BMF+SUPURATII
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Transcript of BMF+SUPURATII
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CHIRURGIE MAXILO-FACIALA
AN V
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CAPITOLE
•TRAUMATISMELE ORO-MAXILO-FACIALE•INFECTIILE ORO-MAXILO-FACIALE•SINUZITA MAXILARA ODONTOGENA•TUMORI BENIGNE ALE OASELOR MAXILARE SI PARTILOR MOI•PATOLOGIA A.T.M.•TRATAMENTUL CHIRURGICAL AL ANOMALIILOR DENTO-MAXILARE
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INFECTII O.M.F.
• Stare de suferinta organica septica
• Proces patologic complex cu fenomene alterative,exudative,dar si reparatorii
• Mai frecvente la organismele cu capacitate imunologica de aparare scazuta
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FORME ANATOMO-PATOLOGICE
• CELULITA = stadiu I reversibil, fenomene exudative importante; clinic tumefactie localizata
• ABCESUL = forma localizata a unei colectii purulente,delimitat de memebrana piogena. Clinic : tumefactie,hiperemie,fluctuenta, curbatura,febra,frisoane,durere locala
• FLEGMONUL = forma difuza,necrozanta,buloasa cu sfacele. Clinic : tumefactie difuza,tegument si mucoasa livide, infiltrat indurat,dureros, aspect toxico-septic.
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ETIOPATOGENIA
Factori favorizanti locali :• Punctia septica• Complicatiile extractiei + tratamente odontale• Leziunile osoase post-traumatice• Corpi straini• Tumori• Litiaze• Infectii faringo-amigdaliene
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ETIOPATOGENIA
Factori favorizanti generali
• Varsta
• Reactivitatea naturala scazuta
• Casexie,malnutritie
• Afectiuni neurologice
• Terapia orala indelungata cu Ab sau Corticosteroizi
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ETIOPATOGENIA
Factori determinanti :
A. Leziuni dento-parodontale :
1. gangrena complicata
2. pungi parodontale
3. fracturi dentare
4. accidente de eruptie
B. Rezistenta crescuta a agentilor patogeni
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MECANISMELE DE DIFUZARE
• Calea transosoasa
endodentar periodontal endoosos
subperiostal submucos
• Calea submucoasa : post-fracturi,accidente de eruptie sau parodontopatii. Posibilitate de evacuare spontana
• Calea sistemului circulator – limfatice+vene
• Calea directa – puncti septice
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CLASIFICARE
A. Circumscrise
B. Abcesele lojilor
A. Supuratii difuze
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CLASIFICARE
perimax : abces vestibular
abces palatinal
abces parodontal
A.Circumscr.
muc : abces vestibular
abces perimand int
perimand abces parod marg
teg : abces perimand ext
abces semisferic
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CLASIFICARE superf. : submandibular
sublingual
limbii
submentoniere
B. Abcesele lojilor parotidiene
maseterine
migrator
genian
orbitei
temporale
prof. : infratemporale
latero-faringian
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CLASIFICARE
C. Supuratii difuze
- flegmonul difuz al palatului
- flegmonul difuz hemifacial
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ABCESE PERIMAXILARE
ABCES VESTIBULAR
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ABCES VESTIBULAR
• Cel mai frecvent abces dentar, evol. submucos• Dureri pulsatile la debut, continue in evol• Stadiu subperiostal : tumefiere congestiva a
mucoasei, impastare, durere acuta, curbatura,febra,frison
• Dupa erodarea periostului durerile dispar, palpare-fluctuenta, edeme de parti moi functie de localizare (buza de tapir,palpebral,etc.)
• DGN POZ ex clinic+RX : radiotransp neomogena difuza periapicala sau forma rot.,regulata,omogena (proces mai vechi)
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ABCES VESTIBULAR
• DGN DIF:
1. chist maxilar exteriorizat – inflamatie
2. chist de maxilar suprainf – RX
3. tumori endoosoase suprainfectate – RX
4. supuratii la fracturi – anamneza+RX
5. furnuncul fetei – burbion+lipsa semnne intraorale.
