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Controversies on the surgical treatment of patients with Ludwig’s angina
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Flegmonul difuz al planșeului bucal este
un proces infecţios gangrenos, hipertoxic,
care cuprinde spaţiile submandibulare, sublinguale
și spaţiul submentonier, cu tendinţa
de răspândire în spaţiile învecinate. Studiul de
faţă își propune scopul de a face o incursiune/
analiză a literaturii care reflectă tratamentul
chirurgical al flegmoanelor planșeului bucal.
În cadrul studiului, au fost utilizate surse care
conţin informaţii relevante la tema în discuţie,
62 surse în total, dintre care au fost selectate
24. În tratamentul pacienţilor cu flegmon
al planșeului bucal se va respecta cu stricteţe
ordinea priorităţilor: 1) Protejarea căilor respiratorii.
2) Administrarea de antibiotic. 3)
Tratamentul chirurgical. Aceasta este ordinea
manipulărilor prioritare descrisă în cele mai
multe surse. Tratamentul chirurgical va fi
diferit, în funcţie de fiecare pacient în parte.
Inciziile mici prezintă o serie de avantaje, dar
și de dezavantaje, care trebuie luate în calcul
la fiecare intervenţie. Tratamentul complex
al pacienţilor cu flegmon al planșeului bucal
trebuie iniţiat în timpul cel mai scurt posibil.Summary.
Ludwig’s angina is a gangrenous, hypertoxic
infectious process, including submandibular,
sublingual and submental space,
which tends to spread to the surrounding areas.
The purpose of the study is to conduct a
literature reviewon the surgical treatment of
Ludwig’s angina. Topic–related literature was
studiedby using reference sources containing
relevant data. A total amount of 62 sources
wasanalyzed, whereas 24 were selected. The
main priorities in the treatment of patients
with Ludwig’s angina are as following: Airway
protection. Antibiotic administration. Surgical
treatment. This priority order is being
described in a series of sources. The method
of surgical treatment differs, depending on
each individual case. Surgical small incisions
might exhibit a number of both advantages
and disadvantages that should be considered,
prior to each intervention. Patients
with phlegmon of the oral floor should be
subjected to a complex treatment as soon as
possible
Surgical treatment complications to the pacients with infflamatory processes in oromaxilo-facial region
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Pentru realizarea acestui studiu au fost selectati 12 pacienţii cu procese
inflamatorii din sectia de chirurgie oro-maxilo-faciala, la care starea generala si locala s-a agravat cu toate că se aflau sub un tratament complex.
Ne-am propus să observăm situaţiile în care procesele inflamatorii progresează după aplicarea unui tratament complex. În multe cazuri cînd procesele inflamatorii progresează după aplicarea unui tratament complex, sunt
prezente doar manifestările clinice. Adesea leucocitele sunt în scădere, iar
tomografia nu relevă colectii purulente. Pacientul poate prezenta o stare
subfebrilă. Aceste situaţii pot crea confuzii medicului în legătură cu planul
de tratament.Summary.
For this research were selected 12 patients
with inflammatory processes from maxilofacial-surgery section, whose general and local
status were hard affected, although were being
under the complex treatment. Were supposed
to find out the situations of the progressing of
the inflammatory processes after the complex
treatment were applied. A lot of cases of progressing of inflammatory processes after the
complex treatment, are presented just clinical
manifestations. As usually the leukocytes are
being decreased and the computer tomography doesn’t show any pus collections. The
patient can have feverish condition. These
situation can create confusion for the doctor
to appreciate the plan of the following actions
Optimizarea diagnosticului și tratamentului la pacienții cu flegmon al planșeului bucal: Rezumatul tezei de doctor în științe medicale: 323.01 – Stomatologie
No full textActualitatea și importanța problemei cercetate. Flegmonul planșeului bucal este o
infecție, definită ca o afecțiune inflamatorie bilaterală și rapid progresivă a spațiilor sublinguale,
submandibulare și submentonier. Maladia reprezintă o urgență medicală, care se manifestă, de
obicei, prin indurație consistentă și tumefiere a planșeului bucal, asociată cu risc major de
obstrucție a căilor respiratorii și de extindere a infecției de-a lungul planurilor fasciale în lojele
adiacente și spre mediastin [8, 16].
