Chotupa cha Pott's Puffy Tumor (Frontal Bone Osteomyelitis ndi Subperiosteal Abscess Pambuyo pa Frontal Sinusitis): Kutupa Pamphumi Pamaso ndi Kuyesa kwa Intracranial Abscess¶

Ngakhale kuti dzina lake lonyenga la mbiri yakale, Pott's puffy chotupa si*** si khansa kapena neoplasm**: ndi njira yopatsirana yoopsa yomwe imaika moyo pachiwopsezo chadzidzidzi yomwe siinachiritsidwe kapena kuthandizidwa pang'ono Bakiteriya wakutsogolo sinusitis (kapena zoopsa zazing'ono zapamphumi) zimakokera kutsogolo kupita ku fupa lakunja. wa chigaza (periosteum / pericranium) kupanga ** thumba la mafinya lofunda, lanthete, lanthambi, loboola (subperiosteal abscess) molunjika pakati kapena mbali ya mphumi**. Choyamba chofotokozedwa ndi dokotala wa opaleshoni wa ku England Sir Percivall Pott mu 1760, matendawa ndi mbendera yofiira kwambiri chifukwa cha * khoma lakumbuyo.posterior table) ya sinus yakutsogolo ndi yocheperapo theka lakuda ngati khoma lakutsogolo ** ndipo imagawana maukonde a valveless diploic mitsempha (veins of Breschet) zomwe zimakhetsa chammbuyo molunjika mu mitsempha yam'mitsempha yam'mbali ndi mbali zakutsogolo zaubongo. Chifukwa chake, pakati pa 60 and 85 percent za ana ndi achinyamata (ndi 30 to 40 percent achikulire) omwe amabwera ndi chotupa chotupa cha Pott kunja kwa mphumi zawo ALREADY ali ndi vuto lofanana, lomwe nthawi zambiri limangokhala chete (Intracranial Complication)epidural abscess, subdural empyema, frontal lobe brain abscess, or superior sagittal sinus thrombosis) mkati mwa chigaza chawo. Ngati mwana, wachinyamata, kapena wamkulu yemwe ali ndi matenda am'mphuno kapena posachedwapa kapena kumutu kwamutu ayamba ** kutupa komweko, kofewa, kosalala, kapena kusinthasintha kwapamphumi pamwamba pa nsidze, kupweteka kwa mutu, kutentha thupi, kutupa m'zikope, kusanza, kapena kusintha kosawoneka bwino / kuledzera **, imbani foni m'dera lanu. manambala angozi (911 ku United States ndi Canada, 112 ku European Union, 999 ku United Kingdom, kapena 000 ku Australia) kapena pitani mwachangu ku dipatimenti yazadzidzi zachipatala. Pokonzekera zoyendera, yang'anani malangizo athu apa orbital cellulitis ndi cavernous sinus thrombosis, meningitis ndi meningococcal septicemia triage,ndi pachimake coalescent mastoiditis ndi chiopsezo chotupa mu ubongo.

Nchifukwa chiyani achinyamata ndi achinyamata azaka zapakati pa 10 mpaka 18 (makamaka anyamata achichepere) ali gulu #1 lomwe lili pachiwopsezo chachikulu cha chotupa chotupa cha Pott ndi subdural empyema? Chifukwa machimo akutsogolo (omwe amakhala kulibe pobadwa ndipo amangoyamba kupyola pa zaka 6) amakula mwachangu panthawi yakutha msinkhu, kutsagana ndi nsonga yam'mitsempha komanso yotseguka, yopanda ma valve diploic mitsempha ya Breschet yodutsa m'mafupa a spongy a fupa lakutsogolo lomwe likukulirakulira. Chimfine chosavuta cha virus chomwe chimasandulika kukhala bakiteriya wakutsogolo kwa sinusitis wazaka 14 kumatha kumera pamphumi komanso malo ozungulira mkati mwa masiku, ngakhale wachinyamatayo atapatsidwa mankhwala amoxicillin kapena azithromycin kuchipatala chofulumira.

Chitani izi tsopano¶

1. Yang'anani pamphumi pa mbiri yake ndipo gwirani pang'onopang'ono ndi chala chimodzi kuti muwone "Kutupa Kwa Pamphumi, Kuphulika, Kapena Kusinthasintha." Imani kumbali ya wodwalayo ndikuwunikira bwino ndipo yang'anani mozungulira mphumi yawo kuyambira nsidze mpaka kutsitsi:
2. Mosiyana ndi hematoma yolimba ya "dzira la tsekwe" itangogunda pamutu, Chotupa chotupa cha Pott chimayamba kupitilira masiku angapo mpaka milungu ingapo ndi "kuzizira kwa sinus" kapena mutu (kapena milungu 1 mpaka 3 pambuyo pa kugunda pang'ono pamphumi), kumawoneka ngati yosiyana bwino, yotentha, yofewa kwambiri, yothira kapena ngati buluni yamadzi.fluctuant) kutupa pakati kapena dera la nsidze pamphumi.
3. Nthawi zambiri, edema yokoka imayenda pansi kuchokera pamphumi kupita m'chikope chimodzi kapena zonse ** zapamwamba (periorbital edema)**, zomwe zimachititsa kuti madokotala azindikire molakwika kuti ndi matenda a maso kapena pre-septal eyelid cellulitis pokhapokha atakhudza fupa lamphumi pamwamba pa nsonga.
4. Imbani 911 / 112 / 999 nthawi yomweyo ngati kutupa pamphumi kapena kupweteka kwakumbuyo kwa sinus kumatsagana ndi Mbendera YOfiira YA Intracranial kapena Orbital:
5. Kusintha kobisika kwamakhalidwe, malingaliro, kapena umunthu ("Silent Frontal Lobe Sign"): Kusakhudzidwa kwatsopano, kukwiya kopanda khalidwe, chisokonezo, kuchedwa kuyankha mafunso (abulia), kapena kugona.
6. Zizindikiro za Kupanikizika Kwambiri Kwambiri (ICP) kapena Meningismus: Kupweteka kwa mutu komwe kumadzutsa wodwala kutulo, nseru/kusanza, kumva kuwala kowala (photophobia), kapena kuuma khosi.
7. Focal Neurological Deficits or Seizures: Kugwedezeka kulikonse kwatsopano kapena kukomoka kokhazikika (occurs in up to 30% of subdural empyemas), kufooka kumbali imodzi ya nkhope/mkono/mwendo (hemiparesis), kapena kulankhula mosatekeseka.
8. Kukula kwa Orbital: Diso lotupa (proptosis), kutsika ndi kunja kwa diso (globe dystopia), kuwona kawiri, kapena kuyenda kowawa / koletsedwa (subperiosteal orbital roof abscess).
9. Pitani ku dipatimenti yayikulu ya Zadzidzidzi Zachipatala yokhala ndi maola 24 a Neurosurgery ndi Otolaryngology (ENT) chithandizo, OSATI ku chipatala chachangu kapena chipatala chamankhwala. Wodwala aliyense yemwe akuganiziridwa kuti chotupa cha Pott's puffy amafunikira matenda a ubongo/mkuno wosiyana kwambiri ndi ubongo wa MRI, mankhwala olowera m'mitsempha yapakati-amanjenje, ndi *mankhwala ophatikizika ophatikizika ndi neurosupic.
10. OSAYESETSA KUPALITSA, kufinya, kupaka singano, kapena kutupira pachipumi kunyumba kapena kuchipatala chakunja. Chiphuphu cha pamphumi pamakhala chikachulukidwe kudzera pabowo lomwe lakokoloka.bony defect) m'magome akunja ndi akumbuyo a fupa la chigaza chakutsogolo mpaka ku dura mater yomwe imaphimba ubongo ndi fupa lapamwamba la venous sinus. Kudulidwa kosalamulirika kwa odwala kunja popanda kujambula kwa CT/MRI kungayambitse mabakiteriya apakhungu mwachindunji mu epidural space kapena kuyambitsa magazi a venous sinus.
11. Musunge wodwalayo mosamalitsa NPO (pakamwa palibe: chakudya, ziro madzi, zakumwa zoledzeretsa pakamwa) paulendo. Kupitilira 90 percent ya zotupa za Pott's puffy chotupa zimafunika kuthirira mwachangu m'chipinda chopangira opaleshoni (endoscopic frontal sinusotomy / Draf IIb-III, kugwedezeka kwakunja, ndi/kapena neurosurgical craniotomy/burr hole evacuation) pansi pa anesthesia wamba patangotha ​​maola angapo atafika.
12. Sungani mutu wa wodwalayo ndi torso kumtunda pamwamba 30 degrees poyenda kuti muthe kukhathamiritsa ngalande zaubongo kudzera mu sinus yapamwamba ya sagittal ndikuchepetsa kuthamanga kwa intracranial.

Mtengo wosankha: Kuchepetsa kutupa pamphumi, mutu wowopsa wakutsogolo, ndi sinusitis¶

flowchart TD
    Presentation["Mwana, Wachinyamata, Kapena Wamkulu Wodwala Sinusitis, Mutu Wakutsogolo, kapena Mphuno Yapamphumi Imakula Pamphumi (+/- Kutupa kwa Zikope Zapamwamba)"] --> PalpateForehead{"Khwerero 1: Yang'anani & Pang'onopang'ono Pamphumi Pamwamba pa Zinsinsi: Kodi Pali Kutupa, Kutentha, Kutentha, Doughy, Pitting, kapena Fluctuant ('Boggy') Pafupa Lakutsogolo?"}

    PalpateForehead -->|"INDE: Kutupa / Kutupa Pamphumi = POTT'S PUFFY TUMOR (Frontal Bone Osteomyelitis + Subperiosteal Abscess)"| CheckNeuro{"Khwerero 2: Screen for Intracranial & Orbital Complications (Ikupezeka mu 60% mpaka 85% ya Milandu): Kupweteka Kwambiri kwa Mutu, Kusanza, Kutaya Thupi, Kusintha Kwaumunthu, Kugwidwa, Kuuma Pakhosi, Kufooka Mkono / Mwendo, KAPENA Kuphulika / Diso Lozizira?"}

    CheckNeuro -->|"YES kwa Chizindikiro CHONSE cha Neurological kapena Orbital Sign"| Emergent911["POTT'S PUFFY TUMOR CHOKHA NDI KUPULUKA KWAMBIRI / ORBITAL (Epidural Abscess, Subdural Empyema, Brain Abscess, kapena Sagittal Sinus Thrombosis): Imbani 911 / 112 / 999 Nthawi yomweyo -> Kwezani Mutu Stric Degrees 30 ->"]

    CheckNeuro -->|"PALIBE Zizindikiro Zodziwikiratu za Neuro Komabe (Wodwala Wodziwikiratu Wotupa Pamphumi & Chimfine/ Mutu)"| UrgentHospital["POTT'S PUFFY TUMOR (KUCHITIKA KWAMBIRI KWA SILENT EPIDURAL ABSCESS): Pitani Pompopompo Ku Dipatimenti Yodzidzimutsa Zachipatala Chapamwamba (Ndi Neurosurgery & ENT Coverage) -> Strict NPO for Imaging & OR"]

    PalpateForehead -->|"PALIBE Kutupa Pamphumi Kapena Kukoma Kwa Mafupa: Kufiyira Kwa Zikope Kokha"| CheckEye["Yang'anirani za Pre-Septal vs. Post-Septal (Orbital) Cellulitis: Yang'anani Mayendedwe a Maso, Masomphenya, & Proptosis -> Fufuzani Zachipatala za Tsiku Limodzi / ED Evaluation"]

    Emergent911 --> HospitalBundle["Definitive Hospital Protocol: 1. STAT Blood Cultures + Meningeal-Dose IV Vancomycin + IV Ceftriaxone (2g q12h) + IV Metronidazole, 2. High-Resolution Contrast CT ya Sinuses / Orbits / Brain (Bone + Soft Tissue Windows, URV / ENTM 3 Brain 3) Contrast. Endoscopic Frontal Sinus Drainage + Neurosurgical Evacuation of Any Epidural/Subdural/Brain Abscess + 6 Weeks IV Antibiotics"]
    UrgentHospital --> HospitalBundle

Gawo 1: Anatomical Pathophysiology: Makoma Atatu a Frontal Sinus ndi Mitsempha Yopanda Valves ya Breschet¶

Kuti mumvetse chifukwa chomwe matenda wamba a sinus pamwamba pa nsidze amatha kusungunula bowo kudzera pakhungu lapamphumi NDIPO kubaya mafinya kumbuyo kwa ubongo, yang'anani gawo lamphumi la munthu (fupa lakutsogolo):

========================================================================
       SAGITTAL CROSS-SECTION OF THE FRONTAL SINUS & POTT'S TUMOR
========================================================================

  [ FOREHEAD SKIN ]
         |
  [ PERIOSTEUM ] ===> (Lifted off skull by PUS -> "POTT'S PUFFY TUMOR"
         |             Subperiosteal Forehead Abscess)
         |
  +------+-----------------------------------+
  | ANTERIOR TABLE OF FRONTAL BONE           | <-- Thick Bone (2 to 4 mm)
  | (Contains Valveless Diploic Veins        |     Erodes OUTWARD.
  |  of Breschet in Spongy Marrow)          |
  +------------------------------------------+
  |                                          |
  |        [ FRONTAL SINUS CAVITY ]          | <-- Blocked Nasofrontal
  |        (Filled with Pressurized Pus:     |     Outflow Tract
  |         Streptococcus milleri +          |     (Pressure Cooker)
  |         Anaerobes + Staph aureus)        |
  |                                          |
  +------------------------------------------+
  | POSTERIOR TABLE OF FRONTAL BONE          | <-- PAPER-THIN (0.5 to 1 mm)
  +------------------------------------------+     Erodes INWARD.
         |                                                |
         v (60% to 85% Intracranial Spread)              v
  [ EPIDURAL ABSCESS / SUBDURAL EMPYEMA / ]    [ SUPERIOR SAGITTAL SINUS ]
  [ FRONTAL LOBE BRAIN ABSCESS            ]    (Septic Venous Thrombosis)
  ======================================================================
  (Note: Floor of Frontal Sinus = Roof of Eye Socket -> Orbital Abscess)
========================================================================