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ABCES VESTIBULAR• TRATAMENT - endosos : drenaj endodontic - subperiostal : deschidere chirurg - submucos : incizia+drenaj - incizie liniara 2-3 cm in zona cea mai decliva a
colectiei sub anestezie - in forma subperiostala se sectioneaza pana la
corticala - drenajul se realizeaza cu o lama de cauciuc 24-
48h - tratamentul dd cauzal
• EVOLUTIE : osteite,osteomielite,sinuzite,fistulizare
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ABCESE PERIMAXILARE
ABCESUL PALATINAL
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ABCES PALATINAL
• Punct de plecare IL si rad. P ale Pm si M• IL – forma alungita, 1/3 anterior paramedian• Laterali – forma rotunda, in santul pal.
• CLINIC : simptome parod ap ac, tumefactie palatinala,durere vie
• Obiectiv : tumefactie 1-2cm,unilaterala,mucoasa congestiva,dureroasa,extrem de dureroasa
• Stare generala alterata
• DGN POZ clinic+RX
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ABCES PALATINAL
• DGN DIF:
1. chist suprainfectat
2. tumori endoosoase suprainf
3. adenom si carcinom adenoid chistic salivare
4. goma luetica – stadiul de ramolire.
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ABCES PALATINAL
• TRATAMENT - exclusiv chirurgical - anest nazo-palatin si palatin anterior sau
infiltratie de-a lungul liniei de incizie - incizie pe bombarea maxima,paralela cu a.
palatina,cat mai aproape de linia mediana - excizia unei portiuni de fibromuc =felie de
portocala - in plaga se introduce mesa iodoformata - tratamentul dd cauzal
• EVOLUTIE : erodeaza tabla osoasa sinuzala,a foselor nazale, fistulizare
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ABCESE PERIMAXILARE
ABCESUL PARODONTAL
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ABCES PARODONTAL
• Complicatia infl ac a parodontitelor marg profunde
• Durere medie,localizata,pulsatila,raspunde la analgetice
• Dd mobil si dureros la percutie, gg tumefiata,congestionata
• Sonda patrunde in colectie,evacuand o cantit mica de puroi
• DGN POZ clinic + RX(=rezorbtie osoasa).
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ABCES PARODONTAL
• DGN DIF: 1. abces V : simptomat. mai intensa 2. abces perimand submucos int – fata int a
mand Pm-M 3. tumori de granulatie cu debut gg
• TRATAMENT : anestezie, incizie verticala,compresiune. Pt drenaj mesa cu Chlumski si iodoform 24h.
• EVOLUTIE : fistulizare sau evacure spontana,pulpite si gangrene retrograd, mobilizare.
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ABCESE PERIMAXILARE
ABCESUL PERIMANDIBULAR
INTERN SUBMUCOS
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ABCES PERIMANDIBULAR INTERN SUBMUCOS
• Fata ling a corpului mandib• 3 stadii : endodosos,subperiostal,submucos• Punct de plecare : gangrena complicata a lat. Inf.
Sau corpi straini
• CLINIC tumefactie bine delimit,muc congestionata,
disfagie,disfonie,sialoree
• DGN POZ examen endobucal
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ABCES PERIMANDIBULAR INTERN SUBMUCOS
• DGN DIF: 1. abces de loja sublg – “creasta de cocos” 2. wartonita si periwartonita litiazica –
simptomat de debut 3. tumori de planseu buc endofitice – fara fen ac 4. tumori de corp mandib –evol lenta
• TRATAMENT : anestezie, incizie in bombarea maxima,paralela cu festonul gg cat mai aproape de feston, drenaj cu lama de cauciuc, tratamentul dd cauzal
• EVOLUTIE : drenare,fistulizare,difuzare loja sublg,submand,limba
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ABCESE PERIMAXILARE
ABCESUL PERIMANDIBULAR
EXTERN
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ABCES PERIMANDIBULAR EXTERN
• Fata ext a corpului mand, punct de plecare Pm si M inf• Evolutie : apex-subperiostal-subcutan bazilar-fata int a
corpului mand
• CLINIC tumefactie geniana inf,submand sub-bazilar. tegumente destinse,congestionate endobucal muc vest inf edematiata,la palpare
impastarea fornix vestibulare stare generala alterata,sialoree,tulb funct,trismus• DGN POZ clinic+RX, semn patognomonic =localizare stricta
peribazilar.
