Ihe mberede ụgbọ elu nke eze Abscess, Ludwig's Angina, na Ọzịza Submandibular¶

Ludwig's angina bụ polymicrobial cellulitis nke na-eyi ndụ egwu na-aga n'ihu ngwa ngwa na oghere dị n'olu submandibular, kpatara n'ihe karịrị pasenti 80 ruo 90 site na ọrịa eze na-adịghị agwọ ya nke eze ukwu mgbaaka (kpọmkwem n'ala nke abụọ ma ọ bụ nke atọ). N'ihi na ọkpụkpụ azụ agba (mandible) na-egbochi ọzịza ahụ ịgbasa n'èzí ma ọ bụ ala, edema na-ewu ngwa ngwa na-akwali ala ọnụ na ala ire ** kwụ ọtọ n'elu elu ọnụ wee laghachi azụ n'ime akpịrị *, na-eyi egwu ikpo ọkụ zuru ezu n'ime awa ole na ole. Ọ bụrụ na onye nwere eze mgbu ma ọ bụ mmịpụta eze na-etolite ọzịza siri ike n'akụkụ abụọ n'okpuru agba ("olu ehi"), ire dị elu, ụda mmiri, olu "potato-potato" gbachiri emechi, ma ọ bụ enweghị ike imeghe ọnụ ha ( trismus ***), kpọọ mpaghara gị. nọmba mberede ozugbo. Mgbe ị na-eche ndị na-ahụ maka ahụike, nyochaa ntuziaka ụgbọ elu metụtara ọzịza peritonsillar na ọrịa olu miri emi, Epiglottitis, croup, na elu ikuku stridor, na ihe mberede eze na ezé kụpụrụ.

N'ihi na ike ndọda bụ naanị ike na-enyere onye ọrịa aka ijide ire ha zara ntakịrị n'azụ akpịrị ya, otu ọrụ enyemaka mbụ gị kacha mkpa bụ ** idobe onye ọrịa ahụ ka ọ nọrọ ọdụ kwụ ọtọ ma dabere ntakịrị n'ihu ***, ọ dịghị mgbe ọ ga-amanye ha ka ha dinara ala n'azụ ya n'ihi ihe ọ bụla.

Mee nke a ugbu a¶

1. Kpọọ nọmba mberede nke mpaghara gị ozugbo wee kwupụta ihe mberede ụgbọ elu nwere nnukwu ihe egwu. Kpọọ 911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom, 000 na Australia, ma ọ bụ lelee ndepụta nke anyị. nọmba mberede. Kwupụta n'ụzọ doro anya: * "Ihe mberede ụgbọ elu Ludwig angina / eze a na-enyo enyo: ọzịza nke abụọ n'okpuru agbà, ire dị elu, mkpọnwụ, ụda olu, na ihe ize ndụ nke nkwụsị ụgbọ elu mberede."*
2. ** Debe onye ọrịa ahụ ka ọ nọrọ ọdụ kwụ ọtọ ma dabere ntakịrị n'ihu (ọnọdụ "Tripod" ma ọ bụ "Sniffing") oge niile.** Edola onye ọrịa nwere angina Ludwig ma ọ bụ ọzịza eze siri ike nke submandibular dị larịị n'azụ ha n'elu akwa, sofa, ihe ndọtị ụgbọ ala, ma ọ bụ tebụl nyocha CT ụlọ ọgwụ. Ịdị larịị na-eme ka ire dị arọ, edematous na anụ ahụ fụrụ akpụ daa azụ ozugbo na mgbidi pharyngeal dị n'azụ site na ike ndọda, na-emechi ụzọ ikuku n'ime sekọnd ma kpalite njide obi hypoxic ozugbo.
3. ** Kwe ka onye ọrịa ahụ gbụọ mmiri mmiri n'ime iko ma ọ bụ towel, ma araparakwala mkpịsị aka, ihe na-akụda ire, ma ọ bụ ngaji n'ọnụ.** N'ihi na ala ọnụ na-aza nke ọma ka osisi na akwara agba na-ekpochi spasm (trismus), na-agbalị imeghe ezé meghere ma ọ bụ pịa ire ala site na ngaji na-akpata ihe ike na-eme ihe ike gaggingspam, lary mgbachi.
4. ** Tinye iwu NPO siri ike (ọ dịghị ihe ọ bụla site n'ọnụ: enweghị mmiri, ọ dịghị ihe na-ebelata ihe mgbu, enweghị ọgwụ nje). Nke abụọ, onye ọrịa ga-achọ ngwa ngwa ** teta fiberoptic intubation ** ma ọ bụ ** teta ịwa ahụ tracheostomy / cricothyrotomy ** n'ime ụlọ ịwa ahụ mgbe ọ bịarutere ụlọ ọgwụ.
5. ** Mee ka onye ọrịa ahụ dị jụụ, dị jụụ, na enweghị mmegharị, ma tọpụ ihe mkpuchi uwe elu niile, eriri na olu.
6. E tinyela paịlị kpo oku ma ọ bụ karama mmiri ọkụ n'èzí n'olu ma ọ bụ agbà fụrụ akpụ. Itinye okpomọkụ dị n'èzí na nrịanrịa ihu miri emi ma ọ bụ n'olu na-eme ka vasodilation mpaghara na edema anụ ahụ dịkwuo elu, na-eme ka mmechi ikuku na-eme ka ọ dịkwuo elu ma na-ebute ọrịa ahụ na akpụkpọ ahụ ma ọ bụ na-agbada n'olu n'ime obi (** na-agbada necrotizing mediastinitis**).

