RESUMO
Introdução: as infecções odontogênicas tem como principal origem a necrose pulpar com invasão bacteriana no tecido periapical e periodontal, podendo levar à formação de quadros de celulite e posteriormente de abscesso, além disso, possuem o potencial de disseminar-se pelos espaços faciais profundos e comprometer a vida do paciente. Complicações graves, decorrentes dos quadros de infecções odontogênicas, podem ocorrer, se o tratamento instituído não for adequado, como: trombose do seio cavernoso, abscesso cerebral, mediastinite e até óbito. Objetivo: discutir o manejo das infecções odontogênicas disseminados em espaços faciais profundos, através do relato de caso clínico. Caso clínico: paciente de 52 anos, portador de diabetes mellitus tipo 2, com infecção odontogênica, no exame clínico inicial apresentava trismo, disfonia, dispneia, disfagia, hiperemia e edema em lado esquerdo da face, envolvendo os espaços canino, bucal, submandibular e cervical além de unidades dentárias com foco infeccioso. Em exame de tomográfica computadorizada, observou-se desvio da via área, presença de um grande volume de gás e de lojas de infecção. Optou-se como tratamento a remoção dos focos dentários e drenagem intraoral foi realizada pela equipe da CTBMF com anestesia local e posteriormente drenagem sob anestesia geral, intubação com uso de fibroscopia pela equipe de cirurgia cabeça e pescoço. Considerações finais: as infecções odontogênicas que envolvem espaços faciais profundos devem ser tratadas com urgência e o tratamento de escolha dessa condição deve ser remoção imediata do foco infeccioso, exploração e drenagem rápida e agressiva dos espaços faciais envolvidos e associação com antimicrobianos de amplo espectro com características bactericidas.(AU)
Introduction: the main origin of odontogenic infections is pulp necrosis with bacterial invasion in the periapical and periodontal tissue, which may lead to the formation of cellulitis and later abscess, besides having the potential to spread to the deep facial spaces and compromise the patient's life. Severe complications from dental infections may occur if the treatment is not appropriate, such as cavernous sinus thrombosis, brain abscess, mediastinitis and even death. Objective: to discuss the management of disseminated odontogenic infections in deep facial spaces through a case report. Case report: a 52-year-old patient with type 2 diabetes mellitus, with odontogenic infection, presented at the initial clinical examination trismus, dysphonia, dysphagia, dysphagia, hyperemia and edema on the left side of the face involving the canine, buccal, submandibular and cervical spaces. of dental units with infectious focus. CT scan revealed deviation of the airway, presence of a large volume of gas and infection stores. The treatment was chosen to remove dental foci and intraoral drainage was performed by the CTBMF team under local anesthesia and subsequently under general anesthesia drainage, intubation with fibroscopy by the head and neck surgery team. Final considerations: odontogenic infections involving deep facial spaces should be treated urgently and the treatment of choice for this condition should be immediate removal of the infectious focus, rapid and aggressive exploration and drainage of the involved facial spaces and association with broad-spectrum antimicrobials with bactericidal characteristics.(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/microbiologia , Infecção Focal Dentária/complicações , Infecção Focal Dentária/diagnóstico , Trismo/microbiologia , Tomografia Computadorizada por Raios X , Edema/microbiologiaRESUMO
Tetanus is still a common problem in developing countries. Localized tetanus remains a rare clinical presentation dominated by cephalic localization. Head, neck or ear infection strongly guide the diagnosis. A trismus and one or several cranial nerve impairment are the major symptoms. We report two cases of cephalic tetanus associating a trismus with involvement of the cranial nerves. Diagnosis was difficult because the neurological damage preceded the trismus.