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ABCES PERIMANDIBULAR EXTERN
DGN DIF
1. Abces loja submand –extinderea 2. Adenita supurata submand –nodul,fara trismus3. Osteoperiostita –exobucal discret4. Osteomielita mand difuza –dd mobili,papile
hipertrofice,puroi in sant gg5. Chisturi suprainf –RX6. Tumori de corp mand – fara inflamatie
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ABCES PERIMANDIBULAR EXTERN
• TRATAMENT - decubit dorsal,cap in extensie, anestezie de-a lungul liniei de incizie sau generala, incizie 3-5cm, inauntrul,sub si de-a lungul marg inf mand
- se ia ca reper bazilara, se sectioneaza teg,platysma,fascia cerv sup, se patrunde cu o pensa Pean pana la os. Dc colectia e difuza se insinua capul pensei pe fata ext/int a corpului mandibular
- drenaj cu lama dren cauciuc sau tub polietilen fixat cu fir nerezorbabil 48-72h
- tratamentul dd cauzal
• EVOLUTIE : extinderea spre lojile vecine
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ABCESELE LOJELOR SUPERFICIALE
ABCESUL LOJEI
SUBMANDIBULARE
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ABCESELE LOJELOR SUPERFICIALE
ABCESUL LOJEI SUBMANDIBULARE
ANATOMIE - localizare: planseu bucal posterior - delimitata sup-median de mucoasa, milohiodian si
hioglos; infero-lateral de fascia,platysma si tegumente. Peretele lateral = fata int a corpului mandib, peretele medial=digastric,stiloh,miloh,hioglos,stiloglos si fasc faringoglos al constrict sup faring.
- interstitiul hiogloso-miloh : duct Warthon,MVN lg si XII - loja : gl submand,duct Warthon,n lg,a si v fac, a si v
lg,tes lax - comunic : loja sublg,parot,trigon carotic,loja paraamigd
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ABCESUL LOJEI SUBMANDIBULARE
• ETIOPATOG - Procese septice punct de plecare M inf- Adenite supurate submand- Sialolitiaza submand inf- Propagare inf din loji vecine
• CLINIC- i.i. 1/3 distala a corpului mand, tumefactie importanta- Tegumente congestionate,impastare tisulara- Trismus,congestia muc pl buc+pilier ant- Palpare orala dureroasa,fluctuenta sau impastare- Dureri spontane lancinante- Stare generala alterata
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ABCESUL LOJEI SUBMANDIBULARE
• DGN POZ anamneza+RX• DGN DIF:1. Adenita ac submand – noduli,trismus absent2. Submaxilita ac supurata,litiazica – pres pe gl se
scruge puroi3. Abces perimand ext – strict perimand4. Abces de loja sublg – tumefactie in p ant a gatului5. Adenopatii luetice sau TBC – fara infl6. Adenopatii sec unor tumori mlgn7. Actinomicoza - fistule8. Flegmonul de planseu buc – stare toxico-septica
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ABCESUL LOJEI SUBMANDIBULARE
• TRATAMENT- Anestezie- Incizie curba 5-6cm, 1/3 post submand, 2 cm
inauntrul marg baz- Sect teg,platysma si fascia cerv, se patrunde cu
pensa Pean- Explorare atenta cu indexul pt a evita
decolararea inutila a periostului- Drenaj cu 2 tuburi de cauciuc taiate in bizou,
asezate la nivele diferite,fixate cu fir nerezorbabil 48-72h
- Incizie exofac : supuratii masive
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ABCESUL LOJEI SUBMANDIBULARE
- Indicatie incizie endobucala : supuratie in reces submand. Cu bombare in jumat distala a santului mandibulo-lg
- Infiltratie prin inciz sigm pt trismus- Incizie de 2cm in dreptului bombarii maxime- Se patrunde in loja submand cu vf pensei pean- Drenaj lama cauciuc 24-48h
• EVOLUTIE cronicizare, extindere in loji vecine.