Din cauza ratei crescute a afecțiunilor comorbide (imunodepresia, diabetul zaharat), care
sunt și factorii de risc majori pentru pacienții cu flegmon al planșeului bucal, incidența acestei
afecțiuni este în creștere. Deși afecțiunea este rară, rămâne încă a fi o maladie importantă care
poate pune viața în pericol, în primul rând, din cauza obstrucției căilor respiratorii [1, 2]. În circa
90% din cazuri, flegmonul planșeului bucal este de origine odontogenă, dinții 7 și 8 inferiori
constituind 70-80% [2, 7].
Protecția căilor respiratorii și terapia medicamentoasă antiinflamatorie și antibacteriană,
instituită timpuriu, prezintă rezultate favorabile. Cu toate acestea, intervenția chirurgicală care
implică drenajul adecvat al colecțiilor purulente, debridarea țesutului necrotic până la limita
ţesuturilor clinic sănătoase și lavaje cu soluții antiseptice este esențială. Pe lângă avantaje, metoda
clasică de tratament chirurgical are și unele dezavantaje: gradul înalt de agresivitate chirurgicală;
acoperirea rapidă a plăgii cu fibrină, ceea ce împiedică drenarea eliminărilor purulente; regenerare
dificilă a țesuturilor; cicatrici postoperatorii voluminoase și inestetice [4, 9].
Astfel, rezultatele analizei literaturii de specialitate și experiența clinicii noastre
argumentează oportunitatea elaborării unui nou concept/protocol de intervenție chirurgicală
minim-invazivă al flegmonului planșeului bucal, care ar contribui la reabilitarea timpurie, efectivă
și mai puțin traumatică. În acest sens, este important de selectat strategia intervențională
corespunzătoare, care ține cont de particularitățile individuale ale pacientului [12, 13] [....]
Optimizing the diagnosis and treatment in patients with oral floor phlegmon
No full textActualitatea și importanța problemei cercetate. Flegmonul planșeului bucal este o
infecție, definită ca o afecțiune inflamatorie bilaterală și rapid progresivă a spațiilor sublinguale,
submandibulare și submentonier. Maladia reprezintă o urgență medicală, care se manifestă, de
obicei, prin indurație consistentă și tumefiere a planșeului bucal, asociată cu risc major de
obstrucție a căilor respiratorii și de extindere a infecției de-a lungul planurilor fasciale în lojele
adiacente și spre mediastin [8, 16].
Din cauza ratei crescute a afecțiunilor comorbide (imunodepresia, diabetul zaharat), care
sunt și factorii de risc majori pentru pacienții cu flegmon al planșeului bucal, incidența acestei
afecțiuni este în creștere. Deși afecțiunea este rară, rămâne încă a fi o maladie importantă care
poate pune viața în pericol, în primul rând, din cauza obstrucției căilor respiratorii [1, 2]. În circa
90% din cazuri, flegmonul planșeului bucal este de origine odontogenă, dinții 7 și 8 inferiori
constituind 70-80% [2, 7].
Protecția căilor respiratorii și terapia medicamentoasă antiinflamatorie și antibacteriană,
instituită timpuriu, prezintă rezultate favorabile. Cu toate acestea, intervenția chirurgicală care
implică drenajul adecvat al colecțiilor purulente, debridarea țesutului necrotic până la limita
ţesuturilor clinic sănătoase și lavaje cu soluții antiseptice este esențială. Pe lângă avantaje, metoda
clasică de tratament chirurgical are și unele dezavantaje: gradul înalt de agresivitate chirurgicală;
acoperirea rapidă a plăgii cu fibrină, ceea ce împiedică drenarea eliminărilor purulente; regenerare
dificilă a țesuturilor; cicatrici postoperatorii voluminoase și inestetice [4, 9].
