fascial spaces of head and neck pdf writer

Fascial Spaces Of Head And Neck Pdf Writer

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Use best practices in effectively treating infections of the head, neck, and orofacial complex! Head, Neck, and Orofacial Infections: An Interdisciplinary Approach is the only resource on the market with in-depth guidelines to the diagnosis and management of pathology due to severe infections. No longer do you have to search through journal articles and websites, as this comprehensive, full-color reference covers both cutting-edge and time-tested approaches to recognizing and handling infections.

Dental Health, Oral Disorders & Therapy

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Received 26 December Published 9 March Volume Pages — Review by Single anonymous peer review. Editor who approved publication: Dr Joachim Wink. The purpose of this study is to describe a new modified usage of NPWT and investigate the clinical efficacy of this system in a consecutive case series of severe deep fascial space infections.

Methods: The investigators implemented a new modification of NPWT for the management of severe deep fascial space infections. In this new system, the half-plugged bar-shaped foam material was arranged along with the through-and-through side-holed latex drainage tube, which could maintain negative pressure in the distal part of the spaces, and the tube was easy to remove 5— 7 days after surgery. Twelve patients had severe deep fascial space infections in the head and neck with a direct threat to the airway.

The median time of removal of the NPWT device, the median amount of drainage fluid and the median healing time were investigated. Results: A total of 7 male and 5 female patients with an average age of The median time of removal of the NPWT device was 6 days ranging from 4 to 7 days. The median amount of drainage fluid within 3 days after surgery was mL ranging from — mL , and the median time for complete wound healing was 12 days ranging from 10 to 21 days.

Conclusion: The results of this study suggest that the modification of NPWT provides various advantages and leads to excellent clinical outcomes in the treatment of severe deep fascial space infections. Future studies will focus on the safety verification of portable usage and the cost effectiveness analysis of NPWT. Keywords: negative pressure wound therapy, severe deep fascial space infections, modified usage, head and neck.

Fascial spaces in the head and neck are fascia-lined tissue compartments filled with loose, areolar connective tissues. In some circumstances, infections arising from the teeth or tonsils can tend to spread into these spaces, in which the cushioning and lubricating tissues become greatly edematous in response to the exudation of tissue fluid.

Ultimately, liquefactive necrosis in white blood cells as well as the presence of this connective tissue leads to abscess formation, and surgical incision and drainage are typically needed to resolve the abscess. The standard treatment for deep fascial space infections consists of medical support for the patient, surgical drainage of the infection and administration of correct antibiotics. However, traditional wide debridement and drainage result in several problems, including the limited selection of incision sites due to gravity drainage, daily irrigation and dressing changes accompanied by painful patient experience, tremendous invasive secondary tissue trauma, secondary infection and cosmetic changes in the face and neck.

Negative pressure wound therapy NPWT is an alternative type of dressing, that consists of a computer-controlled therapy unit, canister, sterile plastic tubing, foam dressing, and clear drape dressing. This device creates a partial vacuum using suction and removes blood and fluid that may collect in the wound. The vacuum may also help draw together wound edges, increase blood flow, and encourage the formation of granulation tissue. This substantially hampers the utilization of NPWT in the management of deep fascial space infections.

To our knowledge, there have been few detailed reports on NPWT use for severe deep fascial space infections in the maxillofacial surgery literature. To address this problem, we designed a new, modified NPWT that is comprised of the traditional drainage tube and the NPWT for the treatment of severe deep fascial space infections. This new combination allows patent drainage of multiple deep spaces, reduces tube insertion procedures and alleviates pain in patients.

To our knowledge, the existing literature offers little clinical experience on NPWT for dealing with severe deep fascial space infections in the head and neck. The purpose of this article is to present our experience, describe the detailed usage of the modified NPWT strategy and retrospectively investigate the clinical efficacy of this system in a consecutive case series of severe deep fascial space infections in the head and neck region.