Assuntos
Doenças dos Nervos Cranianos/diagnóstico , Tétano/diagnóstico , Trismo/etiologia , Adulto , Doenças dos Nervos Cranianos/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tétano/complicações , Trismo/microbiologiaRESUMO
Tetanus is a rare disease in industrialized countries, largely due to the highly protective effect of immunization. We present a case of tetanus in a formerly preterm infant with myelomeningocele repaired in utero, who presented at 44 days of age with poor feeding, lethargy, and increased tone. His symptoms progressed despite a course of antibiotics for presumed meningitis. At 73 days of age (on 29th day of hospitalization), a clinical diagnosis of tetanus was made based on the presence of risus sardonicus, trismus, and generalized hypertonicity. Consequently, tetanus immune globulin, muscle relaxants, and metronidazole were administered. Five months later, the infant has had complete resolution of the hypertonicity, has regained normal jaw movement and swallowing, and is regaining oral feeding skills. This case involved a delay in diagnosis despite clinical symptoms and signs classic, in retrospect, for tetanus, highlighting the importance of recognizing the constellation of symptoms that should lead us to consider this rare diagnosis.
Assuntos
Tétano/diagnóstico , Diagnóstico Tardio , Fadiga/microbiologia , Humanos , Lactente , Masculino , Hipertonia Muscular/microbiologia , Trismo/microbiologiaRESUMO
Septic arthritis of the temporo-mandibular joint (TMJ) is a rare disease that has been reported infrequently. To the best of the authors' knowledge, only one case of bilateral TMJ septic arthritis has been reported. The contamination may result from direct extension of adjacent infection (dental or ENT), from hematogenous spread of blood-borne organisms or from direct inoculation. The most common presenting are trismus and pain, although swelling, tenderness and erythema have also been described. In addition, patients may develop fever, regional lymphadenopathy and malocclusion. Through a successively bilateral case of TMJ arthritis, without obvious portal of entry of the bacteria, we will analyze characteristics and treatment of this disease.
Assuntos
Artrite Infecciosa/diagnóstico , Transtornos da Articulação Temporomandibular/diagnóstico , Articulação Temporomandibular/microbiologia , Adulto , Artrite Infecciosa/microbiologia , Feminino , Febre/etiologia , Febre/microbiologia , Humanos , Dor/etiologia , Dor/microbiologia , Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/microbiologia , Trismo/etiologia , Trismo/microbiologiaAssuntos
Cefaleia/microbiologia , Sinusite Maxilar/diagnóstico , Abscesso/complicações , Abscesso/microbiologia , Eikenella corrodens/isolamento & purificação , Febre/microbiologia , Infecções por Bactérias Gram-Negativas/complicações , Humanos , Hipestesia/microbiologia , Leucocitose/microbiologia , Masculino , Sinusite Maxilar/microbiologia , Pessoa de Meia-Idade , Infecções Estreptocócicas/complicações , Taquicardia/microbiologia , Trismo/microbiologiaRESUMO
: We report the case of a 56-year-old male patient affected by a severe form of Ebstein's anomaly (type C of Carpentier classification) with secundum atrial septal defect, who presented to the emergency department with impaired consciousness, seizures, and trismus. The brain computed tomography scan showed evidence of a mass located in the frontal lobe, confirmed by brain MRI consistent with brain abscess. Both echocardiography and cardiac MRI showed no evidence of valvular vegetation. This case shows how the combination of increased atrial pressure and bidirectional shunt through atrial septal defect may lead to paradoxical embolization.
Assuntos
Anormalidades Múltiplas , Abscesso Encefálico/microbiologia , Anomalia de Ebstein/complicações , Embolia Paradoxal/microbiologia , Comunicação Interatrial/complicações , Embolia Intracraniana/microbiologia , Antibacterianos/uso terapêutico , Pressão Atrial , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Circulação Coronária , Anomalia de Ebstein/diagnóstico por imagem , Anomalia de Ebstein/fisiopatologia , Ecocardiografia Doppler em Cores , Embolia Paradoxal/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/fisiopatologia , Hemodinâmica , Humanos , Embolia Intracraniana/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Convulsões/microbiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/fisiopatologia , Trismo/microbiologiaRESUMO
A 56-year-old woman presented with fever, pain and restriction of movement of the right temporomandibular joint. She was premorbidly diagnosed to have type 2 diabetes mellitus and rheumatoid arthritis. Local examination revealed a poorly demarcated severely tender, erythematous swelling in the right preauricular region. All haematological and biochemical investigations were within normal limits. MRI of the neck revealed the presence of a masticator space infection with intramuscular abscess involving the masseter and the temporalis muscles along with intracranial extension. Osteomyelitic changes were detected in the right mandibular condyle, temporal bone and in the temporomandibular joint. Melioidosis was suspected due to this unique clinical presentation of an abscess at an unusual and atypical site. Blood cultures identified the Gram-negative bacilli Burkholderia pseudomallei, which established the diagnosis of Melioidosis. Remarkable improvement was attained with antibiotics meropenem and cotrimoxazole, deferring the need for any surgical intervention.