Osisi mkpebi: eze mgbu, ọzịza ihu, na triage ikuku angina Ludwig¶

flowchart TD
    Start["Isi ọwụwa, mgbawa agbajiri agbaji, ma ọ bụ mmịpụta eze na-adịbeghị anya site na ihu, agba, ma ọ bụ ọzịza n'okpuru chin"] --> AirwayScreen{"Kwụpụ 1: Lelee ọkọlọtọ ụgbọ elu & Ludwig Angina Red Flags: Ọzịza n'okpuru akụkụ abụọ nke agba, ire na-ebuli elu, na-ada ụda, olu nduku na-ekpo ọkụ, trismus, ma ọ bụ kwụ ọtọ kwụ ọtọ?"}

    AirwayScreen -->|"EE nye ọkọlọtọ uhie ọ bụla"| LudwigEmergency["MGBERE ikuku ikuku na-eyi ndụ ozugbo (LUDWIG ANGINA): Kpọọ Ọrụ Mberede (911 / 112 / 999) ozugbo."]

    AirwayScreen -->|"Mba: Ọzịza nwere oke na chịngọm ma ọ bụ otu ntì, ilo nkịtị na olu, oghere ọnụ zuru oke."| LocalDental["Mgbagwoju anya na-enweghị mgbagwoju anya ọgbaghara eze: Hazie nyocha dọkịta ezé ngwa ngwa otu ụbọchị; jiri mmiri nnu na-ekpo ọkụ sachaa nke ọma, etinyela okpomọkụ na ntì, wee gaa ED ma ọ bụrụ na ọzịza n'okpuru agba ma ọ bụ trismus amalite."]

    LudwigEmergency --> UprightRule["1. EZIOKWU OKWU KWESỊRỊ (Ọnọdụ Tripod / Sniffing): Edola onye ọrịa ala n'elu tebụl ma ọ bụ tebụl CT; kwe ka drool wụba n'ihu n'ime iko ma ọ bụ akwa nhicha"]

    UprightRule --> HandsOff["2. Chebe okporo ụzọ ụgbọ elu: NPO siri ike (enweghị mmiri ma ọ bụ ọgwụ ọnụ), etinyela ihe na-akụda ire ma ọ bụ agbịrị ọnụ, enweghị paịlị kpo oku na mpụga, ma tọpụ olu"]

    HandsOff --> HospitalOR["3. Ụlọ ọgwụ Double-Setup Airway & Nlekọta ịwa ahụ: Teta na-agbanwe agbanwe Fiberoptic Nasotracheal Intubation na-anọdụ n'otu oge na Prep maka Teta Tracheostomy, IV Dexamethasone, Broad-Spectrum IV Antibiotics, na Ịwa ahụ Decompression."]

Anatomi na pathophysiology: iwu "Mylohyoid Line" na ihe kpatara molars dị ala na-akpata angina Ludwig¶

Onye dibia German Wilhelm Friedrich von Ludwig kọwara na 1836 (onye kpọrọ ya angina sitere na Latin angere , nke pụtara “ịkpagbu ma ọ bụ kpagbuo,” ọ bụghị obi mgbu), ** Ludwig's angina ** na-akọwapụta anatomically site na otu iwu: ọ bụ ngwa ngwa na-agbasa, osisi-dị ka, gangrenous-sellvoldi cellosanguar nke atọ. triangle n'akụkụ abụọ ***:

1. ** Oghere Sublingual *** (n'ala ọnụ, ozugbo * n'elu * akwara mylohyoid).
2. ** The Submylohyoid / Submaxillary Space ** (kpọmkwem * n'okpuru * akwara mylohyoid n'akụkụ aka ekpe na aka nri).
3. ** Oghere Submental ** (n'okpuru etiti agba).