1. Makoma Atatu a Mafupa a Kutsogolo kwa Sinus Pressure Cooker¶

Pamene kutupa kwa mucosal, polyps, kapena mafinya wandiweyani amatchinga kachulukidwe kakang'ono ka hourglass pansi pa sinus yakutsogolo (**pambuyo kutsogolo / nasofrontal outflow thirakiti ), mphuno yakutsogolo imasandulika kukhala chipinda chosindikizira cha fupa chozunguliridwa ndi makoma atatu: 1. ** Table Yam'mbuyo (Front Wall: 2 to 4 millimeters wandiweyani): Amapanga mizere yolimba ya mphumi yanu pansi pa nsidze ndi khungu la pamphumi. Osteomyelitis ikasungunuka kupyola khoma ili (kapena kuyenda kudzera m'mitsempha yaying'ono kwambiri), mafinya amasonkhanitsa pansi pa nembanemba yakunja yolimba ya periosteal (**subperiosteal abscess **), kutulutsa chotupa chapamphumi chakunja (Pott's puffy chotupa). 2. The Posterior Table (Back Wall: Paper-Thin at 0.5 to 1.0 millimeter): Amalekanitsa mphuno yam'tsogolo yomwe ili ndi kachilombo mwachindunji ku dura mater, mphuno yapamwamba ya sagittal venous, ndi makona akutsogolo a ubongo. Chifukwa khoma lakumbuyo ili ndi kuwirikiza kanayi kuwirikiza kanayi kuposa khoma latsogolo , panthawiyi matendawa amakhala owopsawambiri moti amatha kulowa mkati. 4 mm Khoma lakutsogolo pamphumi, pafupifupi nthawi zonse idalowa kale pang'ono klzzwxh:29 khoma lakumbuyo kulowa mu cranial cavity **. 3. The Inferior Wall (Floor of the Frontal Sinus = Roof of the Eye Socket): Amalekanitsa nkusani wakutsogolo ndi diso. Kukokoloka kutsika pansi kutsanulira mafinya pamwamba pa socket (superior orbital subperiosteal abscess), kukankhira diso pansi ndi kunja (inferolateral proptosis) ndi kuyambitsa kutupa kwa chikope kumtunda komwe kumatengera orbital cellulitis.

2. Momwe Matenda Amawolokera Ngakhale Fupa Lachigaza Losalimba (The Valveless Diploic Veins of Breschet)¶

Chochititsa chidwi n'chakuti, wodwala SAKUFUNA kuti bowo looneka libowole ku fupa la chigaza kuti apange chotupa cha Pott's puffy chotupa kapena empyema yakuphayo. - Pakati pa tebulo lolimba lakunja ndi tebulo lamkati la fupa lakutsogolo la chigaza ndi fupa la vascular spongy (the diploë) lomwe limatsatiridwa ndi labyrinth yokhala ndi mipanda yopyapyala, 100% yopanda ma valve ya venous yotchedwa Diploic Veins of Breschet. - Mitsempha ya diploic yopanda valavuyi imagwirizanitsa ** mucosa wa kutsogolo kwa sinus ** molunjika kutsogolo kwa ** periosteum ya pamphumi ** NDIPO kumbuyo kumbuyo kwa ** dural venous plexus ndi superior sagittal sinus ya ubongo **. - Retrograde Septic Thrombophlebitis: Magazi omwe ali ndi kachilombo (septic thrombi) kuyenda molunjika kudzera mu mitsempha yopanda valve ya Breschet kutsogolo pansi pa mphumi periosteum ndi kubwerera mmbuyo kudutsa dura mu danga la subdural ndi parenchyma ya ubongo, ngakhale pamene fupa lakumbuyo likuwonekabe bwino pa CT scan. - Chifukwa chiyani Achinyamata (10 to 18 Years Old) Amagunda Kwambiri: Pamene wachinyamata akumathamanga kwambiri m'mphuno yam'tsogolo, magazi amayenda bwino komanso minyewa ya m'mitsempha imafika pachimake pa moyo wake wonse, zomwe zimapangitsa kuti pakhale msewu wotseguka kwambiri wa venous kuchokera ku sinus kupita kufupa la mafupa ndi ubongo.

3. The 4 Etiologies (Zoyambitsa) za Pott's Puffy Tumor¶

1. Bacterial Frontal Sinusitis yosachiritsika kapena yothandizidwa pang'ono (75% to 80% of Cases): Nthawi zambiri amatsatira chimfine wamba kapena kusambira pakhungu; mpaka theka la odwala anali atapatsidwa kale njira yaifupi ya maantibayotiki amkamwa omwe amalephera kulowa m'mphuno yopingasa yakutsogolo.
2. Kuvulala kwapamphumi (15% to 20% ya Milandu): Kugundana kwamasewera (wosewera mpira, baseball, basketball elbow), kugwa kwa skateboard, kapena ngozi yaying'ono yagalimoto imayambitsa kusweka kwa khoma lakutsogolo lakutsogolo kwa sinus kapena subperiosteal hematoma pamphumi komwe pambuyo pake kumayambitsidwa ndi mabakiteriya a sinus pakatha milungu 1 mpaka 4.
3. Mphuno Cocaine / Methamphetamine Insufflation: Vasoconstriction kosatha ndi ischemic necrosis zimawononga mphuno ya m'mphuno ndi thirakiti lakutsogolo la sinus outflow, zomwe zimatsogolera ku osteomyelitis.
4. Opaleshoni Yam'mbuyo ya Craniofacial Neurosurgery, Frontal Sinus Osteoma, kapena Dental/Skin Spread.

Gawo 2: The 5 Intracranial Complications Opezeka mu 60% to 85% za Milandu¶

Chifukwa odwala anayi mwa asanu mwa odwala omwe ali ndi chotupa cha Pott ali ndi matenda obwera chifukwa cha ubongo, madokotala amawunika mwachangu magulu asanu opangira opaleshoni ya ubongo:

Gawo 3: Kusiyanitsa Chotupa cha Pott's Puffy Chotupa kuchokera ku Benign Pamphumi Zotupa ndi Orbital Cellulitis¶

Gwiritsani ntchito tebulo lofanizira la m'mphepete mwa bedi ili kuti musiyanitse chotupa chotupa cha Pott ndi klzzwxh:0056, ndi **isolat orbital cellulitis**:

Gawo 4: Microbiology ndi Definitive Hospital Management (CT + MRI, CNS-Dose IV Antibiotics,ndi Combined ENT/Neurosurgery)¶

1. Chifukwa chiyani chotupa cha Pott's Puffy Tumor Ndi Polymicrobial Microaerophilic & Anaerobic Infection¶

Chifukwa chotchinga chakumbuyo kwa nkusani kumakhala pabowo wokhala ndi okosijeni wochepa (hypoxic ndi acidic), mabakiteriya omwe amayambitsa chotupa cha Pott's puffy chotupa ndi zotupa zake zokhala m'mutu ndi wosiyana kwambiri ndi matenda osavuta a m'khutu kapena pakhungu: - **Gulu la #1 la olakwa (50% to 70%Streptococcus anginosusStreptococcus milleri) Gulu ** ( S. anginosus *, * S. constellatus *, ndi * S. intermedius *) ndi ma microaerophilic viridans streptococci. Gulu la *Streptococcus intermedius / milleri ndi lodziwika bwino pamankhwala opatsirana opatsirana chifukwa chopanga ma enzymes amphamvu (hyaluronidase and deoxyribonuclease) zomwe zimasungunula fupa ndikupanga ubongo wowononga ndi zilonda zam'mimba . - Olimba Mkamwa & Sinus Anaerobes (30% to 50%): Fusobacterium mitundu (F. nucleatum, F. necrophorum), Prevotella, Porphyromonas, Bacteroides, ndi Peptostreptococcus (yomwe ilipo nthawi zambiri ndi intracranial extension). - Matenda a Staphylococcus aureus15% to 25%, kuphatikizapo MRSA): Ofala makamaka akakumana ndi zoopsa, achinyamata, ndi sinusitis yosatha. - Streptococcus pneumoniae, Haemophilus influenzae, ndi Streptococcus pyogenes (Group A Strep).

2. Mwamsanga Empiric Intravenous Antibiotic Regimen (Meningeal / Brain Abscess Dosing)¶

Atangotenga miyambo ya magazi (ndi ** asanadikire ** kuyembekezera kuti MRI ikwaniritsidwe), asing'anga amayamba mankhwala atatu apakati pa mitsempha-yolowa m'mitsempha: 1. Mtsempha wa Vancomycin (15 to 20 mg/kg IV every 6 to 8 hours) (kuphimba S. aureus yosamva methicillin [MRSA] komanso osamva penicillin S. chibayo), KULUTSA ** 2. Mtsempha wa Ceftriaxone (2 grams IV every 12 hours mwa akuluakulu; 100 mg/kg/day divided q12h mwa ana: mlingo wathunthu wa meningeal double) KAPENA Intravenous Cefotaxime/Cefepime (kuti mukwaniritse CSF yokwera ndi fupa lamphamvu motsutsana ndi gulu la Streptococcus anginosus/milleri ndi gram-negative ndodo), PLUS 3. Mtsempha wa Metronidazole (500 mg IV every 6 to 8 hours mwa akuluakulu; 30 to 40 mg/kg/day mwa ana) (chifukwa metronidazole imakwaniritsa pafupifupi 100% kulowa mu zithupsa za muubongo, mafinya a subdural, ndi necrotic frontal bone kuti athetse ma anaerobes okhwima monga Fusobacterium ndi Prevotella). - (Njira Yina: Mtsempha wa Meropenem + Mtsempha wa Vancomycin). - ** Kutalika Koyenera kwa Chithandizo: Chifukwa chotupa chotupa cha Pott ndi tanthauzo la acute osteomyelitis of the frontal osteomyelitis (kawirikawiri cholumikizidwa ndi epidural/subdural abscess), odwala amafunika **6 mpaka 8 milungu yathunthu yolowera m'mitsempha (kapena high-bioavailability) kudzera munjira yotalikirapo ya antibayotiki *PI-CC) pambuyo opaleshoni ngalande.

3. Chifukwa Chake Odwala Amafunikira ZOCHITIKA Zosiyana Kwambiri CT NDI MRI/MRV Yosiyana ndi Ubongo¶

• Kusiyanitsa Kwapamwamba Kwambiri CT ya Ubongo, Mayendedwe, ndi Sinuses Paranasal (Thin 1 mm Slices with Bone and Soft-Tissue Windows):
• Bone Window ndiyofunikira kwa ENT ndi neurosurgeon: imapanga zolakwika zenizeni za millimeter komwe osteomyelitis yadya kudzera mu ** tebulo lakumbuyo **, ** tebulo lakumbuyo **, ndi ** orbital floor ** ya fupa lakutsogolo, ndikuwonetsa wodwalayo kutsogolo kwa sinus outflow anatomy kuti ayende pa opaleshoni.
• Zenera la Comtrast Soft-Tissue Window likuwonetsa bwino mkombero wa mphumi subperiosteal abscess pansi pa pericranium ndi chiphuphu chachikulu chilichonse cha orbital kapena epidural.
• Chifukwa chiyani CT Yokhayo Siyokwanira -> MRI yaubongo Yoyenera Kusiyanitsa ndi DWI ndi MR Venography (MRV):
• Kuonda koyambirira ma empyemas ocheperako (makamaka omwe amabisala molunjika pakati pa ma hemispheres awiri motsatira falx cerebri / interhemispheric fissure), oyambirira frontal lobe cerebritis, ndi superior sagittal sinus thrombosis akhoza kuphonya pa CT scan.
• ** MRI yaubongo yokhala ndi Gadolinium Contrast ndi Diffusion-Weighted Imaging (DWI)** ndiye muyezo wagolide: mafinya mkati mwa subdural empyema kapena epidural abscess amawonetsa modabwitsa kufalikira kopanda malire pa DWI, pomwe MRV imatsimikizira ngati sinus yapamwamba ya sagittal ndi patent kapena clotted.

4. Kuphatikiza Otolaryngology (ENT) ndi Neurosurgical Source Control mu Malo Opangira Opaleshoni¶

Maantibayotiki okha ** sangathe ** kuchiza chotupa chotupa cha Pott; mafinya pansi pa mphumi periosteum, mkati wotsekedwa wakutsogolo nkusani, ndi mkati epidural/subdural danga ayenera kuchotsedwa opaleshoni (source control), nthawi zambiri ndi gulu la ENT + Neurosurgery panthawi yomweyi: 1. Endoscopic Frontal Sinusotomy (Draf IIa / IIb or Draf III Modified Endoscopic Lothrop Procedure) ± External Frontal Trephination: Pogwiritsa ntchito matanthauzo apamwamba a m'mphuno ndi ma endoscopes otanthauzira motsogozedwa ndi zithunzi kudzera m'mphuno, dokotala wa opaleshoni wa ENT amatsegula njira yotsekeka yakumbuyo yakumbuyo kwa sinus kuchokera pansi, kutsuka mafinya ndi sequestra, ndikukhetsa chiphuphu chapamphumi ( trephination kapena percutaneous singano/kukhetsa kuyika kotero kuti palibe chipsera chowonekera pamphumi). 2. Kuthawa kwa Neurosurgical (Burr Hole or Craniotomy) + Kuchotsedwa kwa Necrotic Bone: Ngati ** abscess, subdural empyema, kapena brain abscess** ilipo pa MRI, neurosurgeon amachita mwadzidzidzi bowo lakutsogolo kapena craniotomy kutsuka mafinya ndikuchotsa mafinya aliwonse akufa, opunduka a mafupa akutsogolo.sequestrectomy).

Nambala zadzidzidzi zachigawo ndi malo opangira opaleshoni ya ana/akuluakulu¶

Oganiziridwa kuti chotupa chotupa cha Pott chimafunikira kusamutsidwa kuchipatala ku Tetiary Medical Center kapena Dedicated Children's Hospital yokhala ndi maola 24 a Neurosurgery, Otolaryngology (ENT) Rhinology, Ophthalmology, ndi Pediatric/Adult Infectious Diseases:

• United States ndi Canada: Imbani 911 pazizindikiro zilizonse zochenjeza za minyewa, zowona, kapena za sepsis, kapena pitani mwachindunji kusukulu yayikulu kapena Dipatimenti Yodzidzimutsa Zachipatala cha Ana. Imayendetsedwa ndi American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), Infectious Diseases Society of America (IDSA), ndi American Academy of Pediatrics (AAP) malangizo ovuta kwambiri a bacterial rhinosinusitis.
• United Kingdom: Imbani 999 kapena pitani kuchipatala chachikulu Dipatimenti yazadzidzidzi (A&E) ndikuyimba foni **ENT ndi Neurosurgery **. Imayendetsedwa pansi pa NICE Guideline NG79 (Sinusitis, Acute: Immediate Hospital Admission for Suspected Intracranial or Periorbital Complications) ndi ENT UK / British Rhinological Society miyezo.
• European Union: Imbani 112. Imayendetsedwa pansi pa European Position Paper pa Rhinosinusitis ndi Nasal Polyps (EPOS 2020/2024: Kasamalidwe ka Osseous and Intracranial Complications of Acute Rhinosinusitis).
• Australia ndi New Zealand: Imbani 000 ku Australia kapena 111 ku New Zealand. Imayendetsedwa pansi pa ASOHNS ndi Royal Children's Hospital (RCH) Melbourne Complicated Sinusitis & Intracranial Sepsis Guidelines.
• Asia-Pacific: Imbani 119 (Japan, South Korea), 995 (Singapore), kapena 112 / 108 (India). Funsani chipatala chapamwamba chokhala ndi MRI ya maola 24, opaleshoni ya ubongo, ndi opareshoni ya sinus endoscopic.

