颈深部间隙及感染课件

,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,精品课件,*,Click to edit Master title style,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,精品课件,Click to 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Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,精品课件,*,Deep Neck Spaces and Infections,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Deep Neck Spaces and Infections,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Deep Neck Spaces and Infections,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Deep Neck Spaces and Infections,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Deep Neck Spaces and Infections,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Deep Neck Spaces and Infections,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Deep Neck Spaces and Infections,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Deep Neck Spaces and Infections,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Deep Neck Spaces and Infections,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Deep Neck Spaces and Infections,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Deep Neck Spaces and Infections,精品课件,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,*,Deep Neck Spaces and Infections,复旦大学耳鼻咽喉科系,华山医院耳鼻咽喉科,孙广滨,Deep Neck Spaces and Infection,解剖,颈筋膜the Cervical Fascia,颈深部间隙the Deep Neck Spaces,颈深部间隙感染,扁桃体周围脓肿Paratonsillar abscesses,咽旁脓肿,Parapharyngeal abscesses,咽后脓肿,Retropharyngeal abscesses,脓性颌下炎 Ludwigs angina,颈深部间隙及感染,解剖颈深部间隙及感染,Superficial Layer,浅层,Platysma,颈阔肌,Deep Layer,深层,Superficial,Middle,Deep,颈筋膜,Superficial Layer浅层颈筋膜,Superficial Layer,of the Deep Cervical Fascia,Muscles Sternocleidomastoid,胸锁乳突肌,Trapezius,斜方肌,Glands Submandibular,颌下腺,Parotid,腮腺,颈筋膜,Superficial Layer of the Deep,Middle Layer,of the Deep Cervical Fascia,Muscular Division,Infrahyoid Strap Muscles,舌骨下带状肌,Visceral Division,Pharynx,咽,Larynx,喉,Esophagus,食管,Trachea,气管,Thyroid,甲状腺,Buccopharyngeal Fascia,颊咽筋膜,颈筋膜,Middle Layer of the Deep Cervi,Deep Layer,of Deep Cervical Fascia,Alar Layer,翼状层,Posterior to visceral layer of middle fascia,Anterior to prevertebral layer,Prevertebral Layer,椎前层,Vertebral bodies,Deep muscles of the neck,颈筋膜,Deep Layer of Deep Cervical Fa,Cervical Fascia,Carotid sheath,颈深深层,颈深中层,颈深浅层,颈浅筋膜,Cervical FasciaCarotid sheath颈,Peritonsillar Space,扁桃体周围间隙,Medialcapsule of palatine tonsil,扁桃体被摸,Lateralsuperior pharyngeal constrictor,上咽缩肌,颈深部间隙,Peritonsillar Space扁桃体周围间隙颈深部间,Deep Neck Spaces,Peritonsillar space,扁桃体周围间隙,前面,Deep Neck SpacesPeritonsillar,Retropharyngeal Space,咽后间隙,咽和食管的后方,颈深筋膜深层的前方,从颅底到T1-T2,颈深部间隙,Retropharyngeal Space咽后间隙颈深部间隙,Entire Length of Neck:Prevertebral Space,椎前间隙,椎前筋膜后方,椎体前方,Extends along entire length of vertebral column,颈深部间隙,Entire Length of Neck:Prevert,Danger space,Retro-pharyngeal space,Pre-vertebral space,颈深部间隙,Danger spaceRetro-pharyngeal s,Cervical Fascia,Prevertebral Space,Danger space,Retro-pharyngeal space,Cervical FasciaPrevertebral Sp,Parapharyngeal Space,咽旁间隙,前界翼下颌缝,后界椎前筋膜,内界颊咽筋膜,外界颈深筋膜浅层,上界颅底,下界舌骨,颈深部间隙,Parapharyngeal Space咽旁间隙颈深部间隙,Parapharyngeal Space,Prestyloid,茎突前,Contains fat,connective tissue,nodes,Poststyloid,茎突后,Carotid sheath,颈动脉鞘,Cranial nerves,颅神经IX,X,XII,颈深部间隙,Parapharyngeal Space颈深部间隙,Deep Neck Spaces,Styloid process,茎突,前面,咽旁间隙,Deep