Ihe kpatara nke abụọ na nke atọ ala molars (eze amamihe) bụ ndị na-eme ihe ọjọọ¶

Kedu ihe kpatara oghere dị mfe ma ọ bụ ọzịza na ** n'ihu ma ọ bụ premolar nke mbụ *** na-ebutekarị chịngọm mpaghara na-esi n'ime ọnụ, ebe ọrịa ** obere molar nke abụọ ma ọ bụ ezé nke atọ (eze amamihe) na-ebute angina Ludwig na-eyi ndụ egwu? Azịza ya dị na otu mpempe akwụkwọ nke a na-akpọ ** mylohyoid muscle **, nke na-agbatị dị ka ihe mgbochi n'ime ime ọkpụkpụ agba nke dị ala iji mepụta ala muscular nke ọnụ:

• Ezé n'ihu molar nke abụọ (incisors, canines, premolars, and often the first molar): Atụmatụ (apices) nke mgbọrọgwụ nke ezé n'ihu ndị a na-anọdụ ala ** n'elu (karịrị) ** mgbakwụnye mịrị nke mylohyoid muscle n'ime ime nke ọkpụkpụ agba. Mgbe ọnya na-etolite na mgbọrọgwụ ezé ndị a, ọnyà na-asọba ọkpụkpụ n'elu èbè muscle ma nọrọ n'ime ọnụ (sublingual ma ọ bụ buccal space).
• ** Mgbochi nke abụọ na nke atọ (70% ruo 90% nke Ludwig's angina case): ** Isi mgbọrọgwụ miri emi nke obere nke abụọ na nke atọ na-erute ala ** n'okpuru (dị ala na) ** eriri mgbakwunye muscle mylohyoid, ebe ọkpụkpụ cortical dị n'ime nke mandible bụ akwụkwọ dị mkpa. Mgbe mgbọrọgwụ mgbọrọgwụ na obere sekọnd ma ọ bụ nke atọ na-agbaji n'ọkpụkpụ dị n'ime ahụ dị gịrịgịrị, nje bacteria na nsị na-atụba ozugbo ** n'okpuru akwara mylohyoid ** n'ime oghere ** submandibular **.
• ** Akpụkpọ ụkwụ inyinya-gburugburu azụ nke uru ahụ:** N'ihi na azụ azụ nke akwara mylohyoid na-ekokwasị n'efu dị ka ákwà mgbochi na-enweghị ihe mgbochi nke na-ekewa oghere submandibular dị n'okpuru ebe dị n'elu, ọrịa ahụ na-agbanye ozugbo n'akụkụ azụ nke mylohyoid muscle n'ime ** sublingual space *** na-agafe n'akụkụ akụkụ nke etiti ahụ. ọnụ na vise nke yiri akpụkpọ ụkwụ.

[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

Gịnị kpatara Ludwig's angina ji bụrụ "cellulitis osisi" kama ịbụ obere akpa akpa n'oge mbụ.¶

N'adịghị ka obụpde chịngọm chịngọm nke na-etolite obere akpa anụ ahụ dị nro ruo ọtụtụ ụbọchị, mmalite Ludwig's angina bụ ** cellulitis na-agbasa ngwa ngwa na-agbasa ngwa ngwa nke ngwakọta ọnụ nke ọnụ ** streptococci ** (* Streptococcus viridans*, * Streptococcus viridans*, * Streptococcus/miller angina). ** anaerobes *** (Prevotella, Porphyromonas, Fusobacterium, Peptostreptococcus).

Nje bacteria ndị a na-emepụta enzymes na-ebibi anụ ahụ, endotoxin, na gas nke na-abanye n'ụgbọ elu anụ ahụ njikọ ngwa ngwa karịa ka ahụ nwere ike ime ka ha banye n'ime oghere. N'ihi ya, mgbe ị na-emetụ aka n'okpuru agba na olu onye ọrịa ahụ, ọ naghị adị nro ma ọ bụ squishy; ọ na-adị ** nkume siri ike, adịghị ike, na enweghị ike dị ka ngọngọ osisi ("brawny or woody induration"), mgbe ụfọdụ na-enwe afụ gas na-ada ada ( subcutaneous crepitus**) n'okpuru akpụkpọ ahụ.

N'ịghọta akara ngosi ụlọ ọgwụ 6 kpochapụrụ nke Ludwig's angina¶

Onye ọrịa ọ bụla nwere eze mgbu dị ala, mgbawa mgbaji, pericoronitis (ọrịa chịngọm na-efe efe n'elu ezé amamihe na-agbawa), mmịpụta ezé na nso nso a, ma ọ bụ mgbaji agbaji nke malitere ihe mgbaàmà ndị a nọ n'ihe ize ndụ dị nso nke ịla n'iyi ụgbọ elu ha:

Otu esi amata ọdịiche nke ọnya eze mpaghara, Ludwig's angina, peritonsillar abscess, na retropharyngeal abscess¶

Ọrịa eze na nke dị omimi n'olu na-ekerịta ihe mgbaàmà ndị dị ka akpịrị akpịrị, ọzịza olu, na ahụ ọkụ, mana nke ọ bụla nwere oghere dị iche iche anatomical ma na-ebu ihe egwu dị iche iche:

Agbasa n'ala n'ime obi: "Oghere dị ize ndụ" na mgbada Necrotizing Mediastinitis¶

Ọ bụrụ na Ludwig's angina anaghị ebelata ngwa ngwa ma jiri ọgwụ nje na-egbu egbu na-agwọ ya, onye nke abụọ na-egbu egbu mgbe ikuku ikuku dị elu gachara ** gbadaa n'ime oghere obi.

N'ime olu, a na-ahazi fascia cervical miri emi n'ime tubes kwụ ọtọ. Oghere ** retropharyngeal ** na aha ya nke ọma ** "Alar / Danger Space" (Oghere 4)** na-agba ọsọ dị ka oghere mbuli elu mepere emepe, nke na-enweghị mgbagha ozugbo site na isi okpokoro isi, n'azụ akpịrị na esophagus, gbadaa site na ntinye thoracic n'ime ** posterior mediastinum ** (Oghere dị n'azụ mediastinum ** (Oghere dị n'azụ, nnukwu akwara obi).

Ike ndọda, jikọtara ya na nrụgide agụụ na-adịghị mma nke a na-emepụta n'ime obi mgbe ọ bụla onye ọrịa na-eku ume, na-amịpụta polymicrobial pus na necrotizing nje bacteria na-agbada n'olu n'ime obi, na-eme ka ** Descending Necrotizing Mediastinitis (DNM)**, nke na-ebu ** 20 ruo 40 pasent ọnwụ ** ọbụlagodi na nlekọta ahụike ọgbara ọhụrụ.

Ọkọlọtọ uhie na ọrịa eze ma ọ bụ olu na-agbada n'ime obi¶

• ** Ọcha ọbara ọbara, ikpo ọkụ na ọzịza na-arịdata n'ihu olu** na-aga n'ọkwa elu (oghere dị n'etiti ọkpụkpụ olu) na n'elu mgbidi igbe.
• ** Ọhụrụ retrosternal (n'azụ-ọkpụkpụ ara) obi mgbu *** ma ọ bụ pleuritic mgbu mgbe iku ume.
• Afụ gas na-agbawa n'okpuru akpụkpọ nke olu nke ala ma ọ bụ mgbidi obi (subcutaneous crepitus) ma ọ bụ ụda na-akụda mmụọ a na-anụ n'ofe obi (Akara Hamman**
• ** Ahụ ọkụ na-efe efe dị elu, ịma jijiji na-ama jijiji, ọ̀tụ̀tụ̀ obi dị ngwa karịa 120 bpm, mgbagwoju anya, na mbelata ọbara mgbali** (septic shock).

Prehospital na enyemaka mbụ nke ụlọ: ihe ị ga-eme (ma ọ dịghị eme) mgbe ị na-eche EMS¶

1. ** Nọgide na-enwe ọnọdụ tripod ziri ezi na-enweghị isi: *** Ka onye ọrịa nọdụ na nsọtụ oche ma ọ bụ akwa ụgbọ ala na-adabere na 15 ruo 30 degrees na isi ha na-ejide na "ọnọdụ imi" (olu dị ntakịrị na-atụgharị n'ihu, isi na-agbatị ntakịrị n'olu). Ọ bụrụ na ndị na-ahụ maka ahụike na-ebuga onye ọrịa ahụ, a ga-akụrịrị ihe ndọtị azụ azụ ruo ** 75 ruo 90 degrees **.
2. ** Nyefee efere ma ọ bụ towel maka mmiri mmiri na mmiri dị nro ma ọ bụrụ na a zụrụ ya:** Ajụla onye ọrịa ka ọ tụgharịa isi ya azụ ka ọ loda mmiri. Ọ bụrụ na EMS ji eriri mmịpụta nke Yankauer bịarutere, ndị na-ahụ maka ahụike ga-eji nwayọọ na-amịpụta mmiri site n'egbugbere ọnụ dị n'ihu na-etinyeghị azụ nke ire ma ọ bụ pharynx (nke na-akpalite laryngospasm).
3. ** Na-elekọta ikuku oxygen na-ekpo ọkụ nke ọma (na-efe efe ma ọ bụrụ na anabataghị ihe nkpuchi):** Onye ọrịa ụjọ na-atụ na-adọga ikuku na-atụkarị ụjọ ma ọ bụrụ na mkpuchi ikuku oxygen siri ike kpuchie ihu ha, na-adị ya ka ọ na-ata ahụhụ. Jide ikuku oxygen na-erute elu n'akụkụ ọnụ na imi (na-efe efe) na-eme ka ikuku oxygen dị n'ọbara na-eme ka ikuku oxygen dị n'ọbara na-eme ka ọ bụrụ ụzọ ikuku ụlọ ọgwụ na-ebuteghị ụjọ.
4. Ihe kpatara na ị na-agaghị ewere ọgwụ nje ahapụla n'ụlọ iji gbuo oge ịga ụlọ ọgwụ: Ndị ọrịa nwere nnukwu eze mgbu na-elodakarị capsules amoxicillin abụọ fọdụrụ n'ime ụlọ ọgwụ wee chere n'abali ka ịhụ ma ọzịza n'okpuru agba na-agbada. Mkpụrụ ọgwụ ọnụ enweghị ike ịbanye n'ọrịa nrụgide dị elu, ọrịa polymicrobial submandibular ngwa ngwa zuru oke, na ichere awa 8 n'abali n'elu akwa bụ windo kpọmkwem ebe mmechi ụgbọ elu na-egbu egbu na-apụta.

Nlekọta okporo ụzọ ụlọ ọgwụ ("Double Setup") na nkwụsịtụ ịwa ahụ¶

Tupu e mepụta penicillin na usoro ụzọ ikuku nke fiberoptic ọgbara ọhụrụ, Ludwig's angina gburu ** ihe karịrị pasentị 50** nke ndị ọrịa (nke bụ isi n'ụbụrụ). Site na njikwa ụzọ ikuku ụlọ ọgwụ ozugbo, ọgwụ nje na-egbu egbu, na mbelata ịwa ahụ, ọnwụ na-agbada na ** ihe na-erughị pasent 5 ruo 8 ***.

1. Kedu ihe kpatara amachibidoro ọkọlọtọ "Rapid Sequence Intubation (RSI)" na Ludwig's angina¶

N'ọtụtụ ọnọdụ mberede ụlọ ọgwụ, ndị dọkịta na-etinye onye ọrịa ka ọ na-eji ọgwụ na-enye ọgwụ na-enye ọgwụ ike kpọnwụrụ akpọnwụ ma jiri ihe mgbochi neuromuscular (succinylcholine ma ọ bụ rocuronium) mee ka uru ahụ ha kpọnwụrụ akpọnwụ tupu ha ebufe tube iku ume n'ọnụ (** Ngwa ngwa Intubation Sequence**).

Na ** Ludwig's angina *, ime ka akwara onye ọrịa ahụ kpọnwụrụ akpọnwụ tupu tube iku ume abanye n'ime trachea bụ nnukwu ọdachi ama ama (" Enweghị ike ịbanye, enweghị ike ikuku ikuku"). - Ozugbo ọgwụ ahụ ahụ kpọnwụrụ akpọnwụ malitere ịrụ ọrụ, onye ọrịa ahụ na-efunahụ ụda akwara na-ejide ire ha zara aza, ụzọ ikuku na-adakwa 100 pasent (ya mere akpa-valve-mask enweghị ike ịkwanye oxygen n'ime). - N'otu oge ahụ, n'ihi nnukwu trismus (agba akpọchiri akpọchi) na nkume siri ike dị elu nke ọnụ, dọkịta ** enweghị ike imeghe ọnụ ma ọ bụ kpachie ire ala ** jiri eriri laryngoscope hụ ụdọ olu, epiglottis fụrụ akpụ wee gbagọọ agbagọ.

