Peterson L J
Department of Oral and Maxillofacial Surgery, College of Dentistry, Ohio State University, Columbus 43210.
J Oral Maxillofac Surg. 1993 Mar;51(3):226-31. doi: 10.1016/s0278-2391(10)80162-4.
Odontogenic infections rarely lead to involvement of the lateral and retropharyngeal spaces. When this does occur, the microbiology of the infection is similar to the typical odontogenic infection, ie, Streptococcus and oral anaerobes including Peptostreptococcus, Bacteroides, and Fusobacterium. There is an increased incidence of Fusobacterium seen in the more severe infections, as well as a higher incidence of Streptococcus milleri. Many patients who have deep cervical infections also have some compromise in their host defense mechanism, such as diabetes. The signs and symptoms of deep cervical space infections are similar to those of the severe submandibular space infection, but also includes sialorrhea, respiratory distress, odynophagia, and dysphagia. Lateral soft-tissue radiographs of the neck are useful in assisting with the diagnosis of retropharyngeal infections, and CT scans can provide definitive information regarding lateral pharyngeal space involvement. Treatment includes the use of high-dose intravenous bacteriocidal antibiotics. The recommended antibiotics are penicillin-metronidazole, ampicillin-sulbactam, or clindamycin. Certain cephalosporins may also be useful in selected patients. Early surgical intervention is also indicated. Aggressive incision and drainage of all of the involved spaces is necessary to assure early resolution of the infection. Continual airway monitoring and the establishment of surgical airways is the final portion of the treatment triad.
牙源性感染很少累及咽旁间隙和咽后间隙。当这种情况确实发生时，感染的微生物群与典型的牙源性感染相似，即链球菌和口腔厌氧菌，包括消化链球菌、拟杆菌和梭杆菌。在更严重的感染中，梭杆菌的发生率增加，米勒链球菌的发生率也更高。许多患有深部颈部感染的患者其宿主防御机制也存在一定缺陷，如糖尿病。深部颈部间隙感染的体征和症状与严重的下颌下间隙感染相似，但也包括流涎、呼吸窘迫、吞咽痛和吞咽困难。颈部侧位软组织X线片有助于辅助诊断咽后感染，CT扫描可提供有关咽旁间隙受累的确切信息。治疗包括使用大剂量静脉注射杀菌抗生素。推荐的抗生素是青霉素-甲硝唑、氨苄西林-舒巴坦或克林霉素。某些头孢菌素在特定患者中可能也有用。早期手术干预也有必要。对所有受累间隙进行积极的切开引流对于确保感染尽早消退是必要的。持续气道监测和建立手术气道是治疗三联的最后一部分。
