Izimo Eziphuthumayo Ze-Dental Abscess Airway, Angina ka-Ludwig, kanye nokuvuvukala kwe-Submandibular¶

I-angina ka-Ludwig iyi-polymicrobial cellulitis ekhula ngokushesha, ebeka ukuphila engozini ye-polymicrobial cellulitis phansi yomlomo kanye nezikhala zentamo ye-submandibular yamazwe amabili, okubangelwa ngaphezu kwamaphesenti angu-80 kuya kwangu-90 ezimeni ukutheleleka kwamazinyo okungelashiwe kwezinyo eliphansi le-molar (ikakhulukazi i-molar ephansi yesibili noma yesithathu). Ngenxa yokuthi umhlathi ongezansi wethambo (mandible) uvimbela ukuvuvukala ekukhuleni ngaphandle noma phansi, i-edema eyakha ngokushesha isunduza phansi emlonyeni kanye nesisekelo solimi iqonde phezulu iqonde phezulu ophahleni lomlomo futhi ihlehle emphinjeni, okusongela ukuhogela okuphelele komshini phakathi namahora. Uma othile ophethwe izinyo noma ukukhishwa kwamazinyo eba nokuvuvukala okuqinile nhlangothi zombili ngaphansi kwesilevu ("intamo yenkunzi"), ulimi oluphakeme, ukuconsa, izwi elivalekile elithi "mazambane ashisayo", noma ukungakwazi ukuvula umlomo wabo (trismus), shayela indawo yangakini. izinombolo eziphuthumayo ngokushesha. Ngenkathi usalinde abezimo eziphuthumayo, buyekeza isiqondiso sendlela yomoya ehlobene ithumba le-peritonsillar kanye nokutheleleka kwentamo ejulile, i-epiglottitis, i-croup, ne-upper airway stridor, futhi izimo eziphuthumayo zamazinyo namazinyo akhishwe.

Ngenxa yokuthi amandla adonsela phansi yiwo kuphela amandla asiza isiguli ukuba sibambe ulimi lwaso oluvuvukile luye phambili kancane lusuka ngemuva komphimbo waso, umthwalo wakho wemfanelo owodwa obaluleke kakhulu wosizo lokuqala uwukuba ukugcina isiguli sihlezi ibhawodi siqondile futhi sincike kancane phambili, ungalokothi usiphoqe ukuba silale sibheke phansi nganoma yisiphi isizathu.

Yenza lokhu manje¶

1. Shayela inombolo yakho yasendaweni yezimo eziphuthumayo ngokushesha futhi umemezele Isimo Esiphuthumayo Somoya esiyingozi kakhulu. Dayela u-911 e-United States nase-Canada, 112 ku-European Union yonkana, 999 e-United Kingdom, 000 e-Australia, noma uhlole uhlu lwethu izinombolo eziphuthumayo. Yisho ngokucacile: "Izimo eziphuthumayo ze-angina ka-Ludwig / umzila womoya wamazinyo: ukuvuvukala kwamazwe amabili ngaphansi komhlathi, ulimi oluphakeme, ukuconsa, izwi elivalekile, kanye nobungozi bokuvinjwa kwendlela yokuphefumula kungazelelwe."
2. Gcina isiguli sihlezi ibhawodi siqondile futhi sincike kancane phambili (indlela "I-Tripod" noma "Yokuhogela") ngaso sonke isikhathi. Ungalokothi ulalise isiguli esiphethwe i-angina ka-Ludwig noma i-submandibular yamazinyo evuvukale kanzima emhlane phezu kombhede, usofa, i-ambulensi stretcher, noma itafula le-CT scanner lasesibhedlela. Ukulala uphansi kubangela ukuba ulimi olusindayo, oluvuvukele kanye nezicubu zepharyngeal ezivuvukele ziwele ziqonde emuva odongeni olungemuva lwepharyngeal ngamandla adonsela phansi, kuvalwe indlela yokuphefumula ngemizuzwana futhi kubangele ukuboshwa kwenhliziyo ye-hypoxic ngokushesha.
3. Vumela isiguli sikhafulele amathonsi enkomishini noma ithawula, UNGALOKOTHI unamathisele iminwe, izinto ezicindezela ulimi, noma izipuni emlonyeni. Ngoba indawo ephansi yomlomo ivuvukele njengokhuni futhi imisipha yomhlathi ivalekile (trismus), ezama ukuvula amazinyo noma ukucindezela ulimi phansi ngesipuni, kubangele ukugeleza komoya okunamandla. ukuvaleka.
4. Sebenzisa i-NPO eqinile (akukho lutho ngomlomo: akukho manzi, akukho okudambisa izinhlungu eziwuketshezi, awekho amaphilisi emithi elwa namagciwane). Okokuqala, ukugwinya kuvinjwa ngomshini ulimi oluphakeme, ngakho noma yimaphi amanzi noma iphilisi lizothela ngqo kuqhoqhoqho (uqhoqhoqho) futhi kubangele ukuminyanisa. Okwesibili, isiguli sizodinga intubation esheshayo evukile ye-fiberoptic noma i-tracheostomy yokuhlinzwa evukile/i-cricothyrotomy egunjini lokuhlinza lapho sifika esibhedlela.
5. Gcina isiguli sizolile, sipholile, futhi singanyakazi, futhi ukhulule wonke amakholomu ehembe, othayi, nemigexo. Ukukhathazeka, ukukhala, noma ukuzikhandla ngokomzimba kusheshisa isivinini sokuphefumula, kuguqule ukugeleza komoya okubushelelezi (laminar) emphinjeni onciphile kube ukugeleza komoya okunyakazayo okumunca izindonga ezivuvukele zomzila womoya wokuvala (**).
6. Ungawagcobi amapadi okushisisa noma amabhodlela amanzi ashisayo ngaphandle kwentamo evuvukele noma emhlathini. Ukufaka ukushisa kwangaphandle endaweni ejulile ebusweni noma entanyeni kwandisa kakhulu i-vasodilation yendawo kanye ne-tissue edema, kusheshise ukuvala kwendlela yokuphefumula futhi kudonsele ukutheleleka esikhumbeni noma ekujuleni kwentamo kuye esifubeni (ukwehla kwe-necrotizing mediastinitis).

