RESUMO
Dialysis patients have an increased risk of acquiring hepatitis B, hepatitis C, and HIV because the dialysis machine is disinfected, not sterilized. Therefore, the dentist must follow standard precautions for infection control when treating dialysis patients. Following the medical complexity status (MCS) system, the patient can be designated as MCS 2B category.
Assuntos
Hepatite B , Hepatite C , Abscesso Periodontal , Humanos , Abscesso Periodontal/complicações , Diálise Renal/efeitos adversos , Hepatite C/complicações , Hepatite B/etiologia , Controle de InfecçõesRESUMO
SUMMARY: Cervical necrotizing fasciitis (NF) is a rare complication of oral cavity infection with high morbi-mortality. Given its low prevalence, adequately reporting cases of NF, its therapeutic management, and associated morphofunctional modifications to the clinical and scientific community is pivotal. To that end, we herein describe a case of cervical NF in a 60-year-old patient with comorbidities and patient presented large, painful cervical swelling associated with a necrotic ulcer lesion in the anterior neck region. Intraoral examination indicated a periodontal abscess in the right mandibular area, while computed tomography indicated the lesion's extension from the right mandibular to the submandibular region. Following empirical intravenous antibiotic treatment, a broad surgical debridement was performed, and the foci of oral infection were removed. Debridement revealed communication between deep and superficial anatomical regions in the submandibular area, where we subsequently placed a Penrose drain. Biopsies showing acute inflammatory infiltrate associated with necrotic and hemorrhagic regions confirmed the diagnosis of NF. When an antibiogram revealed resistance to the empirical treatment, the antibiotic scheme was replaced with an adequate alternative. After a second debridement, we closed the defect with fascio-mucocutaneous advancement flaps with a lateral base while maintaining suction drainage. Having reacted positively, the patient was discharged 10 days after the operation. Despite an extensive morphofunctional change generated in the treated area, the patient showed no difficulties with breathing, phonation, swallowing, or mobilizing the area during control sessions. Altogether, this report contributes to the highly limited literature describing morphological aspects that can facilitate or delay the spread of infection or the morphofunctional disorders associated with the size and depth of surgical interventions for cervical NF, information that is relevant for the comprehensive, long-term prognosis of the treatment of NF.
La fascitis necrosante (FN) cervical es una rara complicación de una infección proveniente de la cavidad bucal asociada a una alta morbimortalidad. Por lo anterior, es fundamental informar a la comunidad clínica y científica los casos de FN, su manejo terapéutico y las modificaciones morfofuncionales asociadas. Se describe un caso de FN cervical en una paciente de 60 años quien presentó una gran tumefacción dolorosa asociada a una lesión ulcerosa necrótica en la región anterior del cuello. El examen intraoral mostró un absceso periodontal en el área mandibular derecha y la tomografía computarizada mostró la extensión de la lesión hacia la región submandibular. Tras el tratamiento antibiótico empírico, se realizó un desbridamiento quirúrgico extenso y se extirparon los focos de infección oral. El desbridamiento reveló comunicación entre las regiones anatómicas profundas y superficiales del área submandibular, donde se colocó un drenaje Penrose. Las biopsias mostraron un infiltrado inflamatorio agudo asociado con regiones necróticas y hemorrágicas, confirmando el diagnóstico de FN. El antibiograma reveló resistencia al tratamiento empírico, por lo que el esquema antibiótico se sustituyó. Tras un segundo desbridamiento, se cerró el defecto con colgajos de avance fascio-mucocutáneos de base lateral manteniendo drenaje aspirativo. El positivo progreso del paciente permitió su alta 10 días después. Aun cuando se generó una gran modificación morfofuncional en el área tratada, la paciente no presentó dificultades para respirar, hablar, deglutir o movilizar el área cervical intervenida durante las sesiones de control. Este informe contribuye a la limitada literatura que describe los aspectos morfológicos que pueden facilitar o retrasar la propagación de la FN y las consecuencias asociadas a los trastornos morfofuncionales provocadas por el tamaño y profundidad de las intervenciones quirúrgicas requeridas por la FN, información relevante para el pronóstico integral a largo plazo del tratamiento de la FN.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Fasciite Necrosante/cirurgia , Abscesso Periodontal/complicações , Resultado do Tratamento , Fasciite Necrosante/etiologia , Fasciite Necrosante/microbiologia , Fasciite Necrosante/patologia , Recuperação de Função Fisiológica , Desbridamento , Pescoço/cirurgia , Pescoço/patologiaRESUMO
La comunicación patológica entre la pulpa y el pe-riodonto se denomina lesión endoperiodontal. Puede presentarse de forma aguda o crónica, y su mani-festación más común es la presencia de un absceso acompañado de dolor. Es importante realizar una detenida evaluación clínica y radiográfica para esta-blecer un correcto diagnóstico y plan de tratamiento. Por este motivo, el objetivo de esta guía es presentar un protocolo consensuado entre las Cátedras de Pe-riodoncia y Endodoncia de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), para su tratamiento (AU)
The pathological communication between the pulp and the periodontium is called Endoperiodontal Lesion. It can be presented in an acutely or chronically form and its most common manifestation is the presence of an abscess accompanied by pain. It is important to carry out a careful clinical and radiographic evaluation to establish a correct diagnosis, prognosis, and treatment plan. For this reason, the objective of this guide is to present a consensus protocol between Periodontics and Endodontics Departments of the Faculty of Dentistry of the University of Buenos Aires (FOUBA) for their treatment (AU)
Assuntos
Humanos , Doenças Periodontais/terapia , Protocolos Clínicos , Doenças da Polpa Dentária/terapia , Abscesso Periodontal/complicações , Doenças Periodontais/cirurgia , Doenças Periodontais/complicações , Doenças Periodontais/diagnóstico por imagem , Argentina , Tratamento do Canal Radicular/métodos , Faculdades de Odontologia , Sinais e Sintomas , Raspagem Dentária/métodos , Doenças da Polpa Dentária/diagnóstico por imagem , Diagnóstico Diferencial , Medicina de EmergênciaRESUMO
Chronic apical periodontitis associated with dental pulp necrosis is the main cause of odontogenic extraoral cutaneous sinus openings. These tracts are often initially misdiagnosed unless the treating clinician considers a dental aetiology. This case report of a 19-year-old woman describes the diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin. Non-surgical conservative endodontic therapy was opted as the involved teeth were restorable. One month after the completion of obturation, there was closure of the sinus tract. One year follow-up showed complete resolution of the sinus tract with minimal scar formation.
Assuntos
Fístula Cutânea/etiologia , Fístula Cutânea/terapia , Abscesso Periodontal/complicações , Desbridamento Periodontal/métodos , Periodontite/terapia , Obturação Retrógrada/métodos , Tratamento do Canal Radicular/métodos , Adulto , Feminino , Humanos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Vertebral osteomyelitis can be attributed to many factors including immunosuppression, diabetes, malignancy, collagen disease, periodontal disease, open fractures, and endoscopic procedures. Anaerobic bacteria, such as Veillonella species, are found in the oral cavity and are rarely implicated in the infection. This report describes vertebral osteomyelitis secondary to a dental abscess with positive Veillonella cultures. CASE DESCRIPTION: A 76-year-old man presented to the hospital due to back pain with a four-day history of fever and chills. CT scans revealed several abscesses in the lumbar region as well as indications of vertebral osteomyelitis. After a psoas drain, the patient began antibiotics with a combination of ampicillin-sulbactam, metronidazole, and levofloxacin, but due to the patient's penicillin allergy, he was initially desensitized to this antibiotic for a significant period of time. Laminectomies, foraminotomies, and facetectomies were performed, but the infection spread to vertebral levels. The patient was then switched to a combination of vancomycin, metronidazole, and levofloxacin which eliminated the infection. Final laminectomy was performed with posterior segmental instrumentation and arthrodesis. Post-operatively, there were no signs of infection. The patient recovered well and regained mobility. Deeper examination of the patient's medical history revealed a severe tooth abscess immediately before the onset of bacteremia. CONCLUSION: We believe that a delay in the onset of antibiotic treatment is what led to the initial bacteremia that ultimately took root in the lower lumbar vertebrae. To the best of our ability, we could identify only one other case that linked vertebral osteomyelitis to the oral cavity.
Assuntos
Abscesso/tratamento farmacológico , Bacteriemia/microbiologia , Osteomielite/etiologia , Osteomielite/terapia , Abscesso Periodontal/complicações , Abscesso/diagnóstico por imagem , Idoso , Antibacterianos/uso terapêutico , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Foraminotomia , Humanos , Laminectomia , Vértebras Lombares/microbiologia , Vértebras Lombares/cirurgia , Masculino , Osteomielite/diagnóstico por imagem , Osteomielite/microbiologia , Abscesso Periodontal/microbiologia , Tomografia Computadorizada por Raios X , Veillonella/patogenicidadeRESUMO
BACKGROUND: The aims of the present study were to establish the incidence of head and neck necrotizing fasciitis (NF) in the Adelaide Oral and Maxillofacial Surgery Unit; review the current literature regarding the management of head and neck NF; and determine the evidence for the role of hyperbaric oxygen therapy in the management of NF. METHODS: A retrospective audit of all patients admitted to the Royal Adelaide Hospital Oral and Maxillofacial Surgery Unit 2006-2015 with severe odontogenic infections was carried out. Patient demographics were recorded and treatment details were collected and analysed. RESULTS: A total of 672 patients were admitted for management of severe odontogenic infections. Of these, three were identified as NF. One case was treated using hyperbaric oxygen as an adjunct to conventional surgical and medical management. Two cases were managed using aggressive surgical management alone. Two patients survived. The incidence of head and neck NF in South Australia is 48/100 000 infections per year. CONCLUSIONS: The first-line treatment of severe odontogenic infections remains conventional surgical and medical management; however, hyperbaric oxygen therapy may have an additional role in the management of NF and other rare severe infections in medically complex patients.
Assuntos
Infecções Bacterianas/etiologia , Fasciite Necrosante/etiologia , Infecção Focal Dentária/complicações , Abscesso Periapical/complicações , Abscesso Periodontal/complicações , Adulto , Idoso , Infecções Bacterianas/terapia , Fasciite Necrosante/terapia , Feminino , Infecção Focal Dentária/terapia , Humanos , Oxigenoterapia Hiperbárica , Masculino , Pessoa de Meia-Idade , Abscesso Periapical/terapia , Abscesso Periodontal/terapia , Estudos Retrospectivos , Austrália do SulAssuntos
Infecções por Bacteroidaceae/etiologia , Infecções por Campylobacter/etiologia , Campylobacter rectus/isolamento & purificação , Coinfecção/microbiologia , Infecções por Fusobacterium/etiologia , Fusobacterium necrophorum/isolamento & purificação , Infecções por Bactérias Gram-Positivas/etiologia , Meningites Bacterianas/microbiologia , Peptostreptococcus/isolamento & purificação , Abscesso Periodontal/complicações , Porphyromonas gingivalis/isolamento & purificação , Idoso , Antibacterianos/uso terapêutico , Infecções por Bacteroidaceae/tratamento farmacológico , Infecções por Bacteroidaceae/microbiologia , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/microbiologia , Coinfecção/tratamento farmacológico , Terapia Combinada , Drenagem , Quimioterapia Combinada , Evolução Fatal , Feminino , Infecções por Fusobacterium/tratamento farmacológico , Infecções por Fusobacterium/microbiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Leucocitose/etiologia , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/cirurgia , Abscesso Periodontal/microbiologiaRESUMO
INTRODUCTION: Cervical necrotizing fasciitis is a rare but very severe infection that affects the soft-tissues of the cephalic extremity. Cervical necrotizing fasciitis most frequently occurs secondarily to inflammatory odontogenic disorders and represents the most severe infection of maxillofacial spaces, with a high lethal potential. MATERIALS AND METHODS: In this study, we selected 55 patients with confirmed cervical necrotizing fasciitis of odontogenic origin, treated in the Clinic of Oral and Maxillofacial Surgery in Cluj-Napoca during January 1996-December 2012. RESULTS: In the majority of cases, the disease evolved without the presence of associated systemic disorders (60% [45.49-72.69]), the rest of the patients having 1-4 types of systemic disorders; type 2 diabetes mellitus was the most frequent type of underlying systemic disorder. From the appearance of the first symptoms until the presentation for treatment, a time interval of 2-30 days elapsed. During this time period, 78.18% (95% confidence interval [CI] [65.49-89.06]) of the patients received antibiotic treatment, but without results. Mandibular molars were the most frequent starting point of the disease, and the submandibular space was the first affected by the disease, 47.27% (95% CI [32.76-61.79]). Bacteriological exams showed that facultatively aerobic/anaerobic G + bacteria were the most frequently identified (72.22% [58.21-83.60]). CONCLUSION: The odontogenic lesions of the lower molars, complicated by submandibular space infections, are the most frequent starting point of odontogenic cervicofacial necrotizing fasciitis. Delayed surgical treatment and strict antibiotic therapy play an important role in favoring the development of odontogenic necrotizing fasciitis.
Assuntos
Infecções Bacterianas/etiologia , Fasciite Necrosante/etiologia , Infecção Focal Dentária/complicações , Abscesso Periapical/complicações , Abscesso Periodontal/complicações , Adulto , Distribuição por Idade , Idoso , Infecções Bacterianas/terapia , Diabetes Mellitus Tipo 2/complicações , Fasciite Necrosante/epidemiologia , Feminino , Infecção Focal Dentária/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Abscesso Periapical/epidemiologia , Romênia/epidemiologiaRESUMO
CASE DESCRIPTION A 22-year-old male gorilla (Gorilla gorilla gorilla) housed in a zoo was evaluated for signs of lethargy, head-holding, and cervical stiffness followed by development of neurologic abnormalities including signs of depression, lip droop, and tremors. CLINICAL FINDINGS Physical examination under general anesthesia revealed a tooth root abscess and suboptimal body condition. A CBC and serum biochemical analysis revealed mild anemia, neutrophilia and eosinopenia consistent with a stress leukogram, and signs consistent with dehydration. Subsequent CSF analysis revealed lymphocytic pleocytosis and markedly increased total protein concentration. TREATMENT AND OUTCOME Despite treatment with antimicrobials, steroids, and additional supportive care measures, the gorilla's condition progressed to an obtunded mentation with grand mal seizures over the course of 10 days. Therefore, the animal was euthanized and necropsy was performed. Multifocal areas of malacia and hemorrhage were scattered throughout the brain; on histologic examination, these areas consisted of necrosis and hemorrhage associated with mixed inflammation, vascular necrosis, and intralesional amoebic trophozoites. Tan foci were also present in the kidneys and pancreas. Immunohistochemical testing positively labeled free-living amoebae within the brain, kidneys, eyes, pancreas, heart, and pulmonary capillaries. Subsequent PCR assay of CSF and frozen kidney samples identified the organism as Balamuthia mandrillaris, confirming a diagnosis of amoebic meningoencephalitis. CLINICAL RELEVANCE Infection with B mandrillaris has been reported to account for 2.8% of captive gorilla deaths in North America over the past 19 years. Clinicians working with gorillas should have a high index of suspicion for this diagnosis when evaluating and treating animals with signs of centrally localized neurologic disease.
Assuntos
Amebíase/veterinária , Doenças dos Símios Antropoides/parasitologia , Balamuthia mandrillaris/isolamento & purificação , Infecções Protozoárias do Sistema Nervoso Central/veterinária , Gorilla gorilla/parasitologia , Abscesso Periodontal/veterinária , Amebíase/parasitologia , Animais , Balamuthia mandrillaris/patogenicidade , Infecções Protozoárias do Sistema Nervoso Central/parasitologia , Masculino , Abscesso Periodontal/complicações , Abscesso Periodontal/parasitologia , Raiz Dentária/parasitologia , Raiz Dentária/patologiaAssuntos
Abscesso Pulmonar/diagnóstico por imagem , Abscesso Periodontal/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Humanos , Abscesso Pulmonar/microbiologia , Masculino , Pessoa de Meia-Idade , Abscesso Periodontal/complicações , Embolia Pulmonar/microbiologia , Radiografia , CintilografiaAssuntos
Actinomicose Cervicofacial/tratamento farmacológico , Fístula Bucal/complicações , Actinomicose Cervicofacial/complicações , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Clindamicina/uso terapêutico , Cárie Dentária/complicações , Quimioterapia Combinada , Feminino , Humanos , Doenças Mandibulares/complicações , Osteomielite/complicações , Abscesso Periodontal/complicações , Adulto JovemAssuntos
Antibacterianos/administração & dosagem , Auditoria Odontológica , Edema/complicações , Face , Fidelidade a Diretrizes , Abscesso Periodontal/tratamento farmacológico , Amoxicilina/administração & dosagem , Unidade Hospitalar de Odontologia , Drenagem , Esquema de Medicação , Humanos , Metronidazol/administração & dosagem , Abscesso Periodontal/complicações , Guias de Prática Clínica como Assunto , Estudos ProspectivosAssuntos
Amoxicilina/administração & dosagem , Anafilaxia/prevenção & controle , Hipersensibilidade a Drogas/tratamento farmacológico , Abscesso Periodontal/tratamento farmacológico , Testes Cutâneos , Corticosteroides/administração & dosagem , Adulto , Alérgenos/efeitos adversos , Alérgenos/imunologia , Amoxicilina/efeitos adversos , Anafilaxia/etiologia , Hipersensibilidade a Drogas/complicações , Serviços Médicos de Emergência , Epinefrina/administração & dosagem , Grécia , Antagonistas dos Receptores Histamínicos/administração & dosagem , Humanos , Imunoglobulina E/sangue , Masculino , Abscesso Periodontal/complicaçõesAssuntos
Anestesia Local/métodos , Abscesso Periodontal/complicações , Trismo/etiologia , Adulto , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Drenagem/métodos , Humanos , Lidocaína/uso terapêutico , Masculino , Abscesso Periodontal/terapia , Piperidinas/uso terapêutico , Remifentanil , Trismo/terapiaAssuntos
Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/terapia , Insuficiência Respiratória/etiologia , Adolescente , Progressão da Doença , Humanos , Veias Jugulares/diagnóstico por imagem , Síndrome de Lemierre/complicações , Masculino , Cervicalgia/complicações , Abscesso Periodontal/complicações , Pneumonia Bacteriana/complicações , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagemRESUMO
We report 3 cases of rare, life-threatening intracranial and internal jugular vein (IJV) thrombosis that were caused by common ENT infections. These infections included otitis media in a 6-year-old girl, tonsillitis in a 21-year-old woman, and odontogenic sepsis in a 56-year-old woman. All 3 patients were treated with culture-directed systemic antibiotics; 2 of them also required surgical drainage (the child and the older adult). The 2 adults also received therapeutic anticoagulation, which was continued until venous recanalization was documented; the duration of combined antibiotic and anticoagulation treatment was 6 weeks. All 3 patients made uneventful recoveries. Significant morbidities associated with intracranial and IJV thrombosis were avoided as a result of prompt diagnosis and judicious treatment.
Assuntos
Trombose Intracraniana/microbiologia , Otite Média Supurativa/complicações , Abscesso Periodontal/complicações , Sepse/complicações , Tonsilite/complicações , Trombose Venosa/microbiologia , Adulto , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Criança , Feminino , Infecções por Fusobacterium/complicações , Infecções por Fusobacterium/tratamento farmacológico , Infecções por Fusobacterium/microbiologia , Humanos , Trombose Intracraniana/tratamento farmacológico , Veias Jugulares , Pessoa de Meia-Idade , Otite Média Supurativa/microbiologia , Otite Média Supurativa/terapia , Abscesso Periodontal/cirurgia , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/microbiologia , Sepse/tratamento farmacológico , Sepse/microbiologia , Streptococcus pneumoniae , Tonsilite/tratamento farmacológico , Tonsilite/microbiologia , Trombose Venosa/tratamento farmacológico , Adulto JovemAssuntos
Cárie Dentária/microbiologia , Abscesso Periapical/microbiologia , Abscesso Periodontal/microbiologia , Psoríase/microbiologia , Cisto Radicular/microbiologia , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Biópsia , Cárie Dentária/complicações , Cárie Dentária/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Periapical/complicações , Abscesso Periapical/tratamento farmacológico , Abscesso Periodontal/complicações , Abscesso Periodontal/tratamento farmacológico , Psoríase/tratamento farmacológico , Psoríase/patologia , Cisto Radicular/complicações , Cisto Radicular/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: The accumulation of pus in the orbit originating from an infected dental root is classified as odontogenic intraorbital abscess. METHODS: Clinical, laboratory, and image evaluation of a non-human primate was performed. RESULTS: The patient was cured after surgical therapy. CONCLUSIONS: This represents the first report of an odontogenic periodontal abscess in Cebus apella.
Assuntos
Cebus , Exoftalmia/veterinária , Doenças dos Macacos/diagnóstico , Doenças dos Macacos/patologia , Doenças dos Macacos/cirurgia , Órbita/patologia , Abscesso Periodontal/veterinária , Animais , Exoftalmia/etiologia , Exoftalmia/cirurgia , Masculino , Abscesso Periodontal/complicações , Abscesso Periodontal/cirurgiaRESUMO
INTRODUCTION: Acute descending necrotizing mediastinitis (DNM) is a severe septic inflammation of the mediastinum with necrosis, which progrediates rapidly and leads to death without adequate surgical treatment in 80% of cases. PATIENTS AND METHOD: 17 patients were treated with acute DNM between 1999 and 2012 at the Thoracic Surgical Department of Koranyi National Institute and Semmelweis University of Hungary. The infection source was primarily in the head-neck region with dental infections in eight cases, retro/parapharyngeal abscess in four patients, primary collar phlegmone and abscess in one case and two retrotonsillar abscesses. Further, in one case there was a previous operation (mediastinoscopy) in the history and in another case there was "difficult intubation process" (not recognized trachea-laesion) mentioned during abdominal operation. Primary exploration was performed from the neck in nine cases, thoracotomies plus collar incisions were carried out in four cases, athoracotomy only was done in one and orofacial exploration in further three patients. Disease progression could be evaluated by computer tomography which had to be followed by immediate surgery. RESULTS: Four patients needed two operations, five patients underwent exploration three times, while three patients needed 4 interventions four times. More than one anatomical region was explored in 70% of the cases. Based on our experience prognosis is affected by the time elapsed between detection and surgical intervention, age of the patient and comorbidites such as diabetes mellitus. We lost nine patients (53%), eight patients recovered and symptom free (47%). CONCLUSIONS: Successful treatment is based on early diagnosis, urgent elimination of the primary source, adequate exploration of the cervico-facial region, debridement, collar and upper mediastinal drainage. If the inflammation spreads below the azygos vein or the aortic arch, a right thoracotomy should be performed with wide mediastinal exploration, debridement, and thoracic suction-lavage drainage. Treatment should be completed with broad spectrum and targeted antibiotics as well as organ support. Mortality and morbidity can be reduced with prompt and aggressive therapy.