Matenda a Dental Abscess Airway Emergency, Angina a Ludwig, ndi Kutupa kwa Submandibular¶

Ludwig's angina ndi matenda owopsa a polymicrobial cellulitis pansi pakamwa komanso m'khosi, zomwe zimayamba pafupifupi 80 mpaka 90 peresenti ya matenda am'no osachiritsidwa a dzino la m'munsi (makamaka lachiwiri kapena lachitatu la molar). Chifukwa nsagwada ya m'munsi ya mafupa (mandible) imalepheretsa kutupa kuti isapitirire kunja kapena pansi, edema yomanga mofulumira imakankhira pansi pakamwa ndi pansi pa lilime ** molunjika pamwamba pa denga la pakamwa ndi kumbuyo ku mmero **, kuwopseza kupuma kwathunthu kwa makina mkati mwa maola. Ngati munthu amene ali ndi dzino likundiwawa kapena kuchotsa mano ayamba kutupa kwambiri mbali zonse ziwiri pansi pa chibwano ("khosi la ng'ombe"), lilime lokwezeka, kudontha, mawu osamveka a "mbatata yotentha", kapena kulephera kutsegula pakamwa (trismus), imbani foni m'dera lanu. manambala angozi nthawi yomweyo. Pamene mukuyembekezera azachipatala, onaninso malangizo okhudzana ndi kayendedwe ka ndege peritonsillar abscess ndi matenda akuya khosi, epiglottitis, croup, ndi upper airway stridor,ndi matenda adzidzidzi ndi mano ong'ambika.

Chifukwa mphamvu yokoka ndiyo mphamvu yokhayo yomwe imathandiza wodwalayo kugwira lilime lake lotupa kutsogolo pang'ono kumbuyo kwa mmero wawo, udindo wanu umodzi wofunikira kwambiri wothandizira choyamba ndi ** kusunga wodwalayo kukhala pansi ndi kutsamira patsogolo pang'ono **, osawakakamiza kuti agone kumbuyo kwawo pazifukwa zilizonse.

Chitani izi tsopano¶

1. Imbani foni nambala yanu yadzidzidzi nthawi yomweyo ndikulengeza za ngozi ya Airway Emergency yomwe ili pachiwopsezo chachikulu. Imbani 911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom, 000 ku Australia, kapena onani mndandanda wathu wa manambala angozi. Nenani momveka bwino kuti: *"Omwe akuganiziridwa kuti Ludwig akudwala angina / njira yapaulendo wapanjira ya mano: kutupa kwapawiri pansi pa nsagwada, lilime lokwezeka, kukodzera, mawu osamveka bwino, komanso chiopsezo cha kutsekeka kwa mpweya mwadzidzidzi."
2. Sungani wodwalayo kukhala bawuti mowongoka ndi kutsamira patsogolo pang'ono (mawonekedwe a "Tripod" kapena "Kununkhiza") nthawi zonse. Osagonekedwa wodwala ndi angina ya Ludwig kapena kutupa kwa mano a submandibular kwambiri pamsana pake pabedi, sofa, ma ambulansi, kapena tebulo lachipatala la CT scanner. Kugona mopanda phokoso kumapangitsa kuti lilime lolemera, lotupa komanso minyewa yotupa ya pharyngeal igwe molunjika kumbuyo ku khoma lakumbuyo kwa pharyngeal ndi mphamvu yokoka, kutseka njira yodutsa mpweya mumasekondi pang'ono ndikuyambitsa kumangidwa kwa mtima wa hypoxic nthawi yomweyo.
3. Lolani kuti wodwalayo alavulire drool mu kapu kapena chopukutira, ndipo MUSAMAike zala, zopondereza lilime, kapena spoons mkamwa. Chifukwa pansi pakamwa patupa molimba ngati nkhuni ndipo minofu ya nsagwada imakhala yotsekeka (trismus), kuyesa kutulutsa mano otsegula kapena kukanikiza lilime pansi ndi supuni, kumayambitsa kutulutsa magazi kwambiri. kutsekereza.
4. Limbikitsani kwambiri NPO (osagwiritsa ntchito pakamwa: palibe madzi, palibe mankhwala ochepetsa ululu, palibe mapiritsi opha maantibayotiki). Choyamba, kumeza kumatsekeka ndi lilime lokwezeka, kotero kuti madzi kapena mapiritsi aliwonse amathira m'mphuno molunjika (trachea) ndikuyambitsa kutsekeka. Chachiwiri, wodwalayo adzafunika mwamsanga ** kudzuka kwa fiberoptic intubation ** kapena ** kudzuka opaleshoni tracheostomy / cricothyrotomy ** m'chipinda cha opaleshoni atangofika kuchipatala.
5. Pezani wodwalayo kukhala chete, kuziziritsa, komanso kusuntha, ndikumasulani makola a malaya, mataye, ndi mikanda. Nkhawa, kulira, kapena zolimbitsa thupi zimafulumizitsa kupuma kwachangu, kutembenuza mpweya wofewa (laminar) kupyola pammero wopapatiza kukhala mpweya wovuta womwe umayamwa makoma otupa a Venturi kutseka (**).
6. klzzwxh:0039 Kupaka kutentha kwaunja kumatenda akunkhope kapena pakhosi kumawonjezera kwambiri vasodilation ndi edema ya m'dera, kutsekereza njira ya mpweya ndikupangitsa kuti matendawa alowe pakhungu kapena pansi pakhosi mpaka pachifuwa (kutsika necrotizing mediastinitis).

Mtengo wosankha: Dzino likundiwawa, kutupa kumaso, ndi Ludwig's angina airway triage¶

flowchart TD
    Start["Kupweteka kwa Dzino Lapansi, Mola Wosweka, Kapena Kuzula Mano Posachedwapa Ndi Kumaso, Chibwano, Kapena Kutupa Kunsi kwa Chin"] --> AirwayScreen{"Khwerero 1: Yang'anani Mbendera Zofiira za Airway & Ludwig Angina: Kutupa pansi mbali ZOWIRI za chibwano, lilime kukankhidwira mmwamba, kudontha, mawu a mbatata yotentha, trismus, kapena kaimidwe ka katatu?"}

    AirwayScreen -->|"INDE ku Red Flag ILIYONSE"| LudwigEmergency["ZONSE ZONSE ZOWONJEZERA MOYO WA AIRWAY (LUDWIG ANGINA): Imbani Ntchito Zadzidzidzi (911 / 112 / 999) Pompo"]

    AirwayScreen -->|"AYI: Kutupa kumangokhala chingamu kapena tsaya limodzi, kumeza kwabwinobwino komanso mawu, kutsegula pakamwa kwathunthu"| LocalDental["Ziphuphu Zam'mano Zam'deralo Zosavuta: Konzani kuwunika kwa mano tsiku lomwelo; tsukani pang'onopang'ono ndi madzi amchere otentha, OSATI perekani kutentha pa tsaya, ndikupita ku ED ngati kutupa kwa chibwano kapena trismus kuyambika."]

    LudwigEmergency --> UprightRule["1. KUKHALA KWAKHALIDWE KWAMBIRI (Malo Katatu / Kununkhiza): MUSAMAgoneke wodwala pansi pa machira kapena tebulo la CT; kulola kuti madzi atuluke mu kapu kapena thaulo"]

    UprightRule --> HandsOff["2. TETEZANI NJIRA YA NDEGE: NPO Wokhwima (wopanda madzi kapena mapiritsi akamwa), MUSAMAike zinthu zofooketsa lilime kapena kutsegula nsagwada, palibe zoyatsira zakunja, ndi kumasula kolala."]

    HandsOff --> HospitalOR["3. Hospital Double-Setup Airway & Surgical Management: Galamukani Flexible Fiberoptic Nasotracheal Intubation atakhala mowongoka ndi Simultaneous Prep for Awake Tracheostomy, IV Dexamethasone, Broad-Spectrum IV Antibiotics, ndi Decompression Decompression"]

Anatomy ndi pathophysiology: lamulo la "Mylohyoid Line" ndi chifukwa chake ma molars otsika amayambitsa angina ya Ludwig.¶

Choyamba chinafotokozedwa mu 1836 ndi dokotala wa ku Germany Wilhelm Friedrich von Ludwig (yemwe adatcha dzina lakuti * angina * kuchokera ku Latin * angere * , kutanthauza "kupotoza kapena kutsamwitsa," osati kupweteka kwa mtima), ** angina ya Ludwig ** imatanthauzidwa mwachibadwa ndi lamulo linalake: ndi kufalikira mofulumira, bolodi-ngati, gangrenous-sellous cell cell submandibular triangle bilaterally**:

1. ** The Sublingual Space ** (pansi pakamwa, mwachindunji * pamwamba pa * mylohyoid minofu).
2. ** The Submylohyoid / Submaxillary Space ** (mwachindunji * pansipa * minofu ya mylohyoid kumanzere ndi kumanja).
3. The Submental Space (pansi pakatikati pa chibwano).

Chifukwa chachiwiri ndi chachitatu m'munsi molars (mano anzeru) ndi olakwa¶

Nchifukwa chiyani chiphuphu kapena chiphuphu cha nono lakutsogolo kapena premolar nthawi zambiri chimangopangitsa kuti chingamu chapakati chithupsa mkamwa, pomwe matenda otsika achiwiri kapena achitatu molar (dzino lanzeru) amachititsa kuti Ludwig azidwala angina? Yankho liri mumnofu umodzi wotchedwa mylohyoid muscle, womwe umayenda ngati hammock mkati mwa nsagwada zapansi kuti apange minofu yapakamwa:

• **Mano kutsogolo kwa molar yachiwiri (incisors, canines, premolars, ndipo nthawi zambiri molar yoyamba): ** Nsonga (ma apices) a mizu ya mano awa akutsogolo amakhala ** pamwamba (apamwamba kuposa) ** cholumikizira cholumikizira cha mylohyoid minofu yomwe ili mkati mwa nsagwada. Chiphuphu chikapangika kunsonga kwa manowa, mafinya amabowoleza fupa pamwamba pa gulaye ndi kukhala mkamwa (malo ang'onoang'ono kapena a buccal).
• M'munsi wachiwiri ndi wachitatu molars (70% mpaka 90% ya matenda Ludwig angina): Mizu yakuya ya m'munsi yachiwiri ndi yachitatu molars amafika pansi pansi (otsika ku) mylohyoid minofu attachment mzere, kumene mkati cortical fupa la mandible ndi pepala-woonda. Pamene chiphuphu cha muzu cham'munsi chachiwiri kapena chachitatu cha molar chikudutsa fupa lamkati lamkati, mabakiteriya ndi poizoni amataya mwachindunji ** pansi pa minofu ya mylohyoid ** mu ** submandibular space **.
• Nsapato za akavalo kuzungulira kumbuyo kwa minofu: Chifukwa m'mphepete kumbuyo kwa minofu ya mylohyoid imapachikidwa momasuka ngati chinsalu chopanda chotchinga cholekanitsa danga la submandibular pansi pa danga laling'ono laling'ono pamwambapa, matendawa amazungulira kumalire akumbuyo kwa minofu ya mylohyoid kupita ku ** danga laling'ono ** ndikudutsa m'mphepete mwa tsinde lapakati * ndikudutsa pakati kukamwa m’chinthu chooneka ngati nsapato ya akavalo.

[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

Chifukwa chiyani Ludwig's angina ndi "woody cellulitis" osati thumba la mafinya msanga¶

Mosiyana ndi chithupsa cham'kamwa cham'kamwa chomwe chimapanga thumba lofewa, lonyezimira la mafinya kwa masiku angapo, angina yoyambirira ya Ludwig ndi kufalikira mwachangu kwamtundu wa cellulitis motsogozedwa ndi kusakanikirana kwapakamwa streptococci (Streptococcus viridans, Streptococcus viriral oral* ndi Streptococcus angina) anaerobes (Prevotella, Porphyromonas, Fusobacterium, Peptostreptococcus).

Mabakiteriyawa amapanga ma enzymes owononga minofu, endotoxin, ndi gasi omwe amalowa mu ndege zolumikizirana mwachangu kuposa momwe thupi lingawatsekere mu chiphuphu. Chotsatira chake, mukamakhudza pansi pa chibwano cha wodwalayo ndi khosi lapamwamba, sizimamveka ** osati ** kumva zofewa kapena zowonongeka; imamveka yolimba, yokhazikika, komanso yosasunthika ngati matabwa ("olimba kapena matabwa"), nthawi zina ndi mpweya wophulika (subcutaneous crepitus) pansi pa khungu.

Kuzindikira zizindikiro 6 zachipatala za Ludwig angina¶

Wodwala aliyense amene ali ndi ululu wam'munsi, kupweteka kwa m'munsi, pericoronitis (chingamu chogwidwa ndi kachilombo koyambitsa dzino), kuchotsa dzino laposachedwapa, kapena kuthyoka kwa nsagwada, yemwe ali ndi zizindikiro zotsatirazi, ali pachiwopsezo chotaya mpweya wake:

Momwe mungasiyanitsire abscess m'mano, Ludwig angina, abscess peritonsillar, ndi abscess retropharyngeal¶

Matenda a mano ndi khosi lakuya amagawana zizindikiro monga zilonda zapakhosi, kutupa kwa khosi, ndi kutentha thupi, koma aliyense amakhala ndi malo ake enieni ndipo amakhala ndi zoopsa zina:

Kutsika kufalikira mu chifuwa: "Danger Space" ndi Kutsika Necrotizing Mediastinitis¶

Ngati angina wa Ludwig sanafooke mwachangu ndikuthandizidwa ndi mankhwala ophatikizika kwambiri m'mitsempha, wakupha wachiwiri pambuyo pa kupuma kwa mpweya ndi kutsika pansi kufalikira pachifuwa.

Mkati mwa khosi, chiberekero chakuya cha chiberekero chimakonzedwa kukhala machubu olunjika. The retropharyngeal space ndi dzina loyenerera "Alar / Danger Space" (Space 4) limayenda ngati shaft lotseguka, lopanda mikwingwirima la elevator molunjika kuchokera pansi pa chigaza, kuseri kwa mmero ndi kum'mero, molunjika pansi kudzera pachifuwa kulowa posterior mediastinum (mtima, chotengera chachikulu cha pachifuwa ndi trache

Mphamvu yokoka, kuphatikizapo mpweya woipa wa vacuum womwe umapangidwa mkati mwa chifuwa nthawi zonse pamene wodwalayo akukoka, amayamwa mafinya a polymicrobial ndi necrotizing mabakiteriya pansi pa khosi mpaka pachifuwa, kuchititsa ** Descending Necrotizing Mediastinitis (DNM) **, yomwe imakhala ndi ** 20 ku 40 peresenti ya imfa ** ngakhale ndi chisamaliro chamakono chamakono.

Mbendera zofiira zomwe matenda a mano kapena khosi akutsikira mu chifuwa¶

• Kufiira, kutentha, ndi kutupa kwaukali kutsika pansi kutsogolo kwa khosi kulowera ku mphako ya suprasternal (bowo lomwe lili pakati pa makola) mpaka ku khoma la pachifuwa chapamwamba.
• Kupweteka kwatsopano kwa retrosternal (kumbuyo-kwa-breastbone) kapena kupweteka kwa pleuritic pakupuma.
• ** Kuphulika kwa mpweya wotsekemera pansi pa khungu la m'munsi mwa khosi kapena khoma la pachifuwa (subcutaneous crepitus) ** kapena phokoso lopweteka lomwe limamveka pa kugunda kwa mtima (** chizindikiro cha Hamman **).
• Kutentha thupi kwambiri, kunjenjemera, kugunda kwa mtima kupitilira 120 bpm, kusokonezeka, komanso kuthamanga kwa magazi (septic shock).

Prehospital ndi Thandizo loyamba la kunyumba: zoyenera kuchita (ndipo osachita) podikirira EMS¶

1. **Pitirizani kukhala ndi kaimidwe ka katatu popanda kupatula: ** Lolani wodwalayo akhale pamphepete mwa mpando kapena ma ambulansi atatsamira patsogolo 15 mpaka madigiri a 30 ndi mutu wawo ali "pamalo owombera" (khosi lopindika pang'ono kutsogolo, mutu wotambasulidwa pang'ono pakhosi). Ngati opereka chithandizo anyamula wodwalayo, machira am'mbuyo ayenera kugwedezeka mpaka 75 mpaka 90 madigiri.
2. Perekani beseni kapena chopukutira ndikuyamwa mofatsa ngati mwaphunzitsidwa: Musamamuuze wodwalayo kuti apendeketse mutu wake kumbuyo kuti ameze malovu. Ngati EMS ifika ndi catheter yolimba ya Yankauer, opereka chithandizo amatha kuyamwa malovu pang'onopang'ono kuchokera ku milomo yakutsogolo popanda kutulutsa kumbuyo kwa lilime kapena pharynx (zomwe zimayambitsa laryngospasm).
3. Perekani mpweya wofewa pang'ono (kuwomberedwa ngati chigoba sichiloledwa): Wodwala wamantha amene akuvutika kuti apeze mpweya nthawi zambiri amachita mantha ngati atamanga chigoba cholimba cha okosijeni cha pulasitiki kunkhope, kumverera ngati akulephera kupuma. Kugwira mpweya wonyezimira wochuluka pafupi ndi kamwa ndi mphuno (kuwombeza) kumathandizira kuti mpweya wa okosijeni ukhale wabwino m'magazi musanalowe m'chipatala popanda kuchita mantha.
4. Chifukwa chiyani simuyenera kumwa maantibayotiki akunyumba otsala kuti muchedwe kupita kuchipatala: Odwala omwe akumva kupweteka kwambiri kwa dzino nthawi zambiri amameza makapisozi awiri otsala a amoxicillin mu kabati ya mankhwala ndikudikirira usiku wonse kuti awone ngati kutupa kwa pansi pa chibwano kutsika. Mapiritsi a pakamwa sangathe kulowa m'matenda othamanga kwambiri, a polymicrobial submandibular mofulumira mokwanira, ndipo kuyembekezera maola 8 usiku pabedi ndi zenera lenileni lomwe kutsekedwa kwakufa kwa mpweya kumachitika.

Kuwongolera njira zakuchipatala ("Double Setup") ndikuchepetsa kwapang'onopang'ono¶

Asanapangidwe penicillin ndi njira zamakono za airway, Ludwig angina anapha kuposa 50 peresenti ya odwala (makamaka ndi kupuma). Ndi chithandizo cham'chipatala mwamsanga, maantibayotiki olowetsera m'mitsempha, ndi kuwonongeka kwa opaleshoni, imfa imatsikira ku ** zosakwana 5 mpaka 8 peresenti **.

1. Chifukwa chiyani mulingo wa "Rapid Sequence Intubation (RSI)" ndi woletsedwa mu angina ya Ludwig?¶

M'zipatala zambiri zadzidzidzi, madokotala amagoneka wodwala ndi mankhwala oletsa magazi m'mitsempha ndikupumitsa minofu yake ndi neuromuscular blocker (succinylcholine kapena rocuronium) asanalowetse chubu chopumira m'kamwa (** Rapid Sequence Intubation **).

Mu Ludwig's angina , kupuwala minofu ya wodwalayo musanayambe kupuma chubu bwinobwino mu trachea ndi tsoka lodziwika bwino ("Can't Intubate, Can't Ventilate"): - Nthawi yomwe mankhwala opuwala ayamba kugwira ntchito, wodwalayo amataya kamvekedwe ka minofu akugwira lilime lake lotupa kutsogolo, ndipo mpweya umagwa 100 peresenti kutsekedwa (kotero thumba-valve-mask silingathe kukankhira mpweya). - Panthawi imodzimodziyo, chifukwa cha ** trismus ** (yotsekeka nsagwada) (nsagwada zokhoma) ndi miyala yokwera pamwamba pakamwa, dokotala ** sangatsegule pakamwa kapena kupondereza lilime pansi ** ndi laryngoscope blade kuti awone zingwe za mawu, ndipo epiglottis ndi kutupa ndi kupotoza.

2. The Gold-Standard Hospital Protocol: Awake Fiberoptic Intubation ndi "Double Setup"¶

M'malo mwake, dokotala wadzidzidzi, dokotala wa opaleshoni, ndi ENT / oral-maxillofacial surgeon amatengera wodwalayo (akukhalabe mowongoka) molunjika kuchipinda chopangira opaleshoni kapena malo otsitsirako Galamukani "Double Setup":

1. Njira yapampweya yam'mwamba + IV Dexamethasone: Pamene wodwala amakhalabe maso ndi kupuma yekha atakhala mowongoka, gululo limatulutsa lidocaine mu mphuno ndi mmero kuti dzanzi za airway reflexes, ndipo amapatsa mtsempha wa dexamethasone (8 mpaka 10 mg IV) ndi **epidemic enephrine enephrine.
2. Sinthani A (Galamukani Flexible Fiberoptic Nasotracheal Intubation): Dokotala wogoneketsa magazi amalumikiza kamera yopyapyala, yosinthika ya fiberoptic yomwe idadzaza kale ndi chubu chopumira kudzera m'mphuno** yazinziri** (kudutsa mano okhoma ndi lilime lotupa), amayendetsa mkamwa mozungulira mphuno. trachea, ndikutsitsa chubu chopumira pamwamba pa kamera musanapereke mankhwala aliwonse oziziritsa.
3. Kukhazikitsa B (Kugalamuka Nthawi Imodzi Yokonzekera Njira Yoyendetsa Ndege): Nthawi yomweyo, dokotala wa opaleshoni wa ENT kapena wovulalayo amaima pambali pa bedi ndipo kutsogolo kwa khosi la wodwalayo kuli kale ndi mankhwala ophera tizilombo toyambitsa matenda, opakidwa dzanzi ndi lidocaine wa m'deralo, ndipo amalemba chizindikiro ndi cholembera, atanyamula scalpel ndi tracheostomy chubu. Ngati kamera ya fiberoptic singadutse pakhosi lotupa kapena ngati laryngospasm ichitika, dotoloyo amamupangira opareshoni yogalamuka kapena cricothyrotomy mkati mwa masekondi 60.
4. Chifukwa chiyani kuyendetsa ndege kumabwera CT scan isanakwane: Wodwala akudontha, stridor, kapena kulephera kugona kwa masekondi 60 osatumizidwa ku dipatimenti ya radiology kuti akamupime khosi mpaka chubu chake chopumira chikhale chokhazikika.

3. Mtsempha wopha maantibayotiki ndi opareshoni incision & ngalande¶

chubu chopumira chikatetezedwa: - Broad-Spectrum Intravenous Antibiotics: Amaperekedwa nthawi yomweyo kuti aphimbe aerobic streptococci, beta-lactamase-producing oral anaerobes, ndi MRSA (odwala omwe ali pachiwopsezo chachikulu): nthawi zambiri IV Ampicillin-Sulbactam (Unasyn) kapena IV Ceftriaxone kapena High-Dosel Piperacillin-Tazobactam / Clindamycin), kuphatikiza IV Vancomycin ngati chiopsezo cha MRSA chilipo. - ** Kuwonongeka kwa Opaleshoni ndi Kuchotsa Dzino: ** Ngati kujambula kwa CT kumasonyeza kusonkhanitsa kwamadzimadzi, gasi, kapena kulephera kusintha mofulumira, opaleshoni ya oral-maxillofacial kapena ENT imapanga mawotchi akunja pansi pa chibwano ndi nsagwada (** submandibular ndi submental incisions ), kutsegula momveka bwino malo a fascial, kutulutsa minofu ndi kutulutsa minofu kudzera mu mylo. mano a m'munsi amene ali ndi kachilomboka amene anayambitsa vutoli.

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

• United States ndi Canada: Imbani 911. Pemphani zoyendera zachangu kupita ku dipatimenti yodzidzimutsa kuchipatala yomwe ili ndi maola 24 oletsa kugona komanso chithandizo cha ENT / Oral ndi Maxillofacial Surgery (OMFS). Osapita ku ofesi yamano kapena kulowera kuchipatala ngati mukudontha, kusintha mawu, trismus, kapena kutupa pansi pachibwano.
• United Kingdom: Imbani 999 kuti mupeze ambulansi ya Gulu ½ kapena pitani molunjika kuchipatala chachikulu Dipatimenti Yowopsa (A&E) yokhala ndi opaleshoni ya Maxillofacial ndi ENT pamalopo. Musadikire kuti mukumane ndi dokotala wa NHS 111 mwachangu ngati pali zizindikiro zofiira.
• European Union: Imbani 112 m'mayiko onse omwe ali m'bungwe la EU ndikupereka zadzidzidzi zadzidzidzi (angine de Ludwig mu French, Angina Ludovici / Mundbodenphlegmone mu German, angina de Ludwig mu Spanish).
• Australia ndi New Zealand: Imbani 000 ku Australia kapena 111 ku New Zealand.
• India ndi Asia-Pacific: Imbani 112 (kapena 108 ku India), 995 ku Singapore, 119 ku Japan ndi South Korea, kapena 999 ku Malaysia ndi Hong Kong. Pitilizani ku chipatala chapamwamba chomwe chili ndi njira yadzidzidzi ya maola 24 komanso magulu ochita opaleshoni a maxillofacial.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi kupweteka kwa dzino lopanda mankhwala kungasinthe bwanji kukhala moyo wangozi wapaulendo wapaulendo?¶

Mizu ya m'munsi wachiwiri ndi wachitatu molars (mano anzeru) amapita pansi mkati mwa nsagwada pansi pa mzere wa mylohyoid minofu, yomwe imapanga pansi pakamwa. Pamene osasamalidwa patsekeke kapena abscess mu mmodzi wa awa m'munsi molars kukokoloka mwa woonda mkati khoma la nsagwada, aukali m`kamwa mabakiteriya kutsanulira mwachindunji mu submandibular danga pansi chibwano ndi kukulunga mozungulira mu sublingual danga pansi pa lilime mbali zonse. Chifukwa nsagwada yolimba komanso khosi lakuya la khosi limalepheretsa kutupa kuti zisatukuke kunja, kutupa kumakankhira pansi pakamwa ndi lilime molunjika mmwamba ndi kumbuyo mpaka kutsekeka kukhosi.

Chifukwa chiyani munthu yemwe ali ndi angina wa Ludwig sayenera kugona chagada?¶

Mu angina wa Ludwig, lilime ndi pansi pakamwa zimakhala zotupa kuwirikiza kawiri kapena katatu makulidwe ake achibadwa ndipo zimakankhira denga la kamwa. Pamene munthuyo wakhala mowongoka ndi kutsamira patsogolo pang’ono, mphamvu yokoka imathandiza kuti tsinde lolemera la lilime likokedwe patsogolo pang’ono kuchokera ku khoma lakumbuyo la mmero, n’kusiya kang’ono kakang’ono kuti mpweya udutse. Munthu akagona chagada chagada, mphamvu yokoka imakokera lilime lotupa kumbuyo kwa hypopharynx, zomwe zimapangitsa kuti nthawi yomweyo, chete, kutsekeka kwathunthu kwa mpweya komanso kumangidwa kwa mtima mkati mwa mphindi zochepa.

Kodi ndi zizindikiro zoyamba ziti zochenjeza kuti matenda a mano akufalikira mumipata yakuya ya khosi?¶

Zizindikiro zazikulu zochenjeza kuti dzino losavuta ladutsa mungozi yakuya ya khosi ndi kutupa komwe kumafalikira pansi pa malire a nsagwada kumbali zonse ziwiri pansi pa chibwano (kutupa kwamatabwa a submandibular), trismus (zovuta kutsegula pakamwa mokulirapo kuposa zala ziwiri), kutupa kapena kukwera kwa minofu yofewa pansi pa lilime, kupweteka kapena kumeza. "mbatata yotentha" mawu. Chilichonse mwa zizindikirozi chimafuna ulendo wachangu wopita kuchipatala chadzidzidzi, osati kuchipatala chachizolowezi cha mano.