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ABCESELE LOJELOR SUPERFICIALE
ABCESUL LOJEI
SUBLINGUALE
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ABCESUL LOJEI SUBLINGUALE
• ANATOMIE- anterior: mucoasa- posterior: m miloh- Medial: genioglos,geniohiloidian si hioglos- Lateo-ant: fosa sublg- Comunicari : loja sublg controlat si submand- Contine : gl sublg, port sublg Warthon,MVN
sublg,XII
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ABCESUL LOJEI SUBLINGUALE
• ETIOPATOG- Pm + Minf, pericoronarite supurate M3 inf.- Supuratii se datoreaza : litiaza inf Warthon,punctii
septice sau corpi straini,difuzare din loja controlat+submand
• CLINIC- congestie+tumefactie sublg unilat, plica sublg acop de
depozite fibrinoase=“creasta de cocos:- Consistenta indurata- Stare generala alterata,durere pulsatila in planseu,tulb
functionale
• DGN POZ anamneza+ex cl
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ABCESUL LOJEI SUBLINGUALE
• DGN DIF: 1. Abces loja submand – manif exobuc
marcate2. Abces perimand int – tumefactie superf3. Warthonita si periwarthonita – clinic4. Flegmonul difuz al pl buc – bilat5. Ranula si chist dermoid – fara fen infl6. Tumori mlg – fara fen infl
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ABCESUL LOJEI SUBLINGUALE• TRATAMENT- Deschiderea cutanata- Anestezie generala sau loco-reg+bazala,incizie
4-5cm, paramedian intre marg baz mentoniera si hiod
- Se sect tegumentul,platysma si facsia cerv, se perforeaza m miloh cu o pensa Pean sub control palpatoriu endobucal
- Drenaj cu 2 tuburi de cauciuc 24-48h- Calea endobuc – colectia superficiala,incizie 2-3
cm sub anestezie Spix intre cr sublg-os pe bombarea maxima stric mucozal, drenaj cu o lama de cauciuc.
• Complicatii : difuzare spre lojile vecine
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ABCESELE LOJELOR SUPERFICIALE
ABCESUL LOJEI
SUMENTONIERE
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ABCESUL LOJEI SUBMENTONIERE
• ANATOMIE- Intre menton-gat- Lateral : pantecele m digastric- Superior : m miloh+genioglos• ETIOPATOG- Frontali inferiori, supuratiile
submandibulare+sublg+adenite supurate+furuncule
• CLINIC- Impastare submentoniera difuza,dureroasa- Tumefactie = “a doua barbie”- Tegumente destinse,fara semne de tulb
functionale
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ABCESUL LOJEI SUBMENTONIERE
• DGN POZ
- Ex clinic+ absenta semnelor endobucale
• DGN DIF1. Abces loja sublg - endobuc
2. Adenita supurata submentoniera – nodul
3. Furuncul submentonier – edem
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ABCESUL LOJEI SUBMENTONIERE
• TRATAMENT- anestezie, incizie arcuata 4-5 cm, 2m inauntrul
arcului mentonier- Se sectioneaza teg,platysma,fascia cerv- Se deschide pensa pt evacuare- Drenaj cu tub de cauciuc,fire nerezorbabile 24-
48h
• EVOLUTIE – fistulizare,difuzare loji vecine.
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ABCESELE LOJELOR SUPERFICIALE
ABCESUL LIMBII
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ABCESUL LIMBII
• Localizare : parenchim lg central (intre geniogl); lat (genio-hio)• ETIOPATOG- loji vecine,agenti traumatici,ulceratii date de dd• CLINIC- central : tumefiere in bloc, muc
congestionata,sialoree,deperditie salivara comisurala,tulb funct datorita durerilor,stare generala alterata
- periferic : tumefactie lat,fluctuenta,stare gen buna,sialoree,halena
- superficial : bombare+fluctuenta- profund : planseu bucal
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ABCESUL LIMBII• DGN POZ clinic+punctie
• DGN DIF
1. Abces planseu buc – limba supla,nedureroasa
2. Inflamatiile lb – lues,TBC
3. Chisturi dermoide infectate de bz de lb – cl
4. Tumori mlg lb – fara infl,evolutie
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ABCESUL LIMBII
• TRATAMENT – urgenta chirurgicala- Exobuc : supuratii centrale,baza lb
anest gen cu intubare
incizie arcuata 4-5cm, paralela cu barbia,menton-hiod
sectionare,pensa Pean in parenchim lg sub control palpatoriu
sectionare rafeu median miloh
drenaj 2 tuburi de cauciuc 48h
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ABCESUL LIMBII
• TRATAMENT Endobucal : portiunea libera, evol superf profund : punctie+incizie anest loc incizie longit evol spre fata pelvina – punctie in
sant paralg, acul=reper pt incizie de o parte si de alta a acului
