Kakoschke T K, Ehrenfeld M, Mast G
Klinik und Poliklinik für Mund‑, Kiefer- und Gesichtschirurgie, Klinikum der Universität München, LMU München, Lindwurmstraße 2a, 80337, München, Deutschland.
Chirurg. 2020 Apr;91(4):283-292. doi: 10.1007/s00104-020-01121-x.
This article gives an overview of severe and fulminant infections of the head and neck region. The focus is on the treatment, diagnostics and causes of abscesses, phlegmon and necrotizing fasciitis.
Despite guideline-conform treatment soft tissue infections of the head and neck can spread rapidly and be life-threatening.
Analysis and discussion of basic research and expert recommendations, case reports.
While purulent tonsillitis is the primary cause of severe bacterial soft tissue infections in children, dental infections are the leading cause in adults. The infections often spread along anatomic spaces and can extend into the brain or mediastinum and a hematogenic dissemination is also possible. Multiple operations and combined antibiotic treatment are often required as well as additional treatment, such as intubation, tracheotomy and dialysis. Late or early onset complications can occur and reconstructive measures might be necessary in addition to rehabilitation.
Severe bacterial soft tissue infections can be still life-threatening despite guideline-conform treatment and are associated with a high mortality especially in high-risk patients even with intensive medical care. They can lead to disfiguration and loss of function resulting in a greatly reduced quality of life. Rapid diagnostics and therapy are essential for successful treatment.
本文概述了头颈部的严重和暴发性感染。重点在于脓肿、蜂窝织炎和坏死性筋膜炎的治疗、诊断及病因。
尽管对头颈部软组织感染进行了符合指南的治疗，但感染仍可能迅速扩散并危及生命。
对基础研究和专家建议进行分析与讨论，并纳入病例报告。
虽然化脓性扁桃体炎是儿童严重细菌性软组织感染的主要原因，但牙源性感染是成人的主要病因。感染常沿解剖间隙扩散，可蔓延至脑部或纵隔，也可能发生血行播散。通常需要多次手术及联合抗生素治疗，还可能需要其他治疗，如插管、气管切开和透析。可能会出现晚期或早期并发症，除康复治疗外，可能还需要采取重建措施。
尽管进行了符合指南的治疗，但严重细菌性软组织感染仍可能危及生命，尤其在高危患者中，即便接受了强化医疗护理，死亡率仍很高。它们可导致毁容和功能丧失，从而使生活质量大幅下降。快速诊断和治疗对于成功治疗至关重要。