Mafunso omwe amafunsidwa pafupipafupi¶

Kodi "chotupa cha Pott's puffy" ndi chotupa kapena khansa?¶

Ayi. Ngakhale kuti mawu ochititsa mantha akuti "chotupa" m'dzina lake, chotupa cha Pott sichikugwirizana ndi khansa. Pamene dokotala wa opaleshoni wachingelezi Sir Percivall Pott anachitcha icho mu 1760, liwu lachilatini lachipatala lakuti "chotupa" limangotanthauza "kutupa" kulikonse komwe kumapezeka. Chotupa cha Pott's puffy chotupa ndi matenda a bakiteriya a mafupa (osteomyelitis) a fupa lakutsogolo la chigaza lomwe limapanga thumba la mafinya pansi pa nembanemba yakunja ya mphumi (abscess subperiosteal), yomwe nthawi zambiri imayambitsidwa ndi matenda am'mphuno osachiritsidwa kapena osathandizidwa pang'ono kapena kugunda kwapamphumi.

Nchifukwa chiyani achinyamata ambiri omwe ali ndi chotupa cha Pott's puffy alinso ndi chiphuphu chobisika mkati mwa chigaza chawo pafupi ndi ubongo?¶

Sinus yakutsogolo ndi thumba la mpweya lomwe lili mkati mwa fupa la pamphumi pakati pa nsidze zanu. Khoma lake lakutsogolo (loyang'ana pamphumi panu) ndi fupa lakuda (2 mpaka 4 millimeters), pamene khoma lakumbuyo (kulekanitsa sinus ku ubongo ndi dura mater) ndi pepala lochepa (0.5 mpaka 1 millimeter). Kuphatikiza apo, mitsempha ya spongy yokhala ndi ziro njira imodzi (mitsempha ya diploic ya Breschet) imayenda molunjika kuchokera ku sinus kupita kumphumi ndi kubwerera kumbuyo mpaka kuphimba kwa ubongo, kufika pachimake kukula ndi kutuluka kwa magazi panthawi ya kukula kwachinyamata. Choncho, pofika nthawi yomwe matenda a sinus achuluka kwambiri moti amatha kukankhira mafinya kutsogolo kupyola fupa lakutsogolo mpaka pamphumi, 60 mpaka 85 peresenti ya odwala ana ndi achinyamata amakhala kale ndi mabakiteriya omwe amadutsa kumbuyo kwa khoma lopyapyala lakumbuyo kapena mitsempha yopanda valve kuti apange epidural abscess kapena subdural empyema mkati mwa chigaza.

Kodi nchifukwa ninji wodwala angakhale ndi chiphuphu mu ubongo wa epidural kapena front lobe chotupa cha Pott's puffy chotupa ndikuyendabe ndi kuyankhula bwinobwino poyamba?¶

Gawo lakutsogolo laubongo lomwe likukhala kumbuyo kwa mphumi (prefrontal cortex ya frontal lobes) silimawongolera kusuntha kwa mkono ndi mwendo, kumva, kapena kulankhula, madera amenewo amakhala kumbuyo kwa ubongo. Madokotala amatcha lobe yakutsogolo kuti ndi "malo opanda phokoso" chifukwa thumba lomwe limakula la mafinya kutsogolo kwa nsonga yakutsogolo nthawi zambiri kumapangitsa kufooka kwa ziro, dzanzi, ndi ziro osalankhula msanga. M'malo mwake, zizindikiro zoyamba kupitirira mutu ndi kutentha thupi ndizobisika umunthu kapena kusintha kwa kamvedwe: wachinyamata kapena wachikulire amakhala chete, osachita chidwi, okwiya, kugona, kapena kuchedwa kuyankha mafunso. Ichi ndichifukwa chake wodwala aliyense yemwe ali ndi kutupa pamphumi pamphumi amapeza kusiyana kwadzidzidzi ndi CT ndi MRI yaubongo mosasamala kanthu kuti mayeso awo oyambira amawonekera bwanji.