drenaj cu tub/lama
• EVOLUTIE – asfixie mecanica,invadarea lojilor vecine
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ABCESELE LOJELOR SUPERFICIALE
ABCESUL LOJEI
MASETERINE
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ABCESUL LOJEI MASETERINE
• ANATOMIE- Fata ext ram mand-fascia maset- Sup : arcada zig- Inf : 1/3 post a marg baz+gonion- Ant : marg ant maseter- Post : marg post ram mand- 2 compartimente : profund ram-muschi superf muschi-fascie- Contine : muschi+prelung parot+Stenon,MVN
maset+VII
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ABCESUL LOJEI MASETERINE
• ETIOPATOG- Osteomielita ram, suprainfect chist de ram, M3 inf,
agenti traumatici
• CLINIC- Tumefactie unghi-arcada zig- Teg congestionate- Impastare dureroasa sau fluctuenta- Stare gen alterata- Trismus puternic
• DGN POZ- clinic
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ABCESUL LOJEI MASETERINE
• DGN DIF
1. Abces genian –localizare2. Abces parot – localiz 3. Parotidita ac supurata – pres pe Stenon4. Ostemielita ram – RX5. Adenita supurata pretragiana - nodul
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ABCESUL LOJEI MASETERINE
• TRATAMENT- Exobuc : superf si prof extensive anest loc/gen incizie arcuata 5-6cm se introduce pensa Pean supero-anterior
sau profund pana la os drenaj lama/tub 48-72h- Endobuc : evol submucos anest loc incizie vertic retromolara se introduce Pean drenaj 3-4z lama/tub• EVOLUTIE – extindere spre lojile invecinate,
constrictie mand
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ABCESELE LOJELOR SUPERFICIALE
ABCESUL LOJEI
PAROTIDIENE
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ABCESUL LOJEI PAROTIDIENE
• ANATOMIE- Ant : marg post ram+Pterid Med+maseter- Post : SCM +pantece post digastric- Sup : mastoida- Inf : linie imag bazilara- Prof : stiloid+per lat faring- Contine : parot+Stenon+VII+auriculo-temp+auric
mare+ACE+VJE+V retromand- Comunica : loja submand,temp,trigon
carotic,fosa infratemp
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ABCESUL LOJEI PAROTIDIENE
• ETIOPATOG- Supuratii parot,adenite intraparotid supurate,infectii
CAE,loji vecine
• CLINIC- Stare septica,tumefactie
importanta,congestie,renitenta,fluctuenta,durere- Secretie sal modif,trismus,torticolis
• DGN POZ- Ex cl+anamneza
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ABCESUL LOJEI PAROTIDIENE
• DGN DIF
1. Parotidita sup : fara infl
2. Litiaza suprainf – sialografia
3. Adenite intraparot sup
4. Tumori bng intraparot – fara infl
5. Tumori mlg intraaparot – pareza VII
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ABCESUL LOJEI PAROTIDIENE
• TRATAMENT- Anest gen/loc- Incizie subangulomand 3-5cm ce ocoleste
gonionul- Pensa Pean se perforeaza fascia parotd- Drenaj cu tub/lama 24-48h
• EVOLUTIE- Extindere spre lojile vecine
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ABCESELE LOJELOR SUPERFICIALE
ABCESUL MIGRATOR
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ABCES MIGRATOR
• ETIOPATOG- Punct de plecare pericoronarita supurata M3 inf- Evol cutanata (ext de m buccinat)- Evol endobuc (Pm)
• CLINIC- Colectie bine delimit,retrocomisurala- Teg congestionate- Durere- Impastare/fluctuenta- Cordon fibros in obraz- Trismus- Endobucal : pericoronarita- St gen alterata
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ABCES MIGRATOR
• DGN POZ- anamneza+ex cl+cordon fibros=semn patognomic
• DGN DIF1. Abces genian2. Abces perimand ext3. Furuncul facial – burbion4. Chist sebaceu inf5. Lipom obraz6. Abces V inf – fara cordon fibros7. Chist mand infectat - RX
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ABCES MIGRATOR
• TRATAMENT- exo/endo- Anest locala- Incizie la polul inf- Drenaj 24-48h tub- Odontotectomia M3inf
• EVOLUTIE- fistulizare, difuzie reg vecine
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ABCESELE LOJELOR SUPERFICIALE
ABCESUL OBRAZULUI
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ABCESUL OBRAZULUI
• ANATOMIE- Sup : arcada zigomatica+rebord orbital- Lat : maseter- Inf : bazilara- Medial : linia care trece prin santul genian- Profunzime : oase maxilare- 2 compartimente : ext si int- Contine : bula lui Bichat, vase faciale,tes conj fibros,lax
• ETIOPATOG- Pm+M, pericoronarita M3 inf, litiaza Stenon, furuncule,
chisturi sebacee infectate, etc.
