UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

下颌下间隙感染(Ludwig咽峡炎)

Author
Anthony W Chow, MD, FRCPC, FACP
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Anna R Thorner, MD

引言

Ludwig咽峡炎是下颌下间隙的一种双侧感染，下颌下间隙包含口底两个间隙，即舌下间隙和下颌舌骨下(也称为下颌)间隙(图 1)。1836年，德国医生Wilhelm Frederick von Ludwig首次对该疾病进行描述。感染最常源于第2或第3下颌磨牙感染。感染为侵袭性、快速散播性蜂窝织炎，不伴有淋巴结肿大，有气道阻塞的可能，需要密切监测及快速干预以预防窒息和吸入性肺炎。

下颌下间隙感染(Ludwig咽峡炎)的解剖学、微生物学、临床表现、影像学及治疗总结在此。其他颈深间隙感染将单独讨论。 (参见“颈深间隙感染”)

定义

尽管术语Ludwig咽峡炎被宽泛地用于描述累及舌下间隙和下颌舌骨下间隙(下颌间隙)的一系列各种各样的感染，该诊断应该局限于以下典型描述：

  • 感染起源于口底。其特征为累及下颌下间隙的侵袭性、快速播散性“木板状”或硬化性蜂窝织炎。
  • 感染为快速播散性蜂窝织炎，不伴有淋巴受累，一般无脓肿形成。
  • 下颌舌骨下间隙和舌下间隙均被累及。
  • 感染为双侧性。

解剖因素

下颌下间隙位于口底黏膜和颈深筋膜浅层之间的颏下和下颌下三角。被下颌舌骨肌分为舌下间隙(其中包含舌下腺、舌下神经、部分下颌下腺及疏松结缔组织)及下颌舌骨下间隙(其中包含下颌下唾液腺和淋巴结)(图 1)。两个间隙在下颌舌骨肌后相连。这种解剖结构可以解释，在Ludwig咽峡炎中下颌下间隙内感染的毗邻播散造成双侧受累。

               

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-07 . | This topic last updated: 2017-07-26.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Boscolo-Rizzo P, Da Mosto MC. Submandibular space infection: a potentially lethal infection. Int J Infect Dis 2009; 13:327.
  2. Furst IM, Ersil P, Caminiti M. A rare complication of tooth abscess--Ludwig's angina and mediastinitis. J Can Dent Assoc 2001; 67:324.
  3. Brook I. Microbiology and principles of antimicrobial therapy for head and neck infections. Infect Dis Clin North Am 2007; 21:355.
  4. Patel M, Chettiar TP, Wadee AA. Isolation of Staphylococcus aureus and black-pigmented bacteroides indicate a high risk for the development of Ludwig's angina. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108:667.
  5. Reynolds SC, Chow AW. Life-threatening infections of the peripharyngeal and deep fascial spaces of the head and neck. Infect Dis Clin North Am 2007; 21:557.
  6. Hurley MC, Heran MK. Imaging studies for head and neck infections. Infect Dis Clin North Am 2007; 21:305.
  7. Roscoe DL, Hoang L. Microbiologic investigations for head and neck infections. Infect Dis Clin North Am 2007; 21:283.
  8. Barakate MS, Jensen MJ, Hemli JM, Graham AR. Ludwig's angina: report of a case and review of management issues. Ann Otol Rhinol Laryngol 2001; 110:453.
  9. Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin North Am 2008; 41:459.
  10. Ovassapian A, Tuncbilek M, Weitzel EK, Joshi CW. Airway management in adult patients with deep neck infections: a case series and review of the literature. Anesth Analg 2005; 100:585.
  11. Barton ED, Bair AE. Ludwig's angina. J Emerg Med 2008; 34:163.