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Chirurgie OMF > Infectii difuze periosoase/omf/fasciita necrozanta > Flashcards

Infectii difuze periosoase/omf/fasciita necrozanta Flashcards

1
Q

Rezultatul a ce este aparitia infectiilor periosoase?

A
  • a evolutiei inflamatiei supurate a parodontiului apical (parodontita apicala acuta exudativa purulenta)
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2
Q

Tipuri de infectii periosoase

A
  • abces vestibular
  • abces palatinal
  • abces perimandibular (peribazilar)
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3
Q

Dg diferential abces vestibular:

A
  1. Ch. osoase maxilare in curs de exteriorizare (fara celsiene) sau suprainfectate(ex rx)
  2. Formatiuni tumorale gingivomucoasa sau osoase
  3. Stafilococii cutanate, fara cauzator dentar
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4
Q

Ce medicatie se da dupa tratamentul abcesului palatinal?

A
  • beta-lactamine, adica lincosamide-la pac cu HS la peniciline
  • analgetice
  • AINS
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5
Q

Care sunt dintii care pot fi factori cauzali in abcesul palatinal?

A
  • ILS
  • PM1
  • Ms
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6
Q

Ce reprezinta o evolutie nefavorabila la abcesul palatinal?

A

In faza submucoasa- infectia se extinde catre valul moale

Pacientul prezinta febra, odinofagie, disfagie+otalgie reflexa, sialoree

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7
Q

Dg diferential abces palatinal

A
  1. Ch. inflamatorii maxilar suprainfectate
  2. Formatiuni tumorale gingivomucoasa sau maxilar
  3. Goma din sifilis tertiar
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8
Q

Unde se fac inciziile in abcesul palatinal?

A
  • colectii anterioare- pe bombare maxima
  • abces spre mg gingivala- la feston ging. decoland fm
  • evolutie spre lm- incizie paramedian, paralel cu artera palatina mare
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9
Q

Dg diferential abces perimandibular:

A
  1. Abces de loja mandibulara: in ⅓ post corp mand, sub mg baz
  2. adenita acuta supurata submandibulara (cu debut nodular)
  3. Tumori corp mandibular suprainfectate (evolutie lenta)
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10
Q

Ce planuri anatomice superficiale sunt sectionate la incizia submandibulara, de 3-5 cm, pt abcesul perimandibular?

A
  • tegument
  • tesut celular subcutanat
  • platisma
  • fascie cervicala superficiala
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11
Q

Care sunt Infectiile difuze OMF?

A
  • Flegmon planseu bucal
  • Flegmon difuz hemifacial
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12
Q

Caracteristici supuratii difuze omf?

A
  • implica tesut subcutanat si fascii
  • manif. generale tpxice severe
  • etiologie plurimicrobiana odontogena
  • bacterii anaerobe+aerobe
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13
Q

Unde isi are debutul flegmonul de planseu bucal si unde se acumuleaza?

A

In loja sublinguala sau submandibulara

Se acumuleaza deasupra MH, in tesutul celulo-adipos subcutanat

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14
Q

Catre ce se extinde rapid supuratia din flegmonul de planseu?

A
  • catre celelalte loji ale pb
  • parenchim lingual
  • spatiu laterofaringian
  • FIT
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15
Q

Etiologia Flegmonului de pb:

A
  • dd arcada inf cu leziuni periapicale acute
  • molari 3 cu pericoronarite
  • complicatie a plagilor pb
  • complicatie a osteomielitei mand
  • complicatie a sialolitiazeia
  • rar-complicatie a infectiilor migdaliene
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16
Q

Examen cervical la FLegmon pb:

A
  • tumefactie masiva, asimetrica, bilat
  • mionecroza da bule gazoase– extindere rapida edem
  • tegumente marmorate, cu pete cianotice: aspect cauzat de necroza subiacenta si de flicte cu continut seros putrid
17
Q

Examen oral Flegmon pb

A
  • trismus moderat
  • “creasta de cocos”
  • planseu cianotic
  • limba edematiata, uscata
18
Q

Stare generala in flegmon pb

A
  • alterata
  • frison urmat de acces febril (40 grade celsius)
  • tahicardie(120-140 b/m)
19
Q

Hemoleucograma la FLegom pb:

A
  • Leucocitoza: >10.000 celule albe (la debut)
  • In evolutie- grav- toxico-septic= disociatie puls-temp(tahicardie/subfebrilitate) si hiperventilatie
  • crestere VSH
  • crestere peste 10% neutrofile nesegmentate(imature)
  • reducere valoare Hb
  • crestere glicemie
20
Q

La ce duce lipsa de tratament in flegom planseu bucal?

A
  • Sepsis sever+hipotensiune
  • disfunctii de organ (crestere INR>1,5, trombocitopenie, crestere creatinina, bilirubina, oligurie acuta)
  • soc septic
  • insuficienta circulatorie acuta
21
Q

La ce poate evolua Flegmonul de pb?

A
  • tromboflebita septica a sinusului cavernos
  • mediastinita acuta
22
Q

Dg diferential Flegmon pb:

A
  • Abcese loja sublinguala/submandibulara
  • Adenopatie Metastatica denivel ib/ia, in suprainfectie
23
Q

Caracteristici tratament Flegmon planseu bucal:

A
  • drenaj larg toate lojile afectate
  • Disectie boanta
  • Drenaj
  • Suprimare factor dentar
  • la nevoie, traheotomie
24
Q

Cum debuteaza flegmonul hemifacial difuz si care ii este etiologia?

A
  • debuteaza ca abces genian ce fuzeaza rapid in FiT, loja maseterina, submandibulara si orbita
  • Etiologie: dd lat superiori, traume, litiaza Stenon, adenite geniene, furuncule
25
In lipsa tratamentului, unde se duce flegmonul hemifacial difuz?
* complicatii septice la nivelul osului maxilar * tromboza vene faciale
26
Dg diferential flegmon difuz hemifacial:
1. Abces genian 2. Tumori benigne/maligne suprainfectate
27
Tratament flegmon hemifacial difuz:
* Drenaj larg * Incizie la nivel temporal, paralela cu traseu vase temo superficiale * Contraincizie submandibular, la 2 cm de mg bazilara * Incizii suplimentare: juxtazigomatice, periorbitare
28
Fasciita necrozanta, generalitati:
* "gangrena de spital" * necroza fascie cervicala, tesut adipos subcutanat * rapid progresiva * stare gen toxico-septica grava * planurile musculare subiacente doar partial afectate(nu ca in flegmoane)
29
Etiologie fasciita si aspect f-p si a-p:
* **Streptococcus Pyogenes**(beta hemolitic de grup A) + **tulpini stafilococice** * **anato-pat**: infiltrat inflamator masiv al fasciei/t.subcutanat celular cu extensie si focare de *necroza* * **fizio-pat**: _siderare perfuzie_ tegumentara din cauza *presiunii* si *trombozelor vasculare* provocate de exotoxine bacteriene
30
Cum e fasciita la debut?
* simpt dureroasa intens, localizata * amelioreaza in 24-48 h * se accentueaza ulterior * simpt d-p absenta * surere maare comparativ cu dimensiunea leziunii
31
Tabloul clinic caracteristic al fasciitei:
* tumefactie si hipermemie tesuturi (sub)cutanate * proces infectios profund→ simptome tegumentare apar tardiv * ecografie/CT→ evidentiere profunzime si extensie a lichefierii.dispersarii structurilor, fara formare de abcese
32
Ce se observa paraclinic la fasciita?
* modificari coagulograma * in hemocultura: Streptococcus Pyogenes
33
Dg diferential Fasciita necrozanta
* Flegmon planseu bucal (la fasciita progresie mai rapida a necrozei si agravare stare gen)
34
In lipsa tratamentului unde duce fasciita?
* mediastinita necrozanta descendenta * tratament tardiv, agresiv→ sepsis-soc-insuficienta de organ multipla si DECES

Chirurgie OMF (16 decks)

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