婴幼儿急性上颌骨骨髓炎合并鼻中隔脓肿1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2021.402

摘要/Abstract

摘要： 目的探讨婴幼儿急性上颌骨骨髓炎合并鼻中隔脓肿的临床表现、诊断思维、治疗方法及预后。方法回顾性分析1例急性上颌骨骨髓炎合并鼻中隔脓肿患儿的临床资料,并检索1956~2021年间国内外发表的相关文献,将包括该病例共有84例患者纳入研究,总结其临床表现、治疗方法及预后。结果典型急性上颌骨骨髓炎84例中,男53例,女29例,未知2例,症状以鼻塞、面部肿胀及发热多见。根据影像学上颌骨骨质破坏与骨质增生硬化间杂分布特点及患儿临床表现可以诊断。细菌培养以金黄色葡萄球菌多见,另外还有表皮葡萄球菌、链球菌及醋酸钙不动杆菌。一般易合并眶周脓肿或上颌牙槽脓肿,合并鼻中隔脓肿患儿少见。文献中只检索到1例14岁患上颌骨骨髓炎合并鼻中隔脓肿病例,既往有牙病史。静脉滴注广谱抗生素及局部脓肿切开引流取得良好治疗效果。结论婴幼儿急性上颌骨骨髓炎细菌培养多为金黄色葡萄球菌,应在早期应用针对该细菌的抗生素控制感染。对局部出现的脓肿如眼部、口腔内上颌牙槽、鼻腔内部等,应该做到早发现早切开引流,可以避免炎症继续发展导致上颌骨死骨形成或导致牙胚坏死脱落或鼻中隔软骨坏死导致外鼻塌陷。

关键词: 婴幼儿, 上颌骨骨髓炎, 鼻中隔脓肿, 细菌培养

Abstract: Objective To investigate the clinical manifestations, diagnostic reasoning, treatment, and prognosis of infant maxillary osteomyelitis complicated with nasal septal abscess. Methods The clinical data of one child with acute maxillary osteomyelitis complicated with septal abscess were retrospectively analyzed. Relevant studies from the literature published in China and overseas from 1956 to 2021 were retrieved and analyzed. In total, the published studies reported on 84 patients. The clinical manifestations, treatment methods, and prognosis, were summarized. Results Of the 84 patients with acute maxillary osteomyelitis, 53 were male, 29 were female, and the sex of 2 was unknown. The key presenting symptoms included nasal obstruction, facial swelling, and fever. The diagnosis was confirmed based on the imaging features of maxillary bone destruction, bone hyperplasia, and sclerosis, as well as the clinical manifestations of the children. Staphylococcus aureus was the most common pathogen identified. Staphylococcus epidermidis, Streptococcus, and Acinetobacter calcoaceticus were also detected. Maxillary osteomyelitis frequently co-occurs with orbital abscess or maxillary alveolar abscess. However, maxillary osteomyelitis with septal abscess in children is rare. In the literature, only one 14-year-old patient with maxillary osteomyelitis complicated with nasal septal abscess and previous relevant dental history has been reported. Treatment with intravenous broad-spectrum antibiotics and incisional drainage of the localized abscess can lead to a positive therapeutic outcome. Conclusion Staphylococcus aureus is the main pathogen associated with acute maxillary osteomyelitis in infants. Early administration of antibiotics to control the infection is recommended. For localized abscesses in the eyes, oral cavity, maxillary alveolar cavity, or nasal cavity, timely detection and early incisional drainage should be performed to minimize the destruction caused by inflammation and infection, leading to necrosis of the maxillary bone, arrested tooth development, or nasal septum cartilage necrosis leading to external nasal collapse.

Key words: Infants, Maxillary osteomyelitis, Nasal septal abscess, Bacterial culture

中图分类号:

R765.3

王娟,宋英鸾,耿江桥,温鑫,史雅楠. 婴幼儿急性上颌骨骨髓炎合并鼻中隔脓肿1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 91-96.

WANG Juan, SONG Yingluan, GENG Jiangqiao, WEN Xin, SHI Yanan. Acute maxillary osteomyelitis complicated with nasal septal abscess in an infant: a case report and literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 91-96.

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