyromonas, Fusobacterium, Peptostreptococcus).

Saa mmoawa yi yɛ enzymes a ɛsɛe ntini, endotoxin, ne mframa a ɛkɔ ntini a ɛka bom no mu ntɛmntɛm sen sɛnea nipadua no betumi afasu akɔ akisikuru mu. Nea afi mu aba ne sɛ, sɛ woka ɔyarefo no hwene ase ne ne kɔn atifi a, ɛnyɛ sɛ ɛyɛ mmerɛw anaasɛ ɛyɛ squishy; ɛte sɛ ɛyɛ den te sɛ abotan, ɛyɛ den, na entumi nnyae te sɛ dua a wɔabɔ no akuturuku ("brawny or woody induration"), ɛtɔ mmere bi a gas a ɛyɛ mmerɛw a ɛyɛ krak (subcutaneous crepitus) wɔ honam ani.

Ludwig angina ho sɛnkyerɛnne 6 a wɔtaa hu wɔ ayaresabea a wohu no¶

Ɔyarefo biara a ne sẽ ayɛ no yaw, ne sẽ abubu, pericoronitis (anom ntini a ɛwɔ nyansa sẽ a ɛrepae so), a wɔayi ne sẽ nnansa yi, anaasɛ ne hwene mu abubu a obenya nsɛnkyerɛnne a edidi so yi no wɔ asiane mu ntɛm ara sɛ ɔbɛhwere ne mframa kwan:

Sɛnea wobehu nsonsonoe a ɛda nsensan mu akisikuru a ɛwɔ baabi, Ludwig angina, peritonsillar akisikuru, ne akyi ntini mu akisikuru¶

Nsõ ne kɔn a emu dɔ mu nyarewa wɔ sɛnkyerɛnne ahorow a ɛka bom te sɛ menewa mu yaw, kɔn mu ahonhon, ne atiridiinini, nanso emu biara gye nipadua mu baabi soronko na ɛde asiane pɔtee bi ba:

Ɛtrɛw kɔ fam kɔ koko no mu: "Asiane Ahunmu" ne Descending Necrotizing Mediastinitis¶

Sɛ wɔantumi antew Ludwig angina no so ntɛmntɛm na wɔde nnuru a ekum ɔyare mmoawa a wɔde fa ntini mu dodow a ɛdɔɔso saa no yare a, owudifo a ɛto so abien a edi awu wɔ mframa kwan a ɛwɔ soro a wɔamene no akyi no yɛ ɛtrɛw kɔ fam kɔ koko mu.

Wɔ kɔn no mu no, wɔahyehyɛ awotwaa no mu ntini a emu dɔ no ayɛ no nhama a ɛda hɔ. retropharyngeal space ne din a ɛfata "Alar / Danger Space" (Space 4) no tu mmirika te sɛ elevator shaft a ɛbue a enni friction fi ti nhwi no ase tẽẽ, wɔ menewa ne esophagus akyi, kɔ fam tẽẽ fa thoracic inlet no mu kɔ posterior mediastinum (mfinimfini koko mu amena a koma, ntini akɛse, trachea, ne esophagus a ɛwɔ aduan mu).

Gravity, a wɔde ka ho ne vacuum nhyɛso bɔne a ɛba wɔ koko mu bere biara a ɔyarefo no bɛhome no, su polymicrobial pus ne necrotizing bacteria no sian kɔ kɔn no mu kɔ koko no mu, na ɛde Descending Necrotizing Mediastinitis (DNM) ba, a ɛde owu dodow ɔha biara mu nkyem 20 kosi 40 ba wɔ nnɛyi ayarehwɛ a emu yɛ den mpo mu.

Frɛko kɔkɔɔ a ɛkyerɛ sɛ nsensan anaa kɔn mu yare bi resiane akɔ koko no mu¶

• Kɔkɔɔ, ɔhyew, ne brawny swelling a ɛwea kɔ fam sian kɔ kɔn no anim kɔ suprasternal notch (tokuru a ɛda kɔla nnompe ntam) na ɛkɔ soro koko no fasu no so.
• Retrosternal (nufu dompe akyi) koko mu yaw foforo anaasɛ pleuritic ɛyaw bere a worehome.
• Mframa a ɛyɛ krak a ɛrehuruhuruw wɔ kɔn anaa moma so fasu a ɛwɔ fam no honam ani (subcutaneous crepitus) anaa nnyigyei a ɛyɛ mmerɛw a wɔte wɔ koma no bɔ so (Hamman sɛnkyerɛnne).
• Atiridiinini a ɛkɔ soro, awɔw a ɛwosow, koma a ɛbɔ ntɛmntɛm boro 120 bpm, adwene a ɛyɛ basaa, ne mogya mmoroso a ɛkɔ fam (septic shock).

