Postoperative infections in the upper respiratory tract.

Pathogenesis, prophylaxis and treatment of postoperative infections in the upper respiratory tract are discussed. Surgical procedures always hamper the normal mucosal defence system, which means that true pathogens and members of the normal flora can establish a heavy growth that will, inevitably, to some extent challenge the humoral and cellular defense of the mucosal and submucosal tissues. It is stressed that the activation of granulocytes and macrophages, which leads to the release of proteolytic proteases, can cause tissue destruction and thus also bacterial invasion. Prophylaxis should be based on good surgical technique, efficient drainage of the wound and prevention of accumulation of secretions. Antibiotic prophylaxis is recommended in risk situations, such as in extensive surgery and when the wound extends through the tissue from the skin to the mucosa. Postoperative infections have to be treated with surgical drainage and elimination of devitalized tissues in combination with antibiotic regimes based on results of bacteriological analysis.