We have read the Helsinki Declaration and have followed the guidelines in this investigation. The patient data were anonymized and maintained with confidentiality. From to , we treated 12 patients with severe deep fascial space infections in the head and neck with the use of NPWT. Patients who had abscess formation in two or more deep spaces in the head and neck and who had a direct threat to the airway were included in this retrospective study.

Patients with necrotizing fasciitis NF in the head and neck were excluded since the usage of NPWT in NF patients is different from the modified method in this study. The involved spaces were recorded and summarized.

The medical conditions of the patients were evaluated, and symptomatic treatments such as oxygen supplementation were given immediately after admission.

Routine physical examinations, including oral and tonsil examination, skin inspection and palpation of the abscess and laboratory tests were performed. Surgical drainage under general anesthesia were performed. Patients underwent extraoral surgical incision and drainage under general anesthesia with intubation. For those patients with a difficult airway due to severe swelling of the neck, aspiration of the pterygomandibular, lateral pharyngeal, submandibular, or sublingual space abscesses was performed with a large-bore needle under local anesthesia in order to decompress the surrounding tissues.

Before the actual incision of the abscess was performed, a specimen was acquired for culture and antibiotic sensitivity testing. Incisions were carefully selected to facilitate drainage and avoid damaging vital structures.

Blunt dissection was performed without direct exposure or visualization of the entire infected anatomic space using the beaks of a hemostat or the fingers until pus was found. The necrotic tissue was removed, and the wound was rinsed thoroughly. To pass a drainage tube through multiple spaces, a large curved hemostat was used to insert the drainage tube from one incision to another. A latex drainage tube was then grasped with the tip of the hemostat and pulled through the dissected pathway to form a through-and-through drain Figure 1.

After the placement of traditional drainage tubes, the NPWT device was applied. First, we cut the foam materials into bar-shaped pieces and inserted them into the wound along with the latex drainage tubes Figure 2.

The foam was placed into the wound at a depth of approximately half of the incision tunnel to achieve suitable negative pressure in the tunnel. Theoretically, the negative pressure would also be acquired in the tip of the tunnel through the holes of the latex drainage tubes. Second, a block of foam dressing was placed on the surface of the face and neck to connect all the branches of the bar-shaped foam Figure 3.

Third, a film dressing was applied carefully to seal the foam and wound. Figure 1 The latex drainage tubes were inserted into the wound. Note that the red lines indicate the direction and depth of the latex side-holed drainage tubes, some of which were pulled through the dissected pathway to form a through-and-through drain.

Figure 2 The foam materials were cut into bar-shaped pieces and inserted into the wound along with the latex drainage tubes. Note that the blue lines indicate the direction and depth of the foam. Figure 3 The bar-shaped foam materials were connected by a block of foam dressing on the surface of the face and neck. Sutures were sometimes needed to stabilize the foam block.

Figure 4 After the application of the film, an adhesive disc and drainage tube were connected to the foam dressing with a pressure-controlled vacuum source. Postoperatively, negative pressure was set at a — mmHg level of suction in continuous suction mode with no irrigation applied.

The seal of the membrane was checked routinely. After extubation, the patients were shifted to their wards and the diet was encouraged. The NPWT device was removed on days 5 to 7 based on the condition of the infection and the amount of drainage fluid. The latex drainage tubes were left in the wound for an extra 2—3 days and the dressings were changed daily. Once drainage ceased, drainage tubes were removed gradually to allow wound closure.

Antibiotics were administered according to culture and sensitivity testing until the interleukin-6 IL-6 and procalcitonin PCT levels were in a normal range. The demography of the patients and the average healing time were investigated.

Figure 5 The drainage was efficient and the container of the NPWT device needed to be replaced once it was almost full.

There were 12 patients included in this study, among whom were 7 men and 5 women, with an average age of The demographics and clinical characteristics of the patients are summarized in Table 1. Overall, three of these patients had diabetes mellitus, and one of these patients had a two-year history of prednisone intake because of rheumatoid arthritis. These patients were treated according to the consultation with the physician, including insulin therapy and corticosteroid withdrawal.