Mmoa a edi kan a wɔde ma ansa na wɔakɔ ayaresabea ne fie: nea ɛsɛ sɛ woyɛ (na wonyɛ da) bere a woretwɛn EMS no¶

1. Kɔ so gyina tripod gyinabea a ɛteɛ no so a wunnye hwee: Ma ɔyarefo no ntena nkongua anaa ambulance mpa ano a ɔde ne ho to n'anim digrii 15 kosi 30 a wɔde wɔn ti akura mu wɔ "sniffing position" (wɔde ne kɔn akɔ anim kakra, ne ti atrɛw kakra wɔ ne kɔn so). Sɛ nnuruyɛfo a wɔboa ɔyarefo no de ɔyarefo no kɔ a, ɛsɛ sɛ wɔde stretcher akyigyina no krank kɔ 75 kosi 90 degrees.
2. Fa basin anaa mpopaho ma drool na brɛoo suction sɛ wɔatete: Mma nkyerɛ ɔyarefo no da sɛ ɔnsen ne ti n’akyi nkɔmene nnompe. Sɛ EMS de Yankauer suction catheter a ɛyɛ den ba a, nnuruyɛfo a wɔboa nkurɔfo no bɛtwe nnompe afi anim ano pɛɛ no ​​mu brɛoo nkutoo a wɔremfa tɛkrɛma anaa anom akyi (a ɛkanyan laryngospasm) no.
3. Fa oxygen a ɛyɛ nwini ma no brɛoo (sɛ wɔmma akatasoɔ no ho kwan a, blow-by): Ɔyarefoɔ a ehu aka no a ɔrepere mframa taa bɔ hu sɛ wɔde plastic oxygen akatasoɔ a ɛyɛ den kyekyere n’anim a, ɔte nka te sɛ nea wɔremene no. Oxygen a ɛyɛ nwini a ɛsen kɛse a wɔde kura ano ne hwene mu (a wɔbɔ) no ma mogya mu oxygen a wɔde asie no tu mpɔn ansa na wɔde ayaresabea mframa kwan no de wɔn ho ahyɛ mu a ɛmma ehu mma.
4. Nea enti a ɛnsɛ sɛ wonom nnuru a ekum ɔyare mmoawa a aka wɔ fie da na ama woatwentwɛn wo nan ase sɛ wobɛkɔ ayaresabea: Ayarefo a wɔn sẽ yɛ wɔn yaw kɛse no taa mene amoxicillin aduru abien a aka fi nnuru dan mu na wɔtwɛn anadwo biako hwɛ sɛ ebia wɔn hwene ase a ɛho ahonhon no so tew anaa. Nnuru a wɔde ano nom ntumi nkɔhyɛn anom yare a ɛwɔ nhyɛso kɛse, a mmoawa pii wom mu ntɛmntɛm sɛnea ɛsɛ, na nnɔnhwerew 8 a wɔtwɛn anadwo wɔ mpa so no ne mfɛnsere pɔtee a ɛma mframa kwan a ɛma obi da a ɛto mu a edi awu no ba.

Ayaresabea mframa kwan sohwɛ ("Double Setup") ne oprehyɛn decompression¶

Ansa na wɔreyɛ penicillin ne nnɛyi fiberoptic mframa kwan ho akwan horow no, Ludwig angina kunkum ayarefo bɛboro ɔha biara mu nkyem 50 (titiriw denam ahurututu a wɔde hyɛ wɔn mu so). Sɛ wɔhwɛ ayaresabea mframa kwan so ntɛm ara, wɔde nnuru a ekum ɔyare mmoawa gu ntini mu, na wɔyɛ oprehyɛn a wɔde yi nhyɛso fi nipadua mu a, nnipa dodow a wowuwu no so tew kodu ennu ɔha biara mu nkyem 5 kosi 8.

1. Nea enti a wɔabara gyinapɛn "Rapid Sequence Intubation (RSI)" wɔ Ludwig angina mu¶

Wɔ ayaresabea tebea horow a egye ntɛmpɛ dodow no ara mu no, nnuruyɛfo de aduru a wɔde fa ntini mu a ɛma ɔyarefo bi da na wɔde aduru a esiw ntini mu ntini ano (succinylcholine anaa rocuronium) ma ne ntini yɛ obubuafo ansa na wɔde ɔhome afiri bi afa ano (Rapid Sequence Intubation).