Neck SpacesStyloid proces,Carotid Sheath,颈动脉鞘,Formed by all three layers of deep fascia,颈动脉,颈内静脉,迷走神经,颈深部间隙,Carotid Sheath颈动脉鞘颈深部间隙,Entire Length of Neck:,Carotid Sheath,颈动脉鞘,颈深部间隙,Entire Length of Neck:Carotid,Sublingual Space,舌下间隙,口底黏膜,下颌舌骨肌,内含：,蜂窝组织,舌骨舌肌,舌下神经和舌神经,舌下腺,颌下腺导管,颈深部间隙,Sublingual Space舌下间隙颈深部间隙,extension from tonsillitis,Symptoms:,Severe sore throat on one side,drooling,dysphagia,咽喉疼痛，流涎，吞咽困难,Otalgia,耳痛,on the affected side,trismus,牙关紧闭,lymphadenopathy,淋巴结病,torticollis,斜颈,nasal regurgitation,鼻反流,扁桃体周围脓肿,extension from tonsillitis扁桃体周,bulging of superior tonsil pole and soft palate,软腭和扁桃体上极膨出,deviation of uvula,悬雍垂偏移,扁桃体周围脓肿,bulging of superior tonsil pol,扁桃体周围脓肿,扁桃体周围脓肿,鉴别诊断,咽旁脓肿,智齿冠周炎,脓性颌下炎,扁桃体恶性肿瘤,扁桃体周围脓肿,扁桃体周围脓肿,Pediatrics,suppurative process in lymph nodes,Nose,adenoids,nasopharynx,sinuses,Adults,Trauma,Instrumentation,Foreign body,咽后脓肿,病因,:,Pediatrics Adults咽后脓肿病因:,96%occur before 6 years of age,Symptoms:,发热，易怒,咽痛，流涎，吞咽困难,颈部淋巴结肿大，斜颈,呼吸困难，打鼾,腭咽反流,咽后脓肿,96%occur before 6 years of ag,Lateral neck plain film,Normal:,7mm at C-2,4mm at C-6 for kids,2mm at C-6 for adults,咽后脓肿,Lateral neck plain film咽后脓肿,咽后脓肿,咽后脓肿,咽后脓肿,咽后脓肿,Nasal,endoscopy,咽后脓肿,Nasal 咽后脓肿,infection of,pharynx,tonsil,adenoids,dentition,parotid,mastoid,suppurative,lymphadenitis,extension from,other deep neck spaces,咽旁脓肿,infection of pharynx,咽旁脓肿,Fever,Pain,dysphagia,trismus,Medial bulge,内侧隆起,of lateral pharyngeal wall,咽旁脓肿,Fever咽旁脓肿,CT scan,CT vs.PE,Accuracy of diagnosis:,CT=77%,PE=63%,Sensitivity:,CT=95%,PE=55%,-Miller,et al:,咽旁脓肿,CT scan咽旁脓肿,脓性颌下炎,病因,:,牙源性感染,厌氧菌多见,脓性颌下炎病因:,Cellulitis,蜂窝组织炎,not abscess,发热、中毒症状,口底、颏下、颌下肿胀，触痛,不伴波动,言语不清,流涎,呼吸困难,喘鸣,脓性颌下炎,Cellulitis蜂窝组织炎,not abscess脓性,Ludwigs angina,脓性颌下炎,脓性颌下炎,Ludwigs angina脓性颌下炎,治疗及转归,处理,监控,气道维护,呼吸困难程度的评估,抗生素,足程联合 培养+药敏,糖皮质激素,咽喉水肿程度的评估,感染性休克,血压、肝肾功能等的监控,DIC处理,DIC全套检查,对症处理,电解质、血糖、蛋白等检查,外科引流,B超、CT、MRI等,相关科室会诊,病情进展治疗效果不佳,治疗及转归 处理监控气道维护呼吸困难程度的评估抗生素足程联合,Airway protection,气道维护,Observation,观察,Intubation,气管插管,Direct laryngoscopy:possible risk of rupture and aspiration,Flexible fiberoptic,Tracheostomy,气管切开,Ideally=planned,awake,local anesthesia,Abscess may overlie trachea,Distorted anatomy and tissue planes,治疗及转归,Airway protection气道维护治疗及转归,LUDWIGS ANGINA=,PERILOUS,危险,AIRWAY,治疗及转归,气管切开术,LUDWIGS ANGINA=PERILOUS 危险A,Antibiotic Therapy,抗生素,足程联合用药,监测细菌培养,必要时感染科会诊,治疗效果不佳要考虑：,Abscess?,drug-resistance bacteria?超级细菌？,Diabetes等全身情况？,治疗及转归,Antibiotic Therapy抗生素治疗及转归,Surgical Drainage,外科引流,Preoperative CT,脓肿是否形成,脓肿与大血管的关系,治疗及转归,Surgical Drainage外科引流治疗及转归,Surgical Drainage,反复细针穿刺引流,根据患者一般情况，脓肿位置和形态等选择性进行,Transoral,经口切开引流,穿刺,钝性分离,External approach,外进路切开引流,EXPOSURE,EXPOSURE,EXPOSURE,治疗及转归,Surgical Drainage治疗及转归,Surgical Drainage,治疗及转归,扁桃体周围脓肿的切开引流,Surgical Drainage治疗及转归扁桃体周围脓肿的,Surgical Drainage,治疗及转归,咽旁脓肿的切开引流,Surgical Drainage治疗及转归咽旁脓肿的切开引,Surgical Drainage,治疗及转归,咽后脓肿的切开引流,Surgical Drainage治疗及转归咽后脓肿的切开引,咽后壁切开引流,治疗及转归,咽后壁切开引流治疗及转归,治疗及转归,咽后脓肿的切开引流,治疗及转归咽后脓肿的切开引流,治疗及转归,脓性颌下炎的切开引流,治疗及转归脓性颌下炎的切开引流,Airway obstruction,气道阻塞,Ruptured abscess,脓肿破裂,Internal Jugular Vein Thrombosis,颈内静脉血栓形成,Carotid Artery Rupture,颈动脉破裂,Mediastinitis,纵隔炎,Infectious shock,感染性休克，DIC,治疗及转归,Airway obstruction气道阻塞治疗及转归,颈深部间隙及感染课件,颈深部间隙及感染课件,颈深部间隙及感染课件,颈深部间隙及感染课件,颈深部间隙及感染课件,颈深部间隙及感染课件,颈深部间隙及感染课件,颈深部间隙及感染课件,颈深部间隙及感染课件,颈深部间隙及感染课件,颈深部间隙及感染课件,