2. The Gold-Standard Hospital Protocol: Teta Fiberoptic Intubation na a "Double Setup"¶

Kama nke ahụ, dibịa bekee mberede, onye na-ahụ maka anesthesiologist, na ENT / oral-maxillofacial dọkịta na-awa ahụ na-akpọga onye ọrịa ahụ (ka ọ na-anọdụ ala kwụ ọtọ) ozugbo gaa n'ọnụ ụlọ ịwa ahụ ma ọ bụ ebe a na-emegharị ahụ maka ** Teta "Ntọala Abụọ"**:

1. N'ọnụ ọnụ ụzọ ikuku ọnụ + IV Dexamethasone: Mgbe onye ọrịa ahụ na-amụ anya kpamkpam ma na-eku ume n'oche nke aka ha, ndị otu ahụ na-agbaji lidocaine n'ime imi na akpịrị iji mee ka ikuku ikuku na-emegharị ahụ, ma na-enye ** dexamethasone intravenous (8 ruo 10 mg IV)** na ** edenebulized mucosa na epinephma.
2. Ntọlite ​​A (Teta Flexible Fiberoptic Nasotracheal Intubation): Onye na-ahụ maka anesthesiologist jiri nwayọ were eriri ikuku na-eku ume site n'ọnụ ọnụ ** imi** (na-agafe ezé akpọchiri kpamkpam na ire fụrụ akpụ), na-anyagharị anya n'okirikiri eriri afọ wee banye n'ọkpụkpụ nke eriri afọ. tube iku ume n'ofe igwefoto tupu inye ọgwụ mgbochi ọ bụla.
3. Ntọlite ​​​​B (Njikere Ịwa Ahụ Maka Ịwa N'otu oge): N'otu oge ahụ, ENT ma ọ bụ dọkịta na-awa ahụ trauma na-eguzo n'akụkụ ihe ndina, ejirila ọgwụ antiseptik sụọ ya n'ihu olu onye ọrịa, were lidocaine mpaghara, ma ka ya na pen ịwa ahụ, na-ejide akwa akpụkpọ anụ na tracheostomy. Ọ bụrụ na igwefoto fiberoptic enweghị ike ịgafe na akpịrị fụrụ akpụ ma ọ bụ ọ bụrụ na laryngospasm pụtara, dọkịta na-awa ahụ na-eme ngwa ngwa ** teta ịwa ahụ tracheostomy ma ọ bụ cricothyrotomy ** n'ime sekọnd 60.
4. ** Gịnị kpatara njikwa ụgbọ elu ji abịa tupu nyocha CT:** Onye ọrịa nwere nkụda mmụọ, stridor, ma ọ bụ enweghị ike ịgha ụgha maka sekọnd 60 agaghị ezigara ya na ngalaba redio maka nyocha CT olu ruo mgbe echekwara tube iku ume ya n'ọnọdụ.

3. Ọgwụ nje na-egbu egbu na mbepụ ịwa ahụ & igbapu mmiri¶

Ozugbo echekwara tube iku ume: - ** Ọgwụ nje nje na-agbasa n'ime nwa:** A na-enye ya ozugbo iji kpuchie streptococci aerobic, beta-lactamase na-emepụta anaerobes ọnụ, yana MRSA (na ndị ọrịa nwere nnukwu ihe ize ndụ): na-abụkarị IV Ampicillin-Sulbactam (Unasyn)* ma ọ bụ IV Ceftriaxone ** Piperacillin-Tazobactam / Clindamycin), gbakwunyere IV Vancomycin ma ọ bụrụ na ihe ize ndụ MRSA dị. - ** Mbelata ịwa ahụ na mmịpụta ezé: *** Ọ bụrụ na onyonyo CT na-egosi mkpokọta mmiri, gas, ma ọ bụ ọdịda imeziwanye ngwa ngwa, ndị dọkịta na-awa maxillofacial ma ọ bụ ENT na-eme ka mpụta transverse mpụga n'okpuru agba na agba (** submandibular na submental incisions ***), na-emeghe oghere ndị na-adọrọ adọrọ, na-emepe oghere ndị na-adọrọ adọrọ, na-eme ka ọkpụkpụ na-eme ka ọ ghara ịdị na-eme ka ọ ghara ịmịpụ. Ezé ndị dị ala butere ọrịa *** malitere nsogbu ahụ.