Assuntos
Melioidose/complicações , Melioidose/diagnóstico , Trismo/microbiologia , Trismo/patologia , Antibacterianos/uso terapêutico , Feminino , Humanos , Imageamento por Ressonância Magnética , Côndilo Mandibular/microbiologia , Côndilo Mandibular/patologia , Músculo Masseter/microbiologia , Músculo Masseter/patologia , Melioidose/tratamento farmacológico , Meropeném , Pessoa de Meia-Idade , Osso Temporal/microbiologia , Osso Temporal/patologia , Articulação Temporomandibular/microbiologia , Articulação Temporomandibular/patologia , Tienamicinas/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
INTRODUCTION: The incidence of tetanus has remained unacceptably high in developing countries. We aimed to describe the profile and outcome of children with tetanus admitted at the Lagos State University Teaching Hospital (LASUTH), Ikeja. METHODS: A prospective and cross-sectional study of children aged 1 month to 12 years of age admitted with clinical diagnosis of tetanus, between January 2011 and December 2013, at the Paediatric department of LASUTH. The age, sex, presenting complaint, immunization status, portal of entry, socio-economic class, complications, duration of admission and outcome of the subjects were analyzed using Microsoft Excel supplemented with Statistical Package for Social Sciences (SPSS) version 17.0. Level of significance set at p<0.05. RESULTS: A total of 49 subject participated in the study. Male: Female ratio was 1.7: 1.0. mean age±SD of 6.5±3.2 years. Only 24.5% of the subjects were fully immunized, lower limb injury was the most common portal of entry (34.7%). Majority (79.6) were of the middle and lower social classes. Most of the subjects (67.3%) presented with generalised spasm. Only 1 patient (2.0%) did not have trismus. Case fatality rate was 4.1%. CONCLUSION: Tetanus is still prevalent among children in our environment. It is commoner among those with no immunization or incomplete immunization, commoner in those in the middle and lower social class. Lower limb injury was the most common portal of entry. Trismus was a common presenting feature. There is a need to develop programmes with will help improve compliance to immunization.
Assuntos
Imunização/estatística & dados numéricos , Toxoide Tetânico/administração & dosagem , Tétano/epidemiologia , Trismo/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitalização , Humanos , Lactente , Masculino , Nigéria/epidemiologia , Estudos Prospectivos , Tétano/etiologia , Tétano/prevenção & controle , Trismo/microbiologiaAssuntos
Doenças Maxilomandibulares/diagnóstico , Músculo Masseter/microbiologia , Mycobacterium tuberculosis , Trismo/diagnóstico , Tuberculose/diagnóstico , Adulto , Feminino , Humanos , Doenças Maxilomandibulares/etiologia , Doenças Maxilomandibulares/microbiologia , Trismo/etiologia , Trismo/microbiologia , Tuberculose/etiologia , Tuberculose/microbiologia , Adulto JovemRESUMO
Submasseteric space infections are rare at any age but particularly so in primary school children. The origin of the infection is usually odontogenic, from pericoronitis in a third molar. Submasseteric inflammation is a deep facial space inflammation, often progressing to mature abscess, and usually misdiagnosed as staphylococcal or streptococcal lymphadenitis or pyogenic parotitis. The hallmark of a masticatory space infection is trismus. The cardinal signs of this infection include a firm mass in the body of the masseter muscle with overlying cellulitis with trismus.