Ten of these patients had odontogenic infections, while the remaining two patients had tonsillar origins. The infected fascial spaces included the submandibular, sublingual, submental, deep temporal, superficial temporal, pterygomandibular, submasseteric, lateral pharyngeal, and pretracheal spaces.

Three patients had Ludwig angina with crepitus. The infected spaces were confirmed by both the preoperative CT scan and the intraoperative findings.

Intubation was challenging before surgery and one patient received puncture with a large-bore needle in the sublingual and submandibular spaces before intubation to decompress the swelling around the epiglottis. No tracheotomy was performed in any of the patients. Bacterial growth on cultures was observed in ten patients, and Streptococcus was the most frequently found bacterium.

The median amount of drainage fluid within 3 days after surgery was mL ranging from — mL. The median time for the administration of antibiotics was Figure 6 This patient recovered 4 days after the removal of the NPWT device, leaving the scars to be corrected later. Figure 7 Scatter plot of the time of removal of NPWT, administration of antibiotics, and complete wound healing of all 12 patients.

The median time and range are indicated. Infection of the deep fascial spaces of the head and neck can compress, deviate or obstruct the airway, invade vital structures and allow extension of the infection into the mediastinum.

The primary principle of management of these infections is to perform surgical drainage for the accumulated pus and necrotic debris. Traditionally, radical incision and debridement, adequate and unobstructed drainage placement, and frequent and daily dressing changes are essential for treatment. However, due to the existence of multiple potential deep spaces and the nature of cellulitis, it takes a rather long time to recover fully.

Moreover, daily or twice daily dressing changes and irrigation can be painful for patients and may result in contagion in the hospital. NPWT has been widely used in wound care, especially for some complicated wounds such as diabetic foot ulcers.

Although it was difficult to compare the wound healing period between the use of NPWT and traditional drainage because of the uneven baseline values among the patients, we empirically observed a shortening of the recovery period in NPWT patients. The sealing of the wound after surgery could also prevent contamination of pathogenic organisms in the hospital. The use of NPWT as a surgical adjuvant in maxillofacial surgery was first described in The first is that the contours of the head and neck make it challenging to obtain an airtight seal for NPWT systems.

In our experience, surgeons who receive proper training can perform sealing with preshaped membranes very well. Even in patients with sublingual or lateral pharyngeal space infections, ruptures that occur during surgery on the mucosa of the mouth can be suctioned and closed after the implementation of negative pressure. Second, the deep spaces in the head and neck make the filling of foam material very difficult.

Fascial Space Infections

Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Received: May 20, Published: May 24, Citation: Hegab A. Management of oral and maxillofacial infection. DOI:


PDF | It is my unpublished work on the fascial spaces in head and neck and one Oral Maxillofacial Surgery journal, the editor of the latter.


Head, Neck, and Orofacial Infections

The aim of this study was to comprehensively review our experience with odontogenic infections in the head and neck region requiring treatment at a national referral center. We excluded patients with nonondontogenic infections or other than purulent clinical forms of dentivitis in the head and neck region. Several demographic, clinicopathological, and treatment variables were assessed.

Odontogenic infection is one of the common infectious diseases in oral and maxillofacial head and neck regions. Clinically, if early odontogenic infections such as acute periapical periodontitis, alveolar abscess, and pericoronitis of wisdom teeth are not treated timely, effectively and correctly, the infected tissue may spread up to the skull and brain, down to the thoracic cavity, abdominal cavity and other areas through the natural potential fascial space in the oral and maxillofacial head and neck. Severe multi-space infections are formed and can eventually lead to life-threatening complications LTCs , such as intracranial infection, pleural effusion, empyema, sepsis and even death. We report a rare case of death in a year-old man with severe odontogenic multi-space infections in the oral and maxillofacial head and neck regions. One week before admission, due to pain in the right lower posterior teeth, the patient placed a cigarette butt dipped in the pesticide "Miehailin" into the "dental cavity" to relieve the pain.

Oral and Maxillofacial Surgery for the Clinician pp Cite as. Dental infection has plagued humankind for as long as our civilization has been a fight against microorganisms by man dates back to ancient civilization. The discovery of antibiotics is encouraging trends conquest of the microbial infections. Infection of the deep facial spaces of the head and neck still represents a major challenge in hospitals. Untreated infections may result in abscess formation that can spread through different levels in and between the facial spaces and result in life-threatening situations including mediastinitis, pericarditis, meningitis, septic shock, airway compromise, jugular vein thrombosis, and arterial erosion, Although the complications are rare, they are serious and life threatening.

Dr Mohan Z Mani "Thank you very much for having published my article in record time. I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.

Fascial spaces pdf download

Boynton and others published Odontogenic Infections of the Fascial Spaces Find, read and cite all the research you. The present case report describes a child with fascial space infection of oral and maxillofacial region who was treated by incision and drainage in. If you continue browsing the site, you agree to the use of cookies on this website. See our User Agreement and Privacy Policy. See our Privacy Policy and User Agreement for details. Submit Search.

Разница между критическими массами. Семьдесят четыре и восемь десятых. - Подождите, - сказала Сьюзан, заглядывая через плечо Соши.

Теперь все умолкло, так что можно было различить облегченный вздох раненого чудовища - ТРАНСТЕКСТА, постепенно стихающее шипение и посвистывание, сопутствующие медленному охлаждению. Сьюзан закрыла глаза и начала молиться за Дэвида. Ее молитва была проста: она просила Бога защитить любимого человека. Не будучи религиозной, она не рассчитывала услышать ответ на свою молитву, но вдруг почувствовала внезапную вибрацию на груди и испуганно подскочила, однако тут же поняла: вибрация вовсе не была рукой Божьей - она исходила из кармана стратморовского пиджака. На своем Скайпейджере он установил режим вибрации без звонка, значит, кто-то прислал коммандеру сообщение.


David W. Eisele, M.D., Section Editor. Head and neck fascia and compartments: No space for spaces. Alice K. Guidera, BSc, MBChB,1* Patrick.


BioMed Research International

При чем здесь таблица умножения? - подумала Сьюзан.  - Что он хочет этим сказать. - Четыре на шестнадцать, - повторил профессор. - Лично я проходил это в четвертом классе. Сьюзан вспомнила стандартную школьную таблицу. Четыре на шестнадцать. - Шестьдесят четыре, - сказала она равнодушно.

Сбой. Вирус. Все, что угодно, только не шифр, не поддающийся взлому. Стратмор сурово посмотрел на. - Этот алгоритм создал один самых блестящих умов в криптографии.

Она вдруг поняла стремление коммандера к необычайной секретности в шифровалке. Стоящая перед ним задача была крайне деликатна и требовала массу времени - вписать скрытый черный ход в сложный алгоритм и добавить невидимый ключ в Интернете. Тайна имела первостепенное значение. Любое подозрение об изменении Цифровой крепости могло разрушить весь замысел коммандера.

Сьюзан также сообщила, что интерес к криптографии появился у нее еще в школе, в старших классах. Президент компьютерного клуба, верзила из восьмого класса Фрэнк Гут-манн, написал ей любовные стихи и зашифровал их, подставив вместо букв цифры. Сьюзан упрашивала его сказать, о чем в них говорилось, но он, кокетничая, отказывался. Тогда она взяла послание домой и всю ночь просидела под одеялом с карманным фонариком, пытаясь раскрыть секрет. Наконец она поняла, что каждая цифра обозначала букву с соответствующим порядковым номером.

Он сделал все, что мог, теперь пора ехать домой. Но сейчас, глядя на толпу завсегдатаев, пытающихся попасть в клуб, Беккер не был уверен, что сможет отказаться от дальнейших поисков. Он смотрел на огромную толпу панков, какую ему еще никогда не доводилось видеть. Повсюду мелькали красно-бело-синие прически.

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