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

• United States na Canada: Kpọọ 911. Rịọ mbugharị ozugbo gaa na ngalaba mberede ụlọ ọgwụ nwere anesthesiology awa 24 yana mkpuchi ENT / Oral na Maxillofacial (OMFS). Agakwala ụlọ ọrụ eze ma ọ bụ na-ejegharị n'ụlọ ọgwụ nlekọta ngwa ngwa ma ọ bụrụ na mmiri ara ehi, mgbanwe olu, trismus, ma ọ bụ ọzịza n'okpuru agba dị n'akụkụ abụọ.
• United Kingdom: Kpọọ 999 maka ụgbọ ihe mberede Category ½ ozugbo ma ọ bụ gaa ozugbo na nnukwu ụlọ ọgwụ ** Ngalaba Mberede (A&E)** na ịwa Maxillofacial na ENT na saịtị. Echela maka oge nhọpụta eze ngwa ngwa NHS 111 ma ọ bụrụ na mgbaàmà ụgbọ elu na-acha uhie uhie dị.
• European Union: Kpọọ 112 gafee mba ndị otu EU niile wee kọọ nnukwu ihe mberede ikuku odontogenic (* angine de Ludwig* na French, Angina Ludovici / Mundbodenphlegmone na German, angina de Ludwig na Spanish).
• Australia na New Zealand: Kpọọ 000 na Australia ma ọ bụ 111 na New Zealand.
• India na Asia-Pacific: Kpọọ 112 (ma ọ bụ 108 na India),995 na Singapore,119 na Japan na South Korea, ma ọ bụ 999 na Malaysia na Hong Kong. Gaba ozugbo na ụlọ ọgwụ dị elu nwere ụzọ ikuku mberede nke awa 24 yana ndị otu ịwa ahụ maxillofacial.

Ajụjụ a na-ajụkarị¶

Kedu ka mgbu eze na-adịghị agwọta ga-esi ghọọ ihe mberede ụgbọ elu na-eyi ndụ egwu?¶

Mgbọrọgwụ nke molars nke abụọ na nke atọ (ezé amamihe) gbatịa n'ime ime ọkpụkpụ agba nke dị n'okpuru ahịrị mgbakwunye nke akwara mylohyoid, nke na-etolite ala ọnụ. Mgbe oghere ma ọ bụ ọzịza a na-agwọghị nke dị n'otu n'ime oghere ndị a dị ala na-esi na mgbidi dị n'ime dị n'ime ọkpụkpụ agba, nje bacteria na-eme ihe ike na-agbanye ozugbo n'ime oghere submandibular n'okpuru agba wee kechie n'ime oghere sublingual n'okpuru ire n'akụkụ abụọ. N'ihi na ọkpụkpụ agba agba agba na fascia olu miri emi na-egbochi ọzịza ahụ ịgbasa n'èzí, ọzịza ahụ na-akwali ala ọnụ na ire kwụ ọtọ elu na azụ ruo mgbe ọ mechiri akpịrị.

Kedu ihe kpatara na onye nwere angina Ludwig na-agaghị adakpu n'azụ ya?¶

N'ime angina Ludwig, ire na ala ọnụ na-aza aza ugboro abụọ ma ọ bụ atọ n'ịdị arọ ha ma na-akwali elu n'elu ụlọ nke ọnụ. Mgbe onye ahụ na-anọdụ ala kwụ ọtọ ma na-adabere ntakịrị n'ihu, ike ndọda na-enyere aka mee ka isi dị arọ nke ire dọpụtatụ ntakịrị n'azụ mgbidi nke akpịrị, na-ahapụ ebe dị warara ka ikuku gafee. Oge onye ahụ dinara ala n'azụ ya, ike ndọda na-adọghachi azụ azụ azụ azụ n'ime hypopharynx, na-ebute ngwa ngwa, ịgbachi nkịtị, mkpokọta ikuku ikuku na njide obi n'ime nkeji nkeji.

Gịnị bụ ihe ịrịba ama mbụ ịdọ aka ná ntị na ọrịa eze na-agbasa n'ime oghere olu?¶

Ihe ịrịba ama ịdọ aka ná ntị bụ isi na mgbu eze dị mfe abanyela n'ime ihe mberede olu dị omimi bụ ọzịza nke na-agbasa n'okpuru ala nke ọkpụkpụ agba n'akụkụ abụọ n'okpuru agba (ọkụ submandibular osisi), trismus (ihe isi ike imeghe ọnụ karịa mkpịsị aka abụọ), ọzịza ma ọ bụ elu nke anụ ahụ dị nro n'okpuru ire, mgbu ma ọ bụ ihe isi ike ilo "ọkụ" na-ekpo ọkụ. Otu n'ime ihe ịrịba ama ndị a chọrọ njem ozugbo gaa na ngalaba mberede ụlọ ọgwụ, ọ bụghị ụlọ ọgwụ eze na-emekarị.