Wɔ Ludwig angina mu no, ɔyarefo no ntini a ɛyɛ mmerɛw ansa na ɔhome afiri no akɔ ahurututu no mu dwoodwoo no yɛ asiane a wonim no yiye ("Can't Intubate, Can't Ventilate"): - Bere a aduru a ɛma obubuafo no fi ase yɛ adwuma no, ɔyarefo no hwere ntini a ɛkura wɔn tɛkrɛma a ahonhon no kɔ n’anim no, na mframa kwan no bubu ɔha biara mu nkyem 100 (enti bag-valve-mask ntumi npia oxygen nkɔ mu). - Bere koro no ara mu no, esiane trismus (anom a wɔatoto mu) a emu yɛ den ne ano no fam a ɛkorɔn te sɛ abotan nti, oduruyɛfo no ntumi mmue ano no anaasɛ ɔmfa laryngoscope agyan nhyɛ tɛkrɛma no nkɔ fam mfa nhu ɛnne nhama no, na epiglottis no ahonhon na akyinkyim.

2. Sikakɔkɔɔ-Gyinapɛn Ayaresabea Protocol: Nyan Fiberoptic Intubation a "Double Setup".¶

Mmom no, oduruyɛfo a ɔhwɛ ntɛmpɛ so, oduruyɛfo a ɔma anesthesiologist, ne ENT / oral-maxillofacial oprehyɛn de ɔyarefo no (ɔda so ara te bolt gyina hɔ) kɔ oprehyɛn dan anaa resuscitation bay tẽẽ ma wɔyɛ Awake "Double Setup":

1. Topical airway numbing + IV Dexamethasone: Bere a ɔyarefo no da so ara da hɔ koraa na ɔhome wɔ n’ankasa so te hɔ tẽẽ no, kuw no de nebulized lidocaine gu hwene ne menewa mu de ma mframa kwan no mu nsunsuanso yɛ mmerɛw, na wɔma intravenous dexamethasone (8 to 10 mg IV) ne nebulized racemic epinephrine ma twetwe mucosal edema a ɛyɛ mmerɛw.
2. Setup A (Awake Flexible Fiberoptic Nasotracheal Intubation): Oduruyɛfo a ɔde aduru a ɛma obi dwensɔ no de nhama a ɛyɛ tratraa a ɛyɛ mmerɛw a ɛyɛ fiberoptic camera scope a wɔadi kan de home tube ahyɛ mu ma no fa *hwene mu a ayɛ mmerɛw no mu (ɔtwa sẽ a wɔatoto ne tɛkrɛma a ahonhon no ho hyia koraa), de aniwa twa epiglottis a ahonhon no ho hyia fa ɛnne no mu nhama no kɔ ahurututu no mu, na ɔde home afiri no hyɛ mfoninitwa afiri no so ansa na ɔde nnuru biara a ɛma obi dwo ama.
3. Setup B (Simultaneous Awake Surgical Airway Ready): Saa bere koro no ara pɛpɛɛpɛ no, ENT anaa trauma oprehyɛn ho oduruyɛfo no gyina mpa no nkyɛn a wɔde nnuru a ekum ɔyare mmoawa aprapra ɔyarefo no kɔn anim dedaw, wɔde mpɔtam hɔ lidocaine ayɛ no mmerɛw, na wɔde oprehyɛn kyerɛwdua ahyɛ no agyirae, na okura scalpel a wɔabue ne tracheostomy tube. Sɛ fiberoptic camera no ntumi mfa menewa a ahonhon no mu anaasɛ sɛ laryngospasm ba a, oprehyɛn no yɛ awake surgical tracheostomy anaa cricothyrotomy ntɛm ara wɔ sikɔne 60 mu.
4. Nea enti a mframa kwan sohwɛ ba ANSA na wɔayɛ CT scan: Ɛnsɛ sɛ wɔde ɔyarefo a nsu retu, stridor, anaasɛ ontumi nna fam sikani 60 no da kɔ radiology department kɔyɛ ne kɔn CT scan kosi sɛ wɔbɛkyekyere wɔn home tube no yiye.