Kodi ndingadziwe bwanji kusiyana pakati pa mikwingwirima ya "mazira a tsekwe" pambuyo pa kugunda kwamutu ndi chotupa chotupa cha Pott?¶

"Dzila la tsekwe" (hematoma) lopwetekedwa bwino limatupa pakangopita mphindi zochepa mutagunda mutu wanu, limakhala lolimba kapena kuti labala, silimatentha thupi kapena limatuluka m'mphuno, ndipo limacheperachepera sabata yamawa. Mosiyana ndi izi, chotupa chotupa cha Pott chimayamba kudwala matenda am'mphuno / kuzizira popanda kuvulala mutu konse, KAPENA amawonekera patatha masiku angapo pakadutsa mphumi pamene chilonda chochira chimayambanso kukula, chimakhala chotentha, chofiyira, chopanda kanthu, komanso chofewa pokhudza, ndipo chimatsagana ndi kugunda kwamutu kumutu, kutentha thupi, kapena kutentha thupi.

Kodi chotupa chotupa cha Pott chingachiritsidwe ndi mapiritsi oletsa kumwa mankhwala kunyumba, kapena kupita kuchipatala chothandizira mwachangu?¶

Ayi. Maantibayotiki a m'kamwa sangathe kulowa atafa, fupa lakumaso lomwe lili ndi kachilombo kapena kukhetsa thumba losindikizidwa la mafinya pansi pamphumi periosteum, kwenikweni, pafupifupi theka la odwala omwe adapezeka ndi chotupa cha Pott anali kumwa kale maantibayotiki amkamwa omwe amaperekedwa chifukwa cha matenda am'mphuno pamene mphumi yawo idatupa. Chofunika kwambiri, dokotala wachangu sayenera kudula pamphumi kutupa popanda chipatala CT ndi MRI scan, chifukwa abscess nthawi zambiri zimagwirizana mwachindunji dzenje mu chigaza ndi ubongo akunja akalowa (dura) ndi yaikulu venous nkusani. Chithandizo nthawi zonse chimafunika kugonekedwa m'chipatala, kuphatikizika kwa ENT ndi minyewa yopangira opaleshoni, komanso masabata 6 mpaka 8 akumwa mankhwala opha tizilombo.

Kodi opaleshoni ya chotupa chotupa cha Pott idzasiya bala lalikulu pamphumi?¶

M’mbuyomu, madokotala ankadula mphumi kapena pamutu kuti atsegule fupa lakutsogolo. Masiku ano, nthawi zambiri popanda kuwonongeka kwa chigaza chachikulu, akatswiri a Otolaryngologists (madokotala a ENT) amagwiritsa ntchito ma endoscopes amphuno otsogozedwa ndi makompyuta omwe amadutsa m'mphuno (endoscopic frontal sinusotomy / Draf process) kuti atsegule mphuno yotsekeka mkati, yomwe nthawi zambiri imakhala yolumikizidwa ndi kachidutswa kakang'ono kakang'ono kamene kamene kamabisala mkati kapena kumanja. nsidze kotero kuti pamphumi kuchira ndi pafupifupi palibe chilonda chooneka.

Magwero ndi malangizo ovomerezeka¶

• ** European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2020/2024, European Rhinologic Society):** Classification and Emergency Management of Osseous and Intracranial Complications of Acute Bacterial Rhinosinusitis (Pott's Puffy Tumor, Epidural Epidural Emergency Emergency Emergency of Osseous and Intracranial Complications of Acute Bacterial Rhinosinusitis) Drainage).
• American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) & American Academy of Pediatrics (AAP, United States): Clinical Practice Guidelines for Complicated Acute Bacterial Sinusitis in Children and Adults (chiwopsezo chachikulu cha achinyamata, diploic vein thrombophlebitis, CT ndi MRI).
• National Institute for Health and Care Excellence (NICE) & ENT UK (United Kingdom): Sinusitis (Acute): Antimicrobial Prescribial and Emergency Hospital Referral Criteria for Suspected Frontal Bone Osteomyelitis kapena Intracranial Spread (NICE Guideline NG79).
• Infectious Diseases Society of America (IDSA, United States): Clinical Practice Guidelines for Intracranial Suppurative Complications and Osteomyelitis (empiric CNS-dose intravenous vancomycin, third-generation cephalosporin, and metronidazole covering the Streptococcus angiromilles and Osteomyelitis)
• Chipatala cha Royal Children's Hospital (RCH) Melbourne & ASOHNS (Australia): Pediatric Complicated Frontal Sinusitis ndi Pott's Puffy Tumor Neurosurgical/ENT Protocol.

Maupangiri ogwirizana¶

• Orbital cellulitis, cavernous sinus thrombosis, ndi matenda a nkhope a triangle
• Cavernous sinus thrombosis: Zithupsa Zowopsa za Triangle, sinusitis, ndi matenda achisanu ndi chimodzi a mitsempha.
• Acute coalescent mastoiditis: pinna ya khutu yotuluka ndi sigmoid sinus thrombosis
• Meningitis ndi meningococcal septicemia non-blanching rash triage
• Kuvulala kwamutu ndi kuzindikira kugwedezeka