Abstract | Odontogena infekcija potječe od zuba i njegovih potpornih tkiva, a spada u jedne od najčešćih infekcija područja glave i vrata. Uglavnom je podrijetla zuba stražnjeg dijela čeljusti. Mikrobiološki govorimo o polimikrobnoj infekciji koju čine fakultativni anaerobi, obligatni anaerobi te aerobi. Infekcija se širi u okolna tkiva ovisno o broju i virulenciji patogena, obrambenom mehanizmu domaćina, limfnoj drenaži, protoku krvi te anatomskom položaju hvatišta mišića, fascija i vrhova korijenova zuba. Neliječenjem bolesti, zahvaća fascijske prostore koji podrazumijevaju ozbiljniju simptomatologiju i složenije liječenje. Upalni sadržaj ponekad može probiti sluznicu