Assuntos
Abscesso/complicações , Infecções Estreptocócicas/complicações , Streptococcus pyogenes , Trismo/microbiologia , Criança , Humanos , Masculino , Músculo MasseterRESUMO
We report a case of cephalic tetanus which initially presented with acute lower motor neurone facial weakness. Tetanus is a rare diagnosis in the developed world but sporadic cases do occur. People born before 1960 in New Zealand are less likely to be immune. Judicious use of human tetanus immunoglobulin (TIG) and immunisation prevents the development of tetanus following injury and should always be considered in the elderly who are less likely to have immunity.
Assuntos
Acidentes por Quedas , Testa/lesões , Tétano/diagnóstico , Idoso de 80 Anos ou mais , Anti-Infecciosos/uso terapêutico , Desbridamento , Músculos Faciais/patologia , Feminino , Testa/cirurgia , Humanos , Imunoglobulinas/uso terapêutico , Lacerações/cirurgia , Metronidazol/uso terapêutico , Necrose , Tétano/imunologia , Tétano/terapia , Toxoide Tetânico , Trismo/microbiologiaAssuntos
Distonia/microbiologia , Rigidez Muscular/microbiologia , Úlcera por Pressão/complicações , Tétano/diagnóstico , Idoso , Doença de Alzheimer/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Imobilização/efeitos adversos , Úlcera por Pressão/microbiologia , Trismo/microbiologiaRESUMO
BACKGROUND: Septic arthritis of the temporomandibular (TM) joint is rare, but it is associated with high risk for significant morbidity. OBJECTIVE: We reviewed the available literature regarding the presentation, evaluation, treatment, and clinical course of TM joint septic arthritis, focusing on elements relevant to emergency physicians. CASE REPORTS: In the first case, a healthy 6-year-old boy presented with fever and trismus; computed tomography with contrast revealed a TM joint effusion. After empiric intravenous antibiotics, intraoperative arthrocentesis of the TM joint returned 1 mL of flocculent fluid, which was cultured and grew pan-sensitive Streptococcus pyogenes. He was discharged home with amoxicillin/clavulanate and experienced complete resolution of his symptoms. In the second case, more than 3 weeks after extraction of her third molars, an 18-year-old woman presented with facial pain, swelling, and trismus and was found to have a loculated abscess involving the left masseteric and pterygomandibular spaces with extension to the left deep temporal region and the skull base. She experienced a complicated postoperative course and required multiple procedures and intravenous antibiotics for growth of multiple bacteria. More than a month later she underwent TM joint arthrotomy for TM joint septic arthritis, and she was found to have acute osteomyelitis. She continued to require multiple treatment modalities; 20 months after her initial presentation, she underwent left total TM joint arthroplasty for fibrous ankylosis of the TM joint. CONCLUSION: Septic arthritis of the TM joint may be caused by hematogenous spread of distant infection or local spread of deep masticator space infections. Patients may present with TM joint septic arthritis acutely or sub-acutely. Septic arthritis of the TM joint should be considered in the differential diagnosis of patients who present with trismus and pain or fever.
Assuntos
Artrite Infecciosa/diagnóstico , Transtornos da Articulação Temporomandibular , Adolescente , Antibacterianos/uso terapêutico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Artroplastia , Criança , Desbridamento , Drenagem , Feminino , Febre/microbiologia , Humanos , Masculino , Dor/microbiologia , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/microbiologia , Transtornos da Articulação Temporomandibular/terapia , Extração Dentária/efeitos adversos , Trismo/microbiologiaRESUMO
This paper presents a rare case of facial soft tissue infection caused by the bacterial strain of Rothia mucilaginosa. Odontogenic background of infection and initial clinical presentation suggested the presence of typical bacterial flora and uncomplicated course of treatment. However, despite surgical intervention and broad-spectrum antibiotic therapy, the expected improvement of a clinical status was not achieved. Only detailed bacteriological examination allowed to establish a bacterial pathogen and start a targeted antibiotic therapy. The unusual clinical course was monitored by imaging CT examination and further surgical interventions. A significant improvement was obtained in the third week of hospitalization and further antibiotic therapy was continued by means of outpatient treatment. Rothia mucilaginosa infection together with dental intervention is a rare case, since most of the reports in the literature concern the patients with decreased immunity. In such patients, the most common areas of infection were: the peritoneum, lung tissue and meningeal spaces of the brain and the presence of a foreign body.