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ABCESUL OBRAZULUI
• CLINIC- Forma circumscrisa : tumefactie redusa,st gen
buna, fara tulb func- Forma difuza : tumefactie voluminoasa,
congestie, edem Mucoasa bombeaza in V,
amprenteaza dd Palpare dureroasa, impastare /
fluctuenta stare gen alterata, halena,
hipersalivatie• DGN POZ- anamneza+ex cl
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ABCESUL OBRAZULUI
• DGN DIF
1. Flegmon hemifacial2. Chist sebaceu infectat3. Lipoamele obrazului4. Angioame si limfangioamele5. Adenite geniene inf6. Tumori mlg obraz
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ABCESUL OBRAZULUI• TRATAMENT- Exobuc – proc difuz Cale submandib Anest gen incizie 5-6cm Pean in loja geniana drenaj cu tuburi- Endobuc : supuratii colectate anest loc incizie 2-3cm spre fornix V drenaj lama/tub 24-48h- Calea mixta – supuratii difuze
• EVOLUTIE – difuziune,embolii ale sin cavernos
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ABCESELE LOJELOR SUPERFICIALE
ABCESUL ORBITEI
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ABCESUL ORBITEI
• ANATOMIE- Piramida patrulatera- 2 loje : pre si retro-capsulare
• ETIOPATOG- Difuzarea infectiei de la obraz,fosa infratemp,sinuzite ,
rar dentoparodontale.
• CLINIC- edem,kemozis,congestie palpebrala, glob ocular
protruzat, fara semne de disfunctie oculara senzitiva, dureri pulsatile, cefalee puternica.
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ABCESUL ORBITEI
• DGN POZ Anamneza + ex cl
DGN DIF
1. Abces palpebral – fara durere la pres oc2. Celulita orbit pasagera – cedeaza la Ab3. Trombofleb sin cav – semne neurol4. Sup spatiului retromax – dureri hemicranie5. Tumori de orbita – fara infl
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ABCESUL ORBITEI
• TRATAMENT- Urgenta chirurg- Anest gen/locala- Incizie marg sup/inf, unghi ext/int functie de
pdp- Se introduce o pensa Pean ce patrunde in
capsula Tenon- Drenaj lama/tub 24-48h
• EVOLUTIE – pierderea ireversibila a vederii
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ABCESELE LOJELOR SUPERFICIALE
ABCESUL LOJEI
TEMPORALE
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ABCESUL LOJEI TEMPORALE
• ANATOMIE- Medial : pl osos fosa temp- Supero-lat : fascia temp prof- Inf-lat : lama super+prof ale fasciei temp prof- Contine : m temp, grasimea temp, grasimea
bucala, MVN temp prof,limfatice- Colectia : os-muschi; muschi-fascie
• ETIOPATOG- Molari max, ag traumatici
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ABCESUL LOJEI TEMPORALE
• DGN POZ- Anamneza + ex cl
• DGN DIF1. Abces fosa infratemp – simptome+localiz2. Tumori temp – fara infl+evol
• TRATAMENT- Anest gen/loc + incizie oblica la polul inf al
colectiei strict tegumentara + drenaj lama 24-48h
• EVOLUTIE – extinderea spre lojile vecine
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ABCESELE LOJELOR PROFUNDE
LOJA INFRATEMPORALA
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LOJA INFRATEMPORALA
• ANATOMIE- Lat : ram mandib- Ant : tuberozitate- Posterior : parotida- Inauntru : apofiza pterigoida, faringe- 2 compartimente : pterigo –max(int), -mand(ext)- Comunica : loja submand,sp
laterofaring,parotida,fosa temp- Contine : n max,mand, ACI,V max int, plex venos
pteriogid,m pterigoi int+ext
• ETIOPATOG- Supuratii dd,max,sinuzale, punctii septice,loji vecine
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LOJA INFRATEMPORALA
• CLINIC- Exo discret- Nevralgii hemicranie,trismus,febra- Edem genian mic, tumefactie
palpebrala,temp,parotido-maset,submand- Afect gl oc : kemozis,edem palpebral
inf,exoftalmie,durere- Endobuc : pterigomax-trismus,tumefactie
perituberozit pterigomand – tumefactie int de ram- Tulb functionale
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LOJA INFRATEMPORALA
• DGN POZ- Stare septica + ex cl + anamneza + punctie
exploratorie
• DGN DIF
1. Nevralgii trigeminale – fara infl2. Abces obraz3. Abces submand4. Tumori de mezostructura cu invadare
infratemp – fara infl
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LOJA INFRATEMPORALA
• TRATAMENT- Urgenta chirurgicala- EXOBUC – pt ambele spatii - se asociaza incizii endob - submand – indicata pt ambele
sp+submand+sp laterofaring. Incizie sub bazila paralela cu 1/3 distala a corpului mand + drenaj cu 2 tuburi 2-4z
- zigomatica+temp – supuratii cauzate d e punctie septica Spix+inf max. Se asoc incizii endobuc. Se poate rezeca arcada zig. cu incizii juxtazig – dezavantaj : estetic.
- incizii zig : sup/inf de arcada, cele temp : paralele cu VII.
- se introduce o pensa Pean + 2 tuburi de dren supraetajate+irigatii cu antiseptice
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LOJA INFRATEMPORALA
• TRATAMENT- ENDOBUC – sup intereseaza strict loja - pterigo-mand : sup acestui spatiu,
incizie vertic pe ram+drenaj cu lama / 2 tuburi 48h - retromax – supuratiile pterigomax,
incizie curba perituberozit + drenaj lama/2tuburi 3-4z - incizii asociate – supuratii extensiv-progresive - transsinusal – cauza empiem. Anestezie
gen + trepanare perete ant+post sinusal + drenaj 4-5 tuburi cu 2 tuburi retromaxilar.
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ABCESELE LOJELOR PROFUNDE
SPATIUL LATERO-FARINGIAN
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ABCESUL LATEROFARINGIAN
• ANATOMIE- ram-faringe-coloana vertebrala- Lateral : PG Intern- Median : faringe- Sup : baza craniu- Posterior : fascia prevertebrala- Inferior : plan prin gonion- 3 loji : paraamigd, parotid, sp retrostilian- Paraamigd : intre constrictor faring-PGint, contine a
pal desc,farinf asc,IX- Retrostilian : ACI,VJI, IX,X,XI,XII, ggl cerv sup+ggl
limf- Comunica : sp retrofaring,fosa infratemp,loja
maset,loja submand,loha marilor vase lae gatului
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ABCESUL LATEROFARINGIAN
• ETIOPATOG- Infectii din lojile vecine, infectii M
mandibulari
• CLINIC- Dureri la deglutitie- Stare generala alterata- Exobucal : tumefactie pre/retro SCM- Endobucal : tumefactie unilat faring + val
palatin,lueta edemetiata,congestionata- Trismus, impastare/fluctuenta- Tulb funct importante
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ABCESUL LATEROFARINGIAN
• DGN POZ
- Anamneza + ex cl
• DGN DIF
1. Abces loja submand – fara tumefactie pal
2. Flegmon amigd – cripte purulente amigd
3. Tumorile laterofaring – fara infl
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ABCESUL LATEROFARINGIAN
• TRATAMENT
- Urgenta chirurg- Endobucal – localiz superf
- anest locala+incizia mucoasei, fara tuburi de dren
- Exobucal – supuratii intinse
- anest locala + incizie submand 5-6cm paralela cu bazila, ant de SCM, fara deschiderea pensei Pean + drenaj tuburi 24h
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ABCESUL LATEROFARINGIAN
• TRATAMENT- Dc e interesata si loja marilor vase, se
practica o incizie 8-10cm evidentiind SCM- Se perforeaza fascia cerv, explorarea cu
index- Drenaj supraetajat
• EVOLUTIE- Invadarea endocraniului, mediastinului,
hemoragii ACI,VJI, edem glotic, pericolul asfixiei in cazul anest gen in abordul endobucal
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SUPURATII DIFUZE
• Absenta colectiilor limitate
• Caracter invaziv
• Tesuturi palide,atone
• Flegmoanele – flora polimorfa
• Asociere aerobi+anaerobi
• Etiologie asemanatoare abceselor, favorizata de scaderea rezistentei organismului.
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FLEGMONUL DIFUZ AL PLANSEULUI BUCAL
• Angina Ludwig, angina Gensoul• Proces hipertoxic care cuprind tot planseul• Caracter puternic invaziv : lb,laterofaringe
• ETIOPATOG
- dd, pericoronarite M3 inf inclusi, punctii septice
- Focarul principal – loja sublg
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FLEGMONUL DIFUZ AL PLANSEULUI BUCAL
• CLINIC- Tumefactie sublg ce se extinde rapid- Edem al obrazului,reg cerv supraclavic +
presternal- Tegumente initial fara semne de infl- Palpare – duritate : flegmon lemnos, fara
fluctuenta- Endobuc : muc sublg “creasta de cocos”, lb
tumefiata, hipersalivatie, deglutitie dureroasa, depertitie sal, tulb de fonatie
- Stare gen alterata : febra 39-40 care apoi scade, puls tahicardic
- Dispnee toxica bulbara
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FLEGMONUL DIFUZ AL PLANSEULUI BUCAL
• DGN POZ
- Clinic + stare toxico-septica
• DGN DIF
1. Litiaza submand inf – modific de secretie
2. Supuratii sublg/submand – localizare
3. Tumori mlg de planseu – evolutie+caracter
4. Adenopatii metastatice submand – fara fen toxico-septice
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FLEGMONUL DIFUZ AL PLANSEULUI BUCAL
• TRATAMENT- Urgenta chirug- Terapie mixta- Anestezie gen/infiltratie functie de stare septica- Incizie “in potcoava” gonion-gonion, se sect miloh+pamd+se
patrunde in loja sublg si submand- Evacuare se realiz cu indexul- Drenaj cu tuburi pt fiecare loja- Irigatii din 2 in 2 h- Terapie cu O2- Ab cu spectru larg,tonic-card,vitmaine- Evol buna : puroi,creste febra,fara semne toxico-septice
• EVOLUTIE- Exitus , meningite,mediastinite,gangrena pulmonara,edem
glotic,sincopa bulbara,colaps cardiac.
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FLEGMONUL DIFUZ HEMIFACIAL
• Toate lojile superf+prof ale fetei
• Dezvoltarea functie de cantit de tes adipos,comunicari
• ETIOPATOG
- Dd max/mand, punctii septice,corpi straini, furuncule, post-traumatice
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FLEGMONUL DIFUZ HEMIFACIAL
• CLINIC- Debut : supuratie localizata la obraz cu
simptomatologie specifica, fara fluctuenta- Faza de stare : semnele supuratiei difuze- Endobuc : tumefactie importanta
submand+parotido-maset+obraz+temp+palpebral
- Buze,aripa nasului,ochi edematiate- Tegumente marmorate- Tumefactie dura,lemnoasa,crepitatii gazoase- Muc lab+jug tumefiata,trismus,halena fetida- Stare generala alterata
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FLEGMONUL DIFUZ HEMIFACIAL
• DGN POZ
- Ex cl
• DGN DIF
1. Abces obraz – fara semne toxico-sept
2. Abces maseterin – fara toxico-septic
3. Osteomielita max – Rx
4. Tumori jugale endofitice – starea gen
5. Tumori de mezostructura mari – starea generala
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FLEGMONUL DIFUZ HEMIFACIAL
• TRATAMENT- Urgenta chirurgicala- Terapie mixta- Anest gen- Incizii submand,suprazig,infraorbit,temp- Incizii endobuc in vestibul,perituberozitar,ram mand- Se desfinteaza septurile fibroase cu indexul- Drenaj cu tuburi cauciuc pt fiecare loja- Irigatii la 2 h
• EVOLUTIE- Extindere reg cerv,mediastin,endocraniu,osteomielita