Chifukwa chiyani sindiyenera kuyika chotenthetsera kapena compress yotentha kunja kwa nsagwada yotupa kapena khosi kuchokera pachiphuphu cha dzino?¶

Kupaka chotenthetsera chotenthetsera kapena botolo lamadzi otentha pakhungu lakunja kwa tsaya, nsagwada, kapena khosi kumakulitsa mitsempha yamagazi ndikutulutsa madzi owonjezera otupa m'malo akuya, omwe amafulumizitsa kutupa kwa mpweya ndikulimbikitsa kuti kachilomboka kawonekere kunja kudzera pakhungu la nkhope (kupanga thirakiti) kapena kufalikira mkati mwa khosi. Sungani kunja kwa khosi kozizira kapena kutentha kwapakati.

N'chifukwa chiyani kuli koopsa kwa madokotala kuti agone wodwala Ludwig wa angina asanamuike chubu chopumira?¶

Kupereka mankhwala ophera mtsempha ndi mankhwala opumitsa minofu musanayambe kupeza chubu chopumira kumatsitsimula minofu ya mmero ndi lilime yomwe wodwala wogalamuka ankagwiritsa ntchito kuti atsegule njira yawo ya mpweya, zomwe zimapangitsa kuti mpweya uwonongeke kotero kuti chigoba sichikhoza kukankhira okosijeni mkati. Chifukwa chake, akatswiri ogonetsa odwala amalola wodwalayo kukhala mowongoka ndi maso, akumanjenjemera mphuno ndi lidocaine spray kuti atsogolere kamera yosinthika ya fiberoptic kudzera m'mphuno kupita kumphepo yamphepo pomwe dotolo wayima wokonzeka pakhosi.

Kodi angina a Ludwig angachitike mwa achinyamata athanzi?¶

Inde. Ngakhale matenda a shuga, kuponderezedwa kwa chitetezo chamthupi, kusakhala ndi ukhondo wamano, komanso kusowa kwa chisamaliro cha mano kumawonjezera chiwopsezo, opitilira theka la milandu yonse ya Ludwig angina imakhudza achikulire athanzi komanso azaka zapakati pazaka zapakati pa 20 ndi 50, zomwe nthawi zambiri zimayambitsidwa ndi dzino lomwe lili ndi kachilombo kapena lotsika kwambiri (molar lachitatu) kapena kutulutsa kwapang'onopang'ono kwaposachedwa.

Magwero ndi malangizo ovomerezeka¶

• Difficult Airway Society (DAS, United Kingdom) & Royal College of Anesthetists (NAP4): Malangizo a Management of the Difficult and Obstructed Head and Neck Airway (kudzuka kwa fiberoptic nasotracheal intubation, kupewa poyimiritsa chapamwamba, ndi kukhazikitsa kawiri opaleshoni tracheostomy).
• American Society of Anesthesiologists (ASA, United States): 2022 ASA Practice Guidelines for Management of the Difficult Airway (njira zodzidzimutsa zokhala ndi matenda a khosi lakuya ndi trismus).
• Infectious Diseases Society of America (IDSA, United States): Clinical Practice Guidelines for Odontogenic and Deep Neck Space Infections (polymicrobial coverage for Streptococcus anginosus/viridans and oral anaerobes, plus MRSA coverage).
• American Association of Oral and Maxillofacial Surgeons (AAOMS) & British Association of Oral and Maxillofacial Surgeons (BAOMS): Emergency Triage and Surgical Decompression of Submandibular, Sublingual, and Submental Space Infections (Ludwig's Angina).
• National Institute for Health and Care Excellence (NICE) & NHS (United Kingdom): Thumba Lamano ndi Deep Neck Space Infection Red Flags for Immediate Emergency Department Referral.

Maupangiri ogwirizana¶

• Kutupa kwa peritonsillar, angina ya Ludwig, ndi matenda a m'khosi
• Epiglottitis, croup, stridor, ndi kutsekeka kwapamwamba kwa mpweya
• Matenda adzidzidzi a mano, kutukusira kwa dzino lotuluka, ndi kupweteka kwa dzino
• Orbital cellulitis, cavernous sinus thrombosis, ndi matenda owopsa pamakona atatu
• Sepsis ndi kuzindikira kugwedezeka kwa septic ndikuyesa mwadzidzidzi