3. Nnuru a wɔde kum ɔyare mmoawa a wɔde fa ntini mu ne oprehyɛn a wɔde twitwa & nsu a wɔde gu mu¶

Sɛ wɔde home afiri no hyɛ mu wie a: - Broad-Spectrum Intravenous Antibiotics: Wɔde ma ntɛm ara de kata aerobic streptococci, beta-lactamase-producing anom anaerobes, ne MRSA (wɔ ayarefo a asiane kɛse wom mu): mpɛn pii no IV Ampicillin-Sulbactam (Unasyn) anaa IV Ceftriaxone + High-Dose Metronidazole (anaasɛ Piperacillin-Tazobactam / Clindamycin), ne IV Vancomycin sɛ MRSA asiane wɔ hɔ a. - Oprehyɛn Decompression ne Tooth Extraction: Sɛ CT mfonini kyerɛ sɛ nsu a wɔaboaboa ano, mframa, anaasɛ entumi ntu mpɔn ntɛmntɛm a, oral-maxillofacial anaa ENT oprehyɛn ho animdefo tu abɔnten transverse incisions wɔ chin ne jaw ase (submandibular ne submental incisions), bue fascial spaces no pefee fa mylohyoid ntini no mu ma gyae nhyɛso na wɔde oprehyɛn no si drains, bere a yiyi molar ase sẽ a ɔyare no wɔ a efii ɔhaw no ase no.

Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

• United States ne Canada: Frɛ 911. Bisa sɛ wɔmfa no nkɔ ayaresabea ntɛmpɛ dwumadibea a wɔde nnɔnhwerew 24 aduru a wɔde kum nipadua no ne ENT / Ano ne Anom Oprehyɛn (OMFS) tua ho ka. Mma nnkɔ adwumayɛbea a wɔhwɛ nsensan so anaa ayaresabea a wɔhwɛ wɔn a wogye ntɛmpɛ sɛ nsu a ɛreworo so, wo nne sesa, trismus, anaasɛ wo hwene ase a ɛho ahonhon wɔ afã abien a.
• United Kingdom: Frɛ 999 na woanya Category ½ ambulance ntɛm ara anaa kɔ ayaresabea kɛse bi a wɔhwɛ wɔn a wɔyare denneennen Emergency Department (A&E) a wɔyɛ Maxillofacial ne ENT oprehyɛn wɔ beae hɔ tẽẽ. Ntwɛn mma NHS 111 sẽ ho nhyehyɛe a egye ntɛmpɛ sɛ mframa kwan a ɛyɛ frankaa kɔkɔɔ ho sɛnkyerɛnne wɔ hɔ a.
• Europa Aman Nkabom: Frɛ 112 wɔ EU aman nyinaa mu na bɔ mframa kwan a ɛyɛ ntɛm a ɛma odontogenic ho amanneɛ (angine de Ludwig wɔ Franse kasa mu, Angina Ludovici / Mundbodenphlegmone wɔ German kasa mu, angina de Ludwig wɔ Spania kasa mu).
• Australia ne New Zealand: Frɛ 000 wɔ Australia anaa 111 wɔ New Zealand.
• India ne Asia-Pacific: Trɛ 112 (anaasɛ 108 wɔ India), 995 wɔ Singapore, 119 wɔ Japan ne South Korea, anaa 999 wɔ Malaysia ne Hong Kong. Kɔ ayaresabea a ɛto so abiɛsa a mframa kwan a egye ntɛmpɛ ne anim oprehyɛn akuw a wɔde nnɔnhwerew 24 yɛ adwuma wom tẽẽ.

Nsɛm a wɔtaa bisa¶

Ɔkwan bɛn so na ɛse a ɛyɛ yaw a wɔansa no betumi adan mframa kwan a egye ntɛmpɛ a ɛde ne nkwa to asiane mu?¶

Ntini a ɛwɔ ase a ɛto so abien ne abiɛsa (nyansa sẽ) no trɛw kɔ akyiri wɔ anom dompe a ɛwɔ fam no mu wɔ mylohyoid ntini a ɛyɛ ano no fam no nhama a ɛbata ho no ase. Sɛ abura anaa akisikuru bi a ɛwɔ saa nsensanee a ɛwɔ fam yi biako mu no sɛe fa anom dompe no mu ɔfasu a ɛyɛ tratraa no mu a, anom mmoawa a wɔyɛ basabasa hwie gu anom ntini ase baabi a ɛwɔ abɔso no ase no mu tẽẽ na wɔkyekyere wɔn ho kɔ kasa ase baabi a ɛwɔ tɛkrɛma no ase wɔ afã abien no nyinaa. Esiane sɛ anom dompe a ɛyɛ den ne kɔn mu ntini a emu dɔ no mma ɔfe no ntrɛw nkɔ abɔnten nti, ɔfe no pia ano ne tɛkrɛma no fam tẽẽ kɔ soro na ɛkɔ akyi kosi sɛ ɛbɛto menewa no mu.