Isihlahla sesinqumo: ukuqaqamba kwamazinyo, ukuvuvukala kobuso, kanye ne-angina airway triage ka-Ludwig¶

flowchart TD
    Start["Ukuqaqamba kwezinyo elingezansi, i-Molar Ephukile, noma Ukukhishwa Kwezinyo Kwakamuva Ngobuso, Umhlathi, noma Ukuvuvukala Ngaphansi Kwesilevu"] --> AirwayScreen{"Isinyathelo 1: Hlola I-Airway & Ludwig Angina Red Flags: Ukuvuvukala ngaphansi kwezinhlangothi ZOMBILI zesilevu, ulimi luphushelwe phezulu, ukuconsa, izwi lezambane elishisayo, i-trismus, noma ukuma kwe-tripod eqondile?"}

    AirwayScreen -->|"YEBO kunoma iyiphi ifulegi elibomvu"| LudwigEmergency["ESIPHUTHUMAYO SE-AIRWAY ESINGAPHILA OKUSHESHAYO (LUDWIG ANGINA): Shayela Amasevisi Ezimo Eziphuthumayo (911 / 112 / 999) Ngokushesha"]

    AirwayScreen -->|"CHA: Ukuvuvukala kunqunyelwe ezinsini noma esihlathini esisodwa, ukugwinya okuvamile nezwi, ukuvuleka komlomo ogcwele"| LocalDental["Ithumba Lamazinyo Elingeyona Inkimbinkimbi Yasendaweni: Hlela ukuhlolwa okuphuthumayo kosuku olufanayo lukadokotela wamazinyo; hlambulula kahle ngamanzi anosawoti afudumele, UNGALOKOTHI ubeke ukushisa esihlathini, futhi uye ku-ED uma ukuvuvukala ngaphansi kwesilevu noma i-trismus iqala"]

    LudwigEmergency --> UprightRule["1. UKUMA OKUQINILE OKUQONDILE (Indawo Ekathathu/Ukuhogela): UNGALOKOTHI ulale isiguli sicaba phezu kohlaka noma etafuleni le-CT; vumela i-drool ukuthi iqhubekele phambili enkomishini noma ithawula"]

    UprightRule --> HandsOff["2. VIKELA UMGWAQO WOmoya: I-NPO Eqinile (awakho amanzi noma amaphilisi omlomo), UNGALOKOTHI ufake izinto ezicindezela ulimi noma uvule umhlathi, azikho izinto zokushisisa zangaphandle, futhi uxege ukhololo."]