Kedu ihe kpatara na m na-agaghị etinye ihe mkpuchi ọkụ ma ọ bụ mpikota onu na-ekpo ọkụ n'èzí agba ma ọ bụ n'olu fụrụ akpụ site na oghere eze?¶

Itinye ihe mkpuchi ọkụ ma ọ bụ karama mmiri ọkụ na akpụkpọ ahụ dị n'èzí nke ntì, agba, ma ọ bụ olu na-agbasa arịa ọbara ma na-adọtakwu mmiri ọkụ n'ime oghere dị omimi, nke na-eme ka ọzịza ikuku dịkwuo elu ma na-agba ume ka ọrịa ahụ pụta ìhè site na akpụkpọ ihu (na-emepụta traktị sinus na-adịghị mma) ma ọ bụ gbasaa n'olu n'ime obi. Debe ihu dị jụụ ma ọ bụ na-ekpo ọkụ n'ọnụ ụlọ.

Kedu ihe kpatara o ji dị ize ndụ nye ndị dọkịta itinye onye ọrịa Ludwig's angina ka ọ hie ụra tupu ha etinye tube iku ume?¶

Inye ọgwụ na-eme ka ahụ dị n'ime ya na ọgwụ na-eme ka ahụ kpọnwụrụ akpọnwụ tupu ị nweta tube iku ume na-eme ka akpịrị na akwara dị jụụ nke onye na-amụ anya na-eji na-emepe ụzọ ikuku ha, na-eme ka ikuku ikuku daa kpam kpam n'ihi na ihe nkpuchi enweghị ike ịkwanye oxygen n'otu oge ahụ, nnukwu mkpọchi (trismus) na ire dị elu nke nkume na-eme ka ọ ghara ikwe omume imeghe ọnụ ma jiri eriri olu hụ ọkọlọtọ. Ya mere, ndị na-ahụ maka anesthesiologists na-eme ka onye ọrịa nọrọ ọdụ na ịmụrụ anya, na-akụ imi lidocaine iji duzie igwefoto fiberoptic na-agbanwe agbanwe site n'oghere imi banye na ikuku ikuku mgbe dọkịta na-awa ahụ guzoro n'olu.

Angina Ludwig nwere ike ime na ndị ntorobịa nwere ahụike?¶

Ee. Ọ bụ ezie na ọrịa shuga, mgbochi mgbochi, ịdị ọcha eze na-adịghị mma, na enweghị ohere nlekọta eze na-abawanye ihe ize ndụ, ihe karịrị ọkara nke ọrịa angina Ludwig na-emetụta ndị na-eto eto na ndị agadi nọ n'afọ 20 na 50, nke na-ebutekarị site na ọrịa ma ọ bụ emetụta ezé amamihe dị ala (molar nke atọ) ma ọ bụ mmịpụta obere molar na nso nso a.

Isi mmalite na nduzi ọchịchị¶

• ** Ihe siri ike Airway Society (DAS, United Kingdom) & Royal College of Anesthetists (NAP4): *** Ntuziaka maka njikwa nke isi ihe siri ike na nke na-egbochi isi na olu ikuku * (na-eteta eriri eriri eriri eriri fiberoptic, izere ịnọ n'elu ala, na nhazi tracheostomy ịwa ahụ ugboro abụọ).
• ** American Society of Anesthesiologists (ASA, United States):** 2022 ASA Practice Guidelines for Management of the Difficult Airway (kpọte ụzọ intubation maka ọrịa oghere olu miri emi na trismus).
• ** Ọrịa na-efe efe Society of America (IDSA, United States):** * Usoro ọgwụgwọ ọgwụgwọ maka Odontogenic na Deep Neck Space Infection* ( mkpuchi polymicrobial maka * Streptococcus anginosus/viridans* na anaerobes ọnụ, yana mkpuchi MRSA).
• ** American Association of Oral and Maxillofacial Surgeons (AAOMS) & British Association of Oral and Maxillofacial Surgeons (BAOMS):** * Nchọpụta Mberede na Ịwa Ahụ nke Submandibular, Sublingual, na Submental Space Infection (Ludwig's Angina)*.
• ** National Institute for Health and Care Excellence (NICE) & NHS (United Kingdom):** * Ọkọlọtọ na-acha uhie uhie na-acha uhie uhie na-ahụ maka ihe mberede ozugbo.

Ntuziaka emetụtara¶

• Peritonsillar abscess, Ludwig's angina, na nrịanrịa dị omimi n'olu
• Epiglottitis, croup, stridor, na nnukwu mgbochi nke elu ikuku
• Mberede eze, eze kụpụrụ agbapụ, na mgbu eze
• Orbital cellulitis, cavernous sinus thrombosis, na ihe ize ndụ ihu-triangle ọrịa.
• Sepsis na nhụta ujo septic yana nleba anya mberede