Astfel, rezultatele analizei literaturii de specialitate și experiența clinicii noastre
argumentează oportunitatea elaborării unui nou concept/protocol de intervenție chirurgicală
minim-invazivă al flegmonului planșeului bucal, care ar contribui la reabilitarea timpurie, efectivă
și mai puțin traumatică. În acest sens, este important de selectat strategia intervențională
corespunzătoare, care ține cont de particularitățile individuale ale pacientului [12, 13] [....].The relevance and importance of the researched issue. Phlegmon of the oral floor is defined as a bilateral and rapidly progressive inflammatory condition affecting the sublingual, submandibular, and submental spaces. This condition represents a medical emergency typically characterized by firm induration and swelling of the floor of the mouth, accompanied by a high risk of airway compromise and spread of infection along fascial planes into adjacent compartments and towards the mediastinum [8, 16]. Due to the increased incidence of comorbid conditions (such as immunosuppression and diabetes mellitus), which are also major risk factors for the oral floor phlegmon, the incidence of this condition is on the rise. Although the condition is rare, it remains an important disease that can be life-threatening, primarily due to airway obstruction [1, 2]. In approximately 90% of cases, the oral floor phlegmon is of odontogenic origin, with teeth 7 and 8 in the mandible accounting for 70-80% [2, 7]. Respiratory tract protection and early use of anti-inflammatory and antibacterial drug therapy show favorable outcomes. However, surgical intervention involving proper drainage of purulent collections, debridement of necrotic tissue to the limit of clinically healthy tissues, and lavage with antiseptic solutions is essential. Despite its benefits, the traditional surgical treatment approach also comes with some disadvantages: a high level of surgical aggression; rapid wound sealing with fibrin, obstructing the drainage of purulent discharge; challenging tissue regeneration with bulky and cosmetically unappealing postoperative scars [4, 9]. Thus, the findings of the specialized literature analysis and our clinical experience advocate for the opportunity to develop a new concept/protocol for minimally invasive surgical intervention of buccal floor phlegmon, which would contribute to early, effective, and less traumatic rehabilitation. In this regard, it is important to select the appropriate interventional strategy, taking into account the individual characteristics of the patient [12, 13] [....]
Optimizing the diagnosis and treatment in patients with oral floor phlegmon: Summary of Ph.D Thesis in Medical Sciences: 323.01 – Dentistry
No full textThe relevance and importance of the researched issue. Phlegmon of the oral floor is
defined as a bilateral and rapidly progressive inflammatory condition affecting the sublingual,
submandibular, and submental spaces. This condition represents a medical emergency typically
characterized by firm induration and swelling of the floor of the mouth, accompanied by a high
risk of airway compromise and spread of infection along fascial planes into adjacent compartments
and towards the mediastinum [8, 16].
Due to the increased incidence of comorbid conditions (such as immunosuppression and
diabetes mellitus), which are also major risk factors for the oral floor phlegmon, the incidence of
this condition is on the rise. Although the condition is rare, it remains an important disease that
can be life-threatening, primarily due to airway obstruction [1, 2]. In approximately 90% of cases,
the oral floor phlegmon is of odontogenic origin, with teeth 7 and 8 in the mandible accounting
for 70-80% [2, 7].
Respiratory tract protection and early use of anti-inflammatory and antibacterial drug
therapy show favorable outcomes. However, surgical intervention involving proper drainage of
purulent collections, debridement of necrotic tissue to the limit of clinically healthy tissues, and
lavage with antiseptic solutions is essential. Despite its benefits, the traditional surgical treatment
approach also comes with some disadvantages: a high level of surgical aggression; rapid wound
sealing with fibrin, obstructing the drainage of purulent discharge; challenging tissue regeneration
with bulky and cosmetically unappealing postoperative scars [4, 9].
Thus, the findings of the specialized literature analysis and our clinical experience advocate
for the opportunity to develop a new concept/protocol for minimally invasive surgical intervention
of buccal floor phlegmon, which would contribute to early, effective, and less traumatic
rehabilitation. In this regard, it is important to select the appropriate interventional strategy, taking
into account the individual characteristics of the patient [12, 13] [....]
Antibioticotherapy used in the treatment of a phlegmon of oral floor
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Flegmonul planșeului bucal este o patologie inflamatorie gravă, cu risc
major de răspândire a supuraţiilor în lojele învecinate și spre mediastin.