    HandsOff --> HospitalOR["3. Isibhedlela Sokusetha Kabili Indlela Yomoya Nokuphathwa Kokuhlinzwa: I-Ake Flexible Fiberoptic Nasotracheal Intubation ihlezi iqondile kanye Nokulungiselela Ngasikhathi sinye I-Awake Tracheostomy, i-IV Dexamethasone, I-Broad-Spectrum IV Antibiotics, kanye Nokucindezeleka Kokuhlinzwa"]

I-Anatomy kanye ne-pathophysiology: umthetho we-"Mylohyoid Line" nokuthi kungani i-molars ephansi ibangela i-angina ka-Ludwig¶

Okokuqala kwachazwa ngo-1836 ngudokotela waseJalimane uWilhelm Friedrich von Ludwig (owayiqamba ngokuthi angina elisuka kwelesiLatini elithi angere, okusho ukuthi "ukuklinya noma ukuminyanisa," hhayi ubuhlungu benhliziyo), I-angina kaLudwig ichazwa ngokwemvelo ngomthetho othize: isakazeka ngokushesha, njengebhodi, i-gangrenous-sellitis emkhathini we-cell unxantathu we-submandibular bilaterally**:

1. Isikhala Esingaphansi Kolimi (phansi emlonyeni, ngqo ngenhla komsipha we-mylohyoid).
2. I-Submylohyoid / Submaxillary Space (ngokuqondile ngezansi kwemisipha ye-mylohyoid kwesokunxele nakwesokudla).
3. I-Submental Space (ngaphansi kwenkaba yesilevu).

Kungani i-molars yesibili neyesithathu ephansi (amazinyo okuhlakanipha) yibo abanecala¶

Kungani imbobo elula noma ithumba ku izinyo langaphambili noma i-premolar yokuqala ngokuvamile ibangela ushingamu wasendaweni ukuthi ubile ngaphakathi emlonyeni, kuyilapho i-molar yesibili ephansi noma yesithathu (izinyo lokuhlakanipha)* ethelelekile ibangela i-angina ka-Ludwig esongela ukuphila? Impendulo ilele eshidini elilodwa lomsipha elibizwa ngokuthi mylohyoid muscle, elinwebeka njenge-hammock phakathi kwethambo lomhlathi elingezansi ukuze lenze iphansi elinemisipha yomlomo:

• Amazinyo phambi kwe-molar yesibili (ama-incisors, ama-canines, ama-premolars, futhi ngokuvamile i-molar yokuqala): Amathiphu (ama-apices) ezimpande zalawa mazinyo angaphambili ahlezi ngenhla (okungaphezu) okunamathiselwe kwemisipha ye-mylohyoid endaweni engaphakathi yomhlathi. Lapho ithumba kwakheka empandeni yala mazinyo, ubomvu bubhoboza ithambo ngaphezu kwesihlilingi somsipha futhi buhlale ngaphakathi emlonyeni (indawo engaphansi noma ye-buccal).
• I-molars ephansi yesibili neyesithathu (70% kuya ku-90% we-angina ka-Ludwig): Amathiphu empande ajulile we-molars ephansi yesibili neyesithathu afinyelela phansi ngezansi (ngaphansi (ngaphansi) umugqa wokunamathiselwe kwemisipha ye-mylohyoid, lapho ithambo lekhohlo elingaphakathi le-mandible lincane ngephepha. Lapho ithumba lempande engxenyeni ephansi yesibili noma yesithathu ligqabuka kulelo thambo elingaphakathi elincanyana elingaphakathi, amagciwane kanye nobuthi kulahla ngokuqondile ngaphansi komsipha we-mylohyoid ku- submandibular space.
• Isicathulo samahhashi sizungeza ngemuva komsipha: Ngenxa yokuthi unqenqema lwangemuva lomsipha we-mylohyoid lulenga njengekhethini ngaphandle komgoqo we-fascial ohlukanisa isikhala esingaphansi kwe-submandibular ngezansi nesikhala solimi olungaphansi ngenhla, isifo sisonga sizungeze umngcele ongemuva we-mylohyoid muscle ungene isikhala esincane bese weqa umugqa ophakathi nendawo** wentamo. umlomo omise okwesicathulo sehhashi.

[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

Kungani i-angina ka-Ludwig iyi-"woody cellulitis" kunokuba iphakethe lobovu kusenesikhathi¶

Ngokungafani nethumba lezinsini zamazinyo lasendaweni elakha iphakethe lobovu elithambile, eli-squishy phakathi nezinsuku ezimbalwa, i-angina ka-Ludwig yasekuqaleni iyi-isifo esisakazeka ngokushesha se-necrotizing-style cellulitis eqhutshwa ingxubevange yomlomo streptococci (Streptococcus viridans, *Streptococcus viriral/villerulent group) ama-anaerobes (Prevotella, Porphyromonas, Fusobacterium, Peptostreptococcus).

Lawa mabhaktheriya akhiqiza ama-enzyme abhubhisa izicubu, i-endotoxin, negesi engena ezindizeni zezicubu ezixhumene ngokushesha kunokuba umzimba ungawakhipha ngodonga ethumba. Ngenxa yalokho, lapho uthinta ingxenye engaphansi yesilevu sesiguli nentamo engenhla, ayizwa ithambile noma i-squishy; izwakala iqinile, ishubile, futhi ingagodli njengebhulokhi yokhuni ("i-brawny noma i-woody induration"), ngezikhathi ezithile kuba namabhamuza egesi aqhekekayo aqulekile (subcutaneous crepitus) ngaphansi kwesikhumba.

Ukubona izimpawu ezingu-6 zomtholampilo zakudala ze-angina ka-Ludwig¶

Noma isiphi isiguli esibuhlungu bezinyo eliphansi, i-molar ephukile, i-pericoronitis (i-gum flap enegciwane phezu kwezinyo lokuhlakanipha eliqhumayo), ukukhishwa kwezinyo kwakamuva, noma ukuphuka komhlathi okuba nezimpawu ezilandelayo sisengozini yokuphelelwa umoya:

Indlela yokuhlukanisa ithumba lamazinyo lasendaweni, i-angina ka-Ludwig, ithumba le-peritonsillar, nethumba le-retropharyngeal¶

Izifo zamazinyo nentamo ejulile zihlanganyela ngezimpawu ezigqagqene njengomphimbo obuhlungu, ukuvuvukala kwentamo, nomkhuhlane, kodwa ngayinye ithatha indawo ehlukile ye-anatomical futhi inezingozi ezithile:

Kusakazeka phansi esifubeni: "Isikhala Esiyingozi" kanye Nokwehla Kwe-Necrotizing Mediastinitis¶

Uma i-angina ka-Ludwig ingacindezelwe ngokushesha futhi yelashwe ngemithi elwa namagciwane enedosi ephezulu, umbulali obulalayo wesibili ngemva kokuphefumula umoya ongenhla ukusakazeka phansi kwesifuba.

Ngaphakathi kwentamo, i-fascia ejulile yomlomo wesibeletho ihlelwe ibe amashubhu aqondile. Isikhala se-retropharyngeal kanye negama elifanele elithi "I-Alar / Isikhala Esiyingozi" (Isikhala 4) sigijima njengomphini wekheshi ovulekile, ongenakungqubuzana ngokuqondile kusukela phansi kogebhezi, ngemva komphimbo nomminzo, uqonde phansi ngethoracic lokungena ku posterior mediastinum (inhliziyo, umgudu wesifuba, umgudu omkhulu oqukethe umgudu wokugaya ukudla).

Amandla adonsela phansi, kuhlangene nomfutho we-vacuum ongemuhle owenziwe ngaphakathi kwesifuba njalo lapho isiguli sihogela, sidonsa ubomvu be-polymicrobial kanye namagciwane ane-necrotizing phansi entanyeni ukuya esifubeni, okubangela Descending Necrotizing Mediastinitis (DNM), ephethe **20 kuya ku-40% izinga lokufa ** ngisho nokunakekelwa okujulile kwesimanje.

Amafulegi abomvu okuthi isifo samazinyo noma sentamo sihlehlela esifubeni¶

• Ubomvu, ukufudumala, nokuvuvukala okunomunyu okuhuquzela phansi phambi kwentamo kuya ku-notch ye-suprasternal (imbobo phakathi kwama-collarbones) naphezu kodonga lwesifuba olungaphezulu.
• Ubuhlungu besifuba obusha obusha be-retrosternal (ngemuva-thebreastbone) noma ubuhlungu be-pleuritic lapho uphefumula.
• Amabhamuza egesi aqhekekayo ngaphansi kwesikhumba sentamo engezansi noma udonga lwesifuba (i-subcutaneous crepitus) noma umsindo ohlabayo ozwakala phezu kokushaya kwenhliziyo (uphawu luka-Hamman).
• I-high spiking fever, ukuqhaqhazela, ukushaya kwenhliziyo okusheshayo ngaphezu kuka-120 bpm, ukudideka, nokwehla komfutho wegazi (septic shock).

I-Prehospital kanye nosizo lokuqala lwasekhaya: okufanele ukwenze (futhi ungalokothi ukwenze) ngenkathi ulinde i-EMS¶

1. Londoloza ukuma kwe-tripod eqondile ngaphandle kokukhetha: Vumela isiguli sihlale emaphethelweni esihlalo noma umbhede we-ambulensi sincike phambili ngamadigri angu-15 kuya kwangu-30 ikhanda laso libanjwe "indawo yokuhogela" (intamo igobe kancane phambili, ikhanda linwetshwe kancane entanyeni). Uma abezimo eziphuthumayo behambisa isiguli, i-backrest ye-stretcher kufanele iklinywe ifike ku-75 kuya ku-90 degrees*.
2. Nikeza indishi noma ithawula lokumunca amanzi kancane uma uqeqeshiwe: Ungalokothi ucele isiguli ukuthi sibhekise ikhanda laso emuva ukuze sigwinye amathe. Uma i-EMS ifika ne-catheter yokumunca eqinile ye-Yankauer, abezimo eziphuthumayo bazomunca amathe kancane ezindebeni zangaphambili ngaphandle kokuhlikihla ingemuva lolimi noma i-pharynx (okubangela i-laryngospasm).
3. Lawula umoya-mpilo oswakanyiswe kahle (uphephetha uma imaski ingabekezeleleki): Isiguli esithukile esilwela umoya ngokuvamile siyatatazela uma imaski yomoya-mpilo yepulasitiki eqinile iboshelwe ebusweni baso, sizizwe sengathi siyaphefumula. Ukubamba umoya-mpilo onomswakama ophezulu eduze komlomo nekhala (ukushaya umoya) kuthuthukisa izindawo zokugcina komoyampilo wegazi ngaphambi kokungenelela komzila womoya esibhedlela ngaphandle kokubangela ukwethuka.
4. Kungani ungalokothi uphuze ama-antibiotic asele ekhaya ukuze ubambezele ukuya esibhedlela: Iziguli ezibuhlungu kakhulu zivame ukugwinya amaphilisi amabili asele e-amoxicillin ekhabetheni lemithi bese zilinda ubusuku bonke ukuze zibone ukuthi ukuvuvukala ngaphansi kwesilevu kuyehla yini. Amaphilisi omlomo awakwazi ukungena ku-high-pressure, ukutheleleka kwe-polymicrobial submandibular ngokushesha ngokwanele, futhi ukulinda amahora angu-8 ubusuku bonke embhedeni kuyifasitela eliqondile lapho ukuvalwa kokuphefumula okubulalayo kwenzeka.

Ukuphathwa komzila womoya esibhedlela ("Ukusethwa Okukabili") kanye nokucindezelwa kokuhlinzwa¶

Ngaphambi kokusungulwa kwe-penicillin nezindlela zesimanje ze-fiberoptic airway, i-angina ka-Ludwig yabulala ngaphezu kwamaphesenti angu-50 eziguli (ikakhulukazi ngokuphelelwa umoya). Ngokulawulwa komgwaqo womoya esibhedlela ngokushesha, ama-antibiotic afakwa emthanjeni, kanye nokuwohloka kokuhlinzwa, ukufa kwehlela kokuthi ngaphansi kwamaphesenti angu-5 kuya kwangu-8.

1. Kungani i-"Rapid Sequence Intubation (RSI)" evamile inqatshelwe ku-angina ka-Ludwig¶

Ezimweni eziningi eziphuthumayo esibhedlela, odokotela balalisa isiguli nge-intravenous sedative futhi bakhubaze imisipha yaso nge-neuromuscular blocker (succinylcholine noma i-rocuronium) ngaphambi kokuslayida ishubhu lokuphefumula ngomlomo (**I-Rapid Sequence Intubation **).

Ku-Ludwig's angina, ukukhubaza imisipha yesiguli ngaphambi kokuba ishubhu lokuphefumula libe ngokuphephile kuqhoqhoqho kuyinhlekelele eyaziwa kakhulu ("Ayikwazi I-Intubate, Ayikwazi Ukukhipha umoya"): - Lapho umuthi okhubazekile uqala ukusebenza, isiguli silahlekelwa ithoni yemisipha sibambe ulimi lwaso oluvuvukele lubheke phambili, futhi umzila womoya uvaleka ngamaphesenti angu-100 (ngakho i-bag-valve-mask ayikwazi ukusunduza umoya-mpilo ngaphakathi). - Ngesikhathi esifanayo, ngenxa ye-trismus* eqinile (umhlathi okhiyiwe) kanye nephansi eliphakeme eliqinile lomlomo, udokotela akakwazi ukuvula umlomo noma ukucindezela ulimi phansi nge-laryngoscope blade ukuze abone izintambo zezwi, futhi i-epiglottis ivuvukele futhi ihlanekezelwe.

2. I-Gold-Standard Hospital Protocol: I-Ake Fiberoptic Intubation "Ngokusetha Okukabili"¶

Esikhundleni salokho, udokotela ophuthumayo, udokotela obulala izinzwa, kanye nodokotela ohlinzayo we-ENT / oral-maxillofacial bayisa isiguli (esisahleli ibhawodi siqondile) baqonde egumbini lokuhlinzela noma indawo yokuvuselela ukuze bathole I-Awake "Setup Double":

1. Indlela yokuphefumula ehamba phambili + IV Dexamethasone: Nakuba isiguli sihlala siphapheme ngokuphelele futhi siphefumula sodwa sihlezi siqondile, iqembu lifaka i-lidocaine nge-nebulize emakhaleni nasemphinjeni ukuze livimbe amandla okuphefumula, futhi linikeza i-dexamethasone emthanjeni (8 kuya ku-10 mg IV) kanye ne-epirinsal ye-enephrine racemic
2. Setha u-A (I-Awake Flexible Fiberoptic Nasotracheal Intubation): Udokotela obulala izinzwa ucubungula ngobumnene ububanzi bekhamera ye-fiberoptic ezacile, eguquguqukayo elayishwe ngaphambili ngeshubhu lokuphefumula nge-nostril elindikindiki (idlule ngokuphelele amazinyo akhiyiwe kanye nolimi oluvuvukele), iqondise imbokodo iphumele ophikweni kuqhoqhoqho, bese uslayida ishubhu lokuphefumula phezu kobubanzi bekhamera ngaphambi kokunikeza noma yimiphi imithi yokulalisa.
3. Isilungiselelo B (Indlela Yokuhlinza Ngokuvuswa Ngaso Ngasikhathi sinye): Ngesikhathi esifanayo, udokotela we-ENT noma ohlinza abantu abahlukumezekile ume eduze kombhede nengaphambili lentamo yesiguli seligezwe ngesibulala-magciwane, lifakwe ndikindiki nge-lidocaine yendawo, futhi liphawulwe ngepeni lokuhlinza, libambe ishubhu le-scalpel elivulekile kanye ne-tracheostomy. Uma ikhamera ye-fiberoptic ingakwazi ukudlula emphinjeni ovuvukele noma uma kwenzeka i-laryngospasm, udokotela ohlinzayo wenza i-tracheostomy yokuhlinzwa ephapheme noma i-cricothyrotomy** ngokushesha phakathi kwamasekhondi angu-60.
4. Kungani ukulawulwa kwendlela yomoya kuza NGAPHAMBI kwe-CT scan: Isiguli esiconsela amathe, i-stridor, noma esingakwazi ukulala phansi imizuzwana engu-60 akumele singalokothi sithunyelwe kumnyango we-radiology ukuze kuhlolwe intamo ye-CT kuze kube yilapho ishubhu yaso yokuphefumula ivikelekile.

3. Imithi elwa namagciwane efakwa emthanjeni kanye nokuhlinza nokukhipha amanzi¶

Uma ishubhu lokuphefumula selivikelekile: - I-Broad-Spectrum Intravenous Antibiotics: Ilawulwa ngokushesha ukuze ihlanganise i-aerobic streptococci, i-beta-lactamase-producing oral anaerobes, kanye ne-MRSA (ezigulini ezisengozini enkulu): ngokuvamile IV Ampicillin-Sulbactam (Unasyn) noma klzzwxh:0038 **I-Piperacillin-Tazobact / Clindamycin), kanye **IVancomycin uma ubungozi be-MRSA bukhona. - **Ukuwohloka Kokuhlzwa kanye Nokukhishwa Kwamazinyo: Uma imaging ye-CT ibonisa ukuqoqwa koketshezi, igesi, noma ukwehluleka ukuthuthukisa ngokushesha, odokotela abahlinzayo bomlomo-maxillofial noma be-ENT benza izimbobo zangaphandle eziphambene ngaphansi kwesilevu nomhlathi (**i-submandibular kanye ne-submental incision ), ngokusobala bevula i-fascial spaces, i-surgical spaces kanye ne-supplement ye-muscle ukuze bakhulule i-myloh. amazinyo aphansi e-molar angenwe yilesi sifo aqala le nkinga.

Izinombolo zezimo eziphuthumayo zesifunda kanye nezinqubomgomo ze-ejensi¶

• I-United States ne-Canada: Dayela u-911*. Cela ezokuthutha ezisheshayo eziya emnyangweni wezimo eziphuthumayo esibhedlela nge-anesthesiology yamahora angama-24 kanye ne-ENT / Oral and Maxillofacial Surgery (OMFS). Ungayi ehhovisi lamazinyo noma emtholampilo wokunakekelwa okuphuthumayo uma kukhona ukuconsa, ukushintsha kwezwi, i-trismus, noma ukuvuvukala ngaphansi kwesilevu.
• E-United Kingdom: Shayela u-999* ukuze uthole i-ambulensi Yesigaba ½ noma uye ngqo esibhedlela esikhulu esibucayi Umnyango Wezimo Eziphuthumayo (A&E) esinokuhlinzwa kwe-Maxillofacial kanye ne-ENT esizeni. Ungalindi ukuqokwa kwamazinyo okuphuthumayo kwe-NHS 111 uma izimpawu zomoya ezibomvu zikhona.
• I-European Union: Dayela u-112* kuwo wonke amazwe angamalungu e-EU futhi ubike isimo esiphuthumayo esiphuthumayo se-odontogenic airway (angine de Ludwig ngesi-French, Angina Ludovici / Mundbodenphlegmone ngesiJalimane, angina de Ludwig nge-Spanish).
• I-Australia ne-New Zealand: Dayela u-000* e-Australia noma 111 eNew Zealand.
• I-India ne-Asia-Pacific: Dayela u-112* (noma 108 e-India), 995 e-Singapore, 119 e-Japan naseNingizimu Korea, noma 999 e-Malaysia nase-Hong Kong. Qhubekela ngqo esibhedlela semfundo ephakeme esinomzila womoya ophuthumayo wamahora angu-24 kanye namaqembu okuhlinzwa ama-maxillofacial.

Imibuzo ejwayelekile ukubuzwa¶

Izinyo elingalashwa lingashintsha kanjani libe yisimo esiphuthumayo somoya esisongela ukuphila?¶

Izimpande ze-molars engezansi yesibili neyesithathu (amazinyo okuhlakanipha) afinyelela ekujuleni kwethambo lomhlathi elingezansi ngaphansi komugqa wokunamathisela we-mylohyoid muscle, eyakha iphansi lomlomo. Lapho umgodi ongalashiwe noma ithumba kwelinye lalezi zimila ezingezansi ziguguleka odongeni oluncane lwangaphakathi lomhlathi, amagciwane omlomo anolaka atheleka ngqo esikhaleni esingaphansi kwesilevu futhi azungeze endaweni yolimi olungaphansi kolimi nhlangothi zombili. Ngenxa yokuthi umhlathi oqinile kanye nentamo ejulile i-fascia ivimbela ukuvuvukala ekukhuleni ngaphandle, ukuvuvukala kuphusha phansi komlomo kanye nolimi luqonde phezulu nangemuva kuze kuvale umphimbo.

Kungani umuntu one-angina ka-Ludwig kungafanele alale phansi ngomhlane?¶

Ku-angina kaLudwig, ulimi nephansi lomlomo kuvuvukale kuze kube kabili noma kathathu ukujiya kwakho okuvamile futhi kuphushelwe ophahleni lomlomo. Ngenkathi umuntu ehlezi eqondile futhi encike phambili kancane, amandla adonsela phansi asiza ukugcina isisekelo esisindayo solimi sidonseleka kancane sisuka odongeni olungemuva lomphimbo, lushiye umkejana omncane ukuze kudlule umoya. Lapho umuntu elele phansi ngomhlane wakhe, amandla adonsela phansi adonsela ulimi oluvuvukele luhlehlisele emuva ku-hypopharynx, okubangela ukuvinjwa kwendlela yokuphefumula ngokushesha, kuthuleke, kanye nokuboshwa kwenhliziyo phakathi nemizuzu.

Yiziphi izimpawu zokuqala eziyisixwayiso zokuthi isifo samazinyo sibhebhetheka ezindaweni ezijulile zentamo?¶

Izimpawu eziyisixwayiso eziyinhloko zokuthi izinyo elibuhlungu liye lawela esimweni esiphuthumayo sentamo ejulile ukuvuvukala okusakazeka ngaphansi komngcele ophansi womhlathi ezinhlangothini zombili ngaphansi kwesilevu (ukuvuvukala okunamandla okuphansi kwe-submandibular), i-trismus (ubunzima bokuvula umlomo ube banzi kuneminwe emibili), ukuvuvukala noma ukuphakama kwezicubu ezithambile ngaphansi kolimi, ukugwinya amathe noma ukugwinya. "hot-potato" izwi. Noma yisiphi salezi zimpawu sidinga uhambo olusheshayo oluya emnyangweni wezimo eziphuthumayo esibhedlela, hhayi umtholampilo wamazinyo ojwayelekile.

Kungani kungafanele ngibeke i-pad yokushisisa noma ukucindezela okufudumele ngaphandle komhlathi ovuvukele noma intamo ephuma ethumba lezinyo?¶

Ukufaka i-pad yokushisisa noma ibhodlela lamanzi ashisayo esikhumbeni esingaphandle sesihlathi, umhlathi, noma intamo kunweba imithambo yegazi futhi kudonsele uketshezi olwengeziwe oluvuvukalayo ezindaweni ezijulile, okusheshisa ukuvuvuka kwendlela yomoya futhi kukhuthaze ukutheleleka ukuthi kukhomba ngaphandle ngesikhumba sobuso (okwenza umgudu we-sinus olimazayo) noma usakazeke ekujuleni kwentamo. Gcina ingaphandle lentamo lipholile noma izinga lokushisa elivamile legumbi.

Kungani kuyingozi ukuthi odokotela balalise isiguli sika-Ludwig se-angina ngaphambi kokufaka ishubhu lokuphefumula?¶

Ukunikeza amaphilisi okulalisa ngemithambo kanye nemithi ekhubaza imisipha ngaphambi kokuvikela ishubhu lokuphefumula kuphumuza umphimbo kanye nemisipha yolimi isiguli esiphapheme ebesiyisebenzisa ukuze sibambe indlela yaso yokuphefumula ivulekile, okubangela ukubhidlika ngokuphelele kwendlela yokuphefumula ukuze imaski ingakwazi ukusunduza umoya-mpilo phakathi. Ngesikhathi esifanayo, i-lockjaw eqinile (i-trismus) kanye nolimi oluphakeme oluqinile kwenza kube nzima ukuvula i-vocal code kanye nokubona i-vocal code. Ngakho-ke, odokotela ababulala izinzwa bagcina isiguli sihlezi siqondile futhi siphapheme, bebabaza ikhala ngesifutho se-lidocaine ukuze baqondise ikhamera ye-fiberoptic eguquguqukayo ngekhala iye epayipini lomoya kuyilapho udokotela ohlinzayo emi elungile entanyeni.

Ingabe i-angina ka-Ludwig ingenzeka kubantu abadala abanempilo?¶

Yebo. Nakuba isifo sikashukela, ukucindezelwa kwamasosha omzimba, ukungahlanzeki kwamazinyo, nokuntuleka kokufinyelela ekunakekelweni kwamazinyo kwandisa ubungozi, ngaphezu kwengxenye yazo zonke izigameko ze-angina zika-Ludwig zihlasela abantu abadala abaphile kahle ngaphambili nabaphakathi kweminyaka yobudala engama-20 kuya kwengama-50, ngokuvamile ebangelwa izinyo elinokuhlakanipha elithelelekile noma elithintekile (i-molar yesithathu) noma isizinda somzimba esiphansi sakamuva.

Imithombo neziqondiso ezisemthethweni¶

• I-Difficult Airway Society (DAS, United Kingdom) kanye ne-Royal College of Anesthetists (NAP4): Imihlahlandlela Yokuphathwa Komgwaqo Onzima Novinjiwe Wekhanda Nentamo (ukuphaphama kwe-fiberoptic nasotracheal intubation, ukugwema ukuma kwe-pine, kanye ne-double-setup tracheostomy yokuhlinzwa).
• I-American Society of Anesthesiologists (ASA, United States): 2022 ASA Practice Guidelines for Management of the Difficult Airway (izindlela zokuphaphama zokungena ezifweni zentamo ejulile kanye ne-trismus).
• Infectious Diseases Society of America (IDSA, United States): Imihlahlandlela Yokuzilolonga Yomtholampilo Ye-Odontogenic and Deep Neck Space Infections (i-polymicrobial coverage ye-Streptococcus anginosus/viridans kanye ne-oral anaerobes, kanye nokufakwa kwe-MRSA).
• I-American Association of Oral and Maxillofacial Surgeons (AAOMS) & British Association of Oral and Maxillofacial Surgeons (BAOMS): I-Emergency Triage and Surgical Decompression of Submandibular, Sublingual, and Submental Space Infections (Ludwig's Angina).
• Isikhungo Sikazwelonke Sezempilo Nokunakekelwa Okuvelele (NICE) kanye ne-NHS (e-United Kingdom): Ithumba Lamazinyo kanye Ne-Deep Neck Space Infection Amafulegi Abomvu Wokudluliselwa Komnyango Wezimo Eziphuthumayo.

Iziqondiso ezihlobene¶

• Ithumba le-Peritonsillar, i-angina ka-Ludwig, kanye nezifo ezijulile zentamo
• I-Epiglottitis, i-croup, i-stridor, nokuvinjelwa komzila womoya ophezulu
• Izimo eziphuthumayo zamazinyo, izinyo elikhishwe ngokuqhuqha, kanye nezinyo elibuhlungu
• I-Orbital cellulitis, i-cavernous sinus thrombosis, kanye nezifo zobuso ezinobungozi obunxantathu
• Ukubonwa kwe-Sepsis kanye nokushaqeka kwe-septic kanye nokuhlolwa kwesimo esiphuthumayo