Assuntos
Abscesso/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Micrococcus/isolamento & purificação , Infecções dos Tecidos Moles/microbiologia , Odontalgia/complicações , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Adulto , Antibacterianos/administração & dosagem , Bochecha , Esquema de Medicação , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Rifampina/administração & dosagem , Infecções dos Tecidos Moles/tratamento farmacológico , Extração Dentária/efeitos adversos , Trismo/microbiologia , Adulto JovemAssuntos
Traumatismos do Pé/complicações , Tétano/microbiologia , Trismo/microbiologia , Ferimentos Perfurantes/complicações , Idoso , Anti-Infecciosos/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Relaxantes Musculares Centrais/uso terapêutico , Tétano/diagnóstico , Tétano/tratamento farmacológico , Toxoide Tetânico/uso terapêutico , Resultado do Tratamento , Trismo/diagnóstico , Trismo/tratamento farmacológicoRESUMO
Tetanus is a very serious neuromuscular disease caused by a powerful exotoxin, tetanospasmin, from the Clostridium tetani bacillus. Its incidence in the developed world has diminished considerably since the introduction of primary vaccination. Tetanus is diagnosed clinically, through recognition of the characteristically inducible muscle spasms. Three clinical forms described in adults are generalised, localised and cephalic tetanus. Management of tetanus aims at removing the source of tetanospasmin, neutralising circulating toxin, and providing adequate supportive care for muscle spasms, respiration and autonomic instability. Tetanus is a forgotten disease in developed countries since many practicing primary care physicians have not seen a single case in their career. We present a case of tetanus and review briefly the pathogenesis, clinical features and therapy in order to educate the internist in recognising and adequately treating this disease.
Assuntos
Antibacterianos/administração & dosagem , Emergências , Fatores Imunológicos/administração & dosagem , Antitoxina Tetânica/administração & dosagem , Tétano/diagnóstico , Tétano/terapia , Idoso , Astenia/microbiologia , Feminino , Humanos , Respiração Artificial/métodos , Tétano/microbiologia , Resultado do Tratamento , Trismo/microbiologia , OcidenteRESUMO
The authors are presenting our experience of managing an interesting case of a 12-year-old girl who presented to our clinic with otorrhea for 3 months and trismus for 1 week. Examination showed bilateral ear discharge with central perforations in tympanic membranes, palatal paralysis and trismus. Systemic examination revealed only mild stiffness of hand muscles. CT-scan head and neck was done to look for intracranial complications of otitis media. However; it revealed only decreased pneumatisation of mastoid cells. She was admitted in the hospital and started on intravenous and local antibiotics after sending ear swab and blood cultures. But she showed no improvement in 48 h. So on the clinical suspicion (trismus and stiffness of hands) remote possibility of otogenic tetanus was considered and she was given tetanus toxoid and immunoglobulins. She gradually showed improvement in her symptoms. Thereafter, culture from ear discharge was also reported positive for Clostridium tetani.
Assuntos
Clostridium tetani/isolamento & purificação , Tétano/diagnóstico , Tétano/tratamento farmacológico , Trismo/microbiologia , Perfuração da Membrana Timpânica/microbiologia , Criança , Feminino , Mãos/fisiopatologia , Humanos , Imunoglobulinas/uso terapêutico , Tétano/complicações , Toxoide Tetânico/uso terapêuticoRESUMO
Two men developed severe tetanus after the 2010 Haitian earthquake. They were admitted to the United States Naval Ship Comfort, a hospital ship sent to provide humanitarian relief. Severe masseter and intercostal muscle spasm impaired airway access and ventilation. Propofol and sevoflurane relieved the tetany, allowing airway control and ventilation without intubation or neuromuscular blocking drugs during wound debridement. Presynaptic impairment of inhibitory neurotransmitter release by tetanospasmin toxin is countered by enhancement of spinal cord postsynaptic inhibitory receptor activity by general anesthetics. Avoidance of tracheal intubation and mechanical ventilation during anesthesia may be desirable in the settings of limited resources in which tetanus usually presents.