Pentru evitarea eventualilor complicaţii este necesar ca diagnosticul sa fie
stabilit cât mai timpuriu și de administrat un tratamentul complex. Prima
prioritate în tratament este mereu salvarea vieţii. Tratamentul este orientat
în 3 direcţii: menţinerea respiraţiei; terapie agresivă cu antibiotice; decompresia chirurgicală a spaţiilor submentonier, sublingual și submandibular[6]. Aceasta ne-a determinat să facem o analiză în această direcţie.Summary
The phlegmon of oral of it’s a severe inflammatory disease with a high
risk of spreading of the pus to the adjacent spaces and mediastinum. To
avoid the complications it is necessary to put the earlier diagnosis and indicate the complex treatment of it. The main priority of the treatment is to
save the life of the patient. The treatment is orientated in three directions:
to maintain the breathing, aggressive antibioticotherapy, surgery decompression of the submental, sublingual and submandibular space. It’s determined us to make analyses in this direction
Septicemia as a complication of diffuse phlegmon of the mouth floor
Get PDFDepartment of Oral and Maxillofacial
Surgery and Oral Implantology Arsenie Gutan,
Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Despite all the steps made in recent decades in the knowledge of pathogenesis, in
improving diagnosis and therapy of septicemia, this disease, regardless of the age at which it
occurs, is a complex medical problem. We need a multidisciplinary team to solve it, which
besides the infectious disease doctor, microbiologist, biochemist, and radiologist, often requires
specialists in intensive surgery and surgeons of various profiles. Bacteriology of septic shock
records: Gram-negative germs 50-60%, Gram-positive germs 6-24%.
Aim of the study. The assessment of clinical and paraclinical picture in patients with phlegmon
of the mouth floor, complicated with sepsis.
Materials and methods. Analysis of 50 patients who suffered from phlegmon of the mouth
floor, who were hospitalized in the Oral and Maxillo-facial Surgery department of IMSP IMU
Chisinau between the 2016 and 2017 years. Patients were clinically and paraclinically
investigated. Literature analysis of 17 articles, 5 PhD thesis, 3 books.
Results. 6 % of all patients examined with phlegmon of the mouth floor were diagnosed with
sepsis. Approximately two patients diagnosed with oral phlegmon and complications of this
disease die each year in the Republic of Moldova, which accounts for approximately 7% of all
patients with this diagnosis. The untreated septic shock lasts for several hours to 1-2 days, with a
fatal outcome in 30-60% of cases. According to M. Balş, septicemia occurs in people with a
reasonable defense capacity, which is strong enough to fight, develop a local and general
inflammatory process, but insufficient to stop the infection from the beginning. In people with
collapsed defense, the clinical picture of septicemia is not developed, the infection leads to septic
shock violently.
Conclusions. 1. There is an imbalance betweenpro-inflammatory vs anti-inflammatory,
coagulation vs. anti-coagulation, oxidative vs anti-oxidative, apoptotic vs. anti-apoptotic systems
in patients with severe sepsis. 2. Signs and general symptoms of sepsis are fever higher than 38.3
degrees Celsius; hypothermia lower than 36 degrees Celsius; heart rate higher than 90
beats/minute; tachypnea, hyperglycemia 7.7 mmol/l. 3. The cause of over 90% of the deaths of
patients with inflammatory processes in the Oral and Maxillo-facial department is the septic
shock resulting in polyorganic insufficiency
Phlegmon of the oral floor. Contradictions in diagnosis and treatment
Get PDFBackground: Although the symptoms of oral phlegmon have been described before Hippocrates and Galen, there have been discrepancies in the diagnosis and treatment plan appreciation in patients with phlegmon of the mouth floor until now. Ludwig's angina accounts for less than 1% of all pathologies of maxillofacial surgery. In the pre-antibiotic era, 50% of patients died. At the moment, the mortality rate is below 10%. If the pathology is not treated, patients die in 100% of cases.
Data sources: This study was conducted on specialty literature analysis. We analyzed 45 books and 8 articles. The aim of the study is to compare different sources in which the phlegmon of the oral floor is described.
Discussion: The phlegmon of the mouth floor can involve only the unilateral spaces of the mouth floor, and the diffuse phlegmon of the mouth floor, also called Ludwig’s angina, compulsory involves bilateral spaces of the mouth floor. Two bilateral incisions in the submandibular regions and one in the submental region is the most practiced surgical treatment. The infection is poly microbial, with a mixed flora: aerobic alpha and beta hemolytic streptococci, staphylococci and gram-negative bacilli, anaerobic bacteroides and peptostreptococcus. Usually, the flora is from the oral cavity and pharynx.
Conclusions: Patient intubation is the method of choice when it is possible. Aggressive antibiotic treatment needs to be taken as early as possible. Surgical treatment is required to be performed as early as possible. The number of incisions and their location are chosen depending on the situation.</p
Local anesthetic solutions in dentistry: a comparative study
Get PDFDepartment of Oral and Maxillofacial surgery and Oral Implantology „Arsenie Guțan“, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction.
Pain control requires the study of local anesthesia. Local anesthetics have been
available in dentistry since 1884 and today lidocaine and articaine are most
often used. The main question is which one is more suitable and presents more
advantages. Material and methods.
In order to carry out the study, there were studied a large number of dental books –
14 and foreign clinical studies from PubMed – 7, researchgate – 4, emedicine – 5
and US Library – 6. Purpose: Analysis of specialty literature to determine if articaine or
lidocaine is more effective. Results.
The chemical and pharmacologic properties of a local anesthetic can give valuable
information about the clinical effects . The most important ones for both articaine
and lidocaine are listed in Table 1.
The dissociation constant (pKa) affects the onset of action. Lower pKa, means that
more molecules are present to diffuse through the nerve, thus the onset time is
decreased. Lipid solubility affects the anesthetic potency. Increased lipid solubility enhances
diffusion through the nerve, which itself is 90 % lipid (Malamed 2013), more easily.
Articaine differs from lidocaine,because it contains both ester and amide linkages.
As a result, it is more lipid soluble (Isen 2000).
Protein binding affects the duration. Increased protein binding allows anesthetic
cations to be more firmly attached to proteins located at receptor sites. Thus the
duration of action is increased.
Approximately 70 % of lidocaine undergoes liver biotransformation . Patients with
poor liver function are unable to biotransform it at a normal rate. This leads to
increased toxicity. The extra ester linkage in articaine alows it to be 90-95 %
metabolized with the help of the cholinesterase enzyme in blood, and only 5-10 % in
the liver. This feature is clearly demonstrated when the half-life between articaine
and lidocaine is compared, 27 min versus 90 min.
Malamed & al conducted a study to compare the safety between articaine 4 % with
adrenaline 1:100 000, and lidocaine 2 % with adrenaline 1:100 000. A total of 1325
subjects participated in these study, 882 in the articaine group, and 443 in the
lidocaine. These are the most common adverse effects: Conclusion.
Lidocaine is considered to be more safe, being administrated to children under 4,
pregnant woman and allergic pacients, but articaine has a 1,5 times bigger potency,
it diffuses faster, binds better with the plasmatic proteins and also is better for
pacients with liver problems.
Paraesthesia is the most common side effect of articaine (Jacques A. Baart), but
lidocaine also can cause adverse events, which must be taken in consideration.
If we have a standard patient, then articaine will be more suitable to use
Evolution of the comparative treatment in the postextractional alveolitis
Get PDFCatedra Chirurgie Oro-Maxilo-Facială USMF „Nicolae Testemiţanu”The paper includes obtained treatment results in the same time with different drugs. During 2007 years in the stomatological service of T.D.M.C.A.C. postextractional complications in alveolitis form in 28 patients have been observed. There were used the following preparations in this treatment metronidazolum and levomecol. The study consists of local status description comparative with different patients group in the treatment dinamica with different drugs, fips improvement of symptoms after clinical examination, distinction among patient who were divided depending of age, treatment results in the postextractional alveolitis according to season.
Lucrarea î-şi propune să aducă în atenţie rezultatele tratamentului obţinute în paralel cu diferite medicamente. Pe parcursul anului 2007 în serviciul stomatologic C.C.D.A.M.T. sau întâlnit complicaţii postextracţionale sub formă de alveolită la 28 de pacienţi. În scopul tratamentului au fost aplicate local următoarele preparate: metronidazol şi levomecol. Studiul include: descrierea statusului local în comparaţie la diverse grupe de pacienţi, la tratamentul în dinamică cu diferite medicamente, ameliorarea simptoamelor depistate în urma examenului clinic, deosebiri între pacienţii repartizaţi pe vârstă, rezultatele tratamentului în alveolita postextracţională în dependenţă de anotimp
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