Dɛn nti na ɛnsɛ sɛ obi a ɔwɔ Ludwig angina da n’akyi da?¶

Wɔ Ludwig angina mu no, tɛkrɛma ne ano fam ahonhon ma ɛyɛ nea ɛyɛ nea ɛfata no mmɔho abien anaa abiɛsa na ɛpia kɔ soro kɔ ano no atifi. Bere a onipa no te hɔ gyina hɔ na ɔde ne ho to n’anim kakra no, tumi a ɛtwe ade ba fam no boa ma wɔtwe tɛkrɛma no ase a emu yɛ duru no kɔ n’anim kakra fi menewa no akyi ɔfasu no ho, na ɛma kwan ketewaa bi ma mframa fa mu. Bere a onipa no da n’akyi tratraa no, tumi a ɛtwe ade ba fam no twe tɛkrɛma nnyinaso a ahonhon no kɔ akyi kɔ hypopharynx no mu, na ɛma mframa kwan no siw ntɛm ara, ɛyɛ komm, koraa na koma no gyaee wɔ simma kakraa bi mu.

Dɛn ne kɔkɔbɔ nsɛnkyerɛnne a edi kan a ɛkyerɛ sɛ nsensan mu yare retrɛw akɔ kɔn mu mmeae a emu dɔ no?¶

Kɔkɔbɔ nsɛnkyerɛnne atitiriw a ɛkyerɛ sɛ ɛse a ɛyɛ yaw ketewaa bi atwa akɔ kɔn mu ntɛmpɛ a emu dɔ mu ne ɔfe a ɛtrɛw kɔ anom dompe no ase hye ase kɔ afã abien no nyinaa wɔ abɔgyesɛ no ase (nnua submandibular swelling), trismus (ɛyɛ den sɛ wobebue ano no atrɛw asen nsateaa abien), ntini a ɛyɛ mmerɛw a ɛwɔ tɛkrɛma no ase a ɛho ahonhon anaasɛ ɛkɔ soro, ɛyaw anaasɛ ɛyɛ den nnompe a wɔmene (drooling), ne "hot-potato" nne a ɛyɛ mum. Nsɛnkyerɛnne yi mu biara hwehwɛ sɛ wotu kwan ntɛm ara kɔ ayaresabea dwumadibea a wɔhwɛ wɔn a wɔwɔ ayaresa a egye ntɛmpɛ so, na ɛnyɛ ayaresabea a wɔyɛ wɔn sẽ daa.

Dɛn nti na ɛnsɛ sɛ mede afiri a ɛma ɔhyew anaa ade a wɔde hyɛ mu a ɛyɛ hyew gu anom anaa kɔn a ahonhon esiane sẽ a ɛyɛ kurukuruwa nti no akyi?¶

Sɛ wɔde ɔhyew aduru anaa nsu a ɛyɛ hyew toa gu anim, anom, anaa kɔn no akyi honam ani a, ɛma mogya ntini no trɛw na ɛtwetwe nsu a ɛyɛ hyew foforo kɔ fascial mmeae a emu dɔ no mu, na ɛma mframa kwan no hohoro ntɛmntɛm na ɛhyɛ ɔyare mmoawa no nkuran ma ɛnkyerɛ abɔnten denam anim were no so (ɛma honam ani ntini a ɛyɛ mmerɛw ba) anaasɛ ɛtrɛw kɔ akyiri wɔ kɔn no mu kɔ koko no mu. Ma kɔn no akyi nnwo anaasɛ ɛnyɛ dan mu hyew a ɛfata.

Dɛn nti na asiane wom sɛ nnuruyɛfo bɛma ɔyarefo bi a ɔwɔ Ludwig angina ada ansa na wɔde afiri a wɔde home ahyɛ mu?¶

Sɛ wɔde nnuru a ɛma obi dwo ne nnuru a ɛma ntini no yɛ mmerɛw ma ansa na wɔde ahome afiri no abɔ mu a, ɛma menewa ne tɛkrɛma ntini a na ɔyarefo a wada no de di dwuma de kura wɔn mframa kwan no mu no dwo, na ɛma mframa kwan no bubu koraa ma enti akataso ntumi npia oxygen nkɔ mu Bere koro no ara mu no, lockjaw (trismus) a emu yɛ den ne tɛkrɛma a ɛkorɔn te sɛ ɔbotan no ma ɛnyɛ den sɛ wobebue ano na woahu ɛnne nhama a ɛwɔ standard blade. Enti, nnuruyɛfo a wɔde aduru a ɛma obi dwensɔ ma ɔyarefo no tra hɔ gyina hɔ na ɔda hɔ, na wɔde lidocaine aduru a wɔde petepete ne hwene mu no yɛ mmerɛw de kyerɛ fibeoptic mfoninitwa afiri a ɛyɛ mmerɛw kwan fa hwene no mu kɔ mframa afiri no mu bere a oduruyɛfo a ɔyɛ oprehyɛn gyina ne kɔn ho a wasiesie ne ho no.

So Ludwig angina betumi aba wɔ mmerante ne mmabaa a wɔadu mpanyin afe so a wɔwɔ apɔwmuden mu?¶

Aane. Bere a asikreyare, nipadua no mu tumi a ɛko tia nyarewa, ntini mu ahotew a enye, ne nsensan ho hwɛ a wonnya no ma asiane no yɛ kɛse no, Ludwig angina nsɛm nyinaa mu bɛboro fã ka mmerante ne mmabaa a wɔadi mfe 20 kosi 50 a na wɔwɔ apɔwmuden kan no, na nea ɛtaa fi nyansa sẽ a ɛwɔ ase (anom a ɛto so abiɛsa) a ɔyare anaasɛ ɛkaa no anaasɛ nnansa yi anom a ɛwɔ fam a wɔayi afi mu.

Fibea ne aban akwankyerɛ¶

• Difficult Airway Society (DAS, United Kingdom) & Royal College of Anesthetists (NAP4): Akwankyerɛ a ɛfa Ti ne Kɔn Mframa a Ɛyɛ Den na Asiw Ho no Ho Dwumadie Ho (wake fiberoptic nasotracheal intubation, kwati a wɔde si hɔ a wɔde wɔn ho bɛto so, ne oprehyɛn a wɔde bedi dwuma mprenu wɔ tracheostomy mu).
• American Society of Anesthesiologists (ASA, United States): 2022 ASA Adeyɛ Akwankyerɛ a ɛfa Mframa a Ɛyɛ Den no Ho Dwumadie ho (akwan a wɔfa so de afiri a wɔde hyɛ nipadua mu a wɔda ma kɔn mu ahunmu mu yareɛ ne trismus).
• Infectious Diseases Society of America (IDSA, United States): Ayaresabea Dwumadie Akwankyerɛ a ɛfa Odontogenic ne Deep Neck Space Infections (polymicrobial a wɔde kata Streptococcus anginosus/viridans ne anom anaerobes ho, ne MRSA a wɔde ka ho).
• Amerika Anom ne Anom Oprehyɛn Ho Nnuruyɛfo Fekuw (AAOMS) & Britania Anom ne Anom Oprehyɛn Ho Nnuruyɛfo Fekuw (BAOMS): Ntɛm ara a Wɔpaw ne Oprehyɛn a Wɔyɛ de Decompression a Ɛma Anom, Sublingual, ne Submental Space Infections (Ludwig's Angina).
• Ɔman Asoɛe a Ɛhwɛ Akwahosan ne Ɔhwɛ So (NICE) & NHS (United Kingdom): Nsõ mu akisikuru ne kɔn mu ahunmu yareɛ a emu dɔ frankaa kɔkɔɔ a wɔde bɛkɔ Dwumadibea a Ɛhwɛ Ntɛmntɛm so.

Akwankyerɛ ahorow a ɛfa ho¶

• Peritonsillar abscess, Ludwig angina, ne kɔn mu yare a emu dɔ
• Epiglottitis, croup, stridor, ne mframa kwan a ɛwɔ soro a ɛsiw denneennen
• Nsensan ho nsɛm a egye ntɛmpɛ, ɛse a wɔabɔ no akuturuku, ne sẽ a ɛyɛ yaw
• Orbital cellulitis, cavernous sinus thrombosis, ne anim asiane-ahinanan mu nyarewa
• Sepsis ne septic shock a wohu ne ntɛmpɛ triage