1/9. guideline of surgical management based on diffusion of descending necrotizing mediastinitis.BACKGROUND: Descending necrotizing mediastinitis resulting from oropharyngeal abscess, is a serious, life-threatening infection. Exisiting strategies for surgical management, such as transcervical mediastinal drainage or aggressive thoracotomic drainage, remain controversial. methods: Four patients, (three males and one female) were treated for descending necrotizing mediastinitis resulting from oropharyngeal infection. Two had peritonsillar abscesses, while the others experienced dental abscess and submaxillaritis. Descending necrotizing mediastinitis received its classification according to the degree of diffusion of infection diagnosed by computed tomography. mediastinitis in two cases, (Localized descending necrotizing mediastinitis-Type I), was localized to the upper mediastinal space above the carina. In the others, infection extended to the lower anterior mediastinum (Diffuse descending necrotizing mediastinitis-Type IIA), and to both anterior and posterior lower mediastinum (Diffuse descending necrotizing mediastinitis-Type IIB). The spread of infection to the pleural cavity occurred in three cases. RESULTS: The surgical outcome concerning each of the patients was successful. Radical cervicotomy (unilateral in three patients, bilateral in the other) in conjunction with mechanical ventilation with continuous postoperative positive airway pressure, was performed in all cases. tracheostomy was established in three patients and pharyngostomy in two. The two descending necrotizing mediastinitis-Type I cases were successfully managed with transcervical mediastinal drainage. The descending necrotizing mediastinitis-Type IIA case received treatment through transcervicotomy and anterior mediastinal drainage through a subxiphoidal incision. The patient with descending necrotizing mediastinitis-Type IIB required posterior mediastinal drainage through a right standard thoracotomy followed by left minimal thoracotomy. CONCLUSIONS: The mediastinal infection, the extent of which has been accurately determined by computed tomograms, necessitates radical cervicotomy followed by pleuromediastinal drainage. Situations where infection has spread to posterior medisatinum, particularly when it reaches in the level of the carina (descending necrotizing mediastinitis-type I), may not always require aggressive mediastinal drainage. In comparison, diffuse descending necrotizing mediastinitis-Type IIB demands complete mediastinal drainage with debridement via thoracotomy. Subxiphoidal mediastinal drainage without sternotomy may provide adequate drainage in diffuse descending necrotizing mediastinitis-Type IIA.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/9. A five-year-old with a dental abscess: a case study.dental caries remain one of the most common disorders of childhood in the United States. Often nurse practitioners (NPs) will see children who are suffering from the complications of a dental carie, such as a dental abscess and/or cellulitis. This article describes the case of a 5-year-old girl who presented at an evening clinic with tooth pain, fever, and facial swelling. Three treatment choices are discussed: (1) 400 mg of amoxicillin (Augmentin), by mouth, with comfort measures, and return to the clinic in the morning; (2) 2 g of ceftriaxone by injection, with comfort measures, and return to the clinic in the morning; (3) or hospitalize via emergency department for intravenous fluids and antibiotics. The treatment that was chosen not only takes into account the disease process, but also the impact of this choice on the family. A model for the progression of dental caries in low-income groups with recommendations for prevention is also presented.- - - - - - - - - - ranking = 5.1053534634588keywords = mouth (Clic here for more details about this article) |
3/9. Ultrasound-guided needle aspiration of lateral masticator space abscess.Shortly after admission with facial space infection, ultrasound-guided needle aspiration of lateral masticator space abscess was carried out in 2 adult patients. One abscess was associated with pericoronitis and the other with post-extraction infection. Successful aspiration of pus was followed by an instantaneous improvement in the ability to open the mouth for a period of at least 24 hours. This obviated the need for conscious nasoendoscopic intubation and allowed orotracheal intubation for conventional drainage. We concluded that ultrasonography can be beneficial in the management of orofacial infections.- - - - - - - - - - ranking = 5.1053534634588keywords = mouth (Clic here for more details about this article) |
4/9. The natural tooth pontic--a compromise treatment for periodontally involved anterior teeth.A technique which uses a natural tooth pontic to replace a periodontally compromised tooth is described. Following extraction and root resection of a maxillary central incisor, the crown was bonded to the adjacent teeth using acid-etched composite resin located in proximal cavity preparations. Some advantages of the technique are discussed.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/9. osteomyelitis associated with chronic periodontitis: a report of three cases.Correctly differentiating between periodontal abscess (localized, acute suppurative infection of the periodontium) and osteomyelitis (the extension of an infection into the bone medullary cavity) is crucial since the former may not require antibiotics for resolution, while the latter will. Initial assessment and treatment of osteomyelitis should be based on clinical examination, radiographic interpretation, and experience. Three case histories of osteomyelitis are presented, ranging from a periodontally well-localized case to one involving a hemimandible and crossing the midline. Successful early diagnosis and case management may benefit from scintigraphic interpretation and culture-and-sensitivity studies.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
6/9. Cutaneous sinus of dental origin: a diagnosis requiring clinical and radiologic correlation.Cutaneous sinuses may arise from chronic dental infections. These sinus tracts usually appear as suppurative lesions of the chin or neck. Diagnosis is made by palpating the lesion and by radiologic examination demonstrating periapical dental abscess. Treatment with dental extraction or root canal results in resorption of the inflammatory fistula. Since many patients with sinus tracts of dental origin do not have any complaints of tooth or mouth pain, the correct diagnosis may be overlooked by the unsuspecting clinician.- - - - - - - - - - ranking = 5.1053534634588keywords = mouth (Clic here for more details about this article) |
7/9. Pulmonary actinomycosis of periodontal origin.A case of pulmonary actinomycosis of periodontal origin is presented. Microbiologic testing including culture and typing of multiple systemic and oral lesions revealed the presence of actinomyces naeslundii and A viscosus in all sites. In addition, biopsies demonstrating branching filamentous forms and "sulfur granules" were found in exudates from the lungs, submandibular region and left quadrants of the oral cavity. Seeding of tooth-associated materials containing actinomyces sp into the pulmonary field may have resulted in this case of pulmonary actinomycosis. Therapy of the pulmonary and periodontal infections was completed and the patient is maintaining satisfactory health 18 months later.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
8/9. Oropharyngeal sepsis with endothoracic spread.Two patients who had oropharyngeal infection with extension into the thoracic cavity through the fascial planes were recently seen at the health Sciences Centre in Winnipeg. In both instances the infection was odontogenic. A 5-year review of the literature yielded 14 other cases with a similar presentation. In most cases the infection was odontogenic. The overall mortality was 25% (four deaths in 16 patients). Transient deficiency of the swallowing mechanism led to aspiration pneumonia in 44% of the patients. An aggressive surgical approach and appropriate antibiotic therapy are essential in managing these patients. Oral intake should be restricted and nasogastric tube feedings should be considered to diminish the risk of aspiration pneumonia.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
9/9. cellulitis associated with an oral source of infection in breast cancer patients: report of two cases.We present 2 patients with prior lumpectomy, axillary node dissection and radiation therapy for treatment of breast cancer, who subsequently developed arm and chest cellulitis associated with an oral infection (gingivitis with bacteremia in one patient, and dental abscess in another). Our findings suggest that hematogeneous seeding of the compromised extremity and/or breast from the oral cavity should be considered as a possible cause of cellulitis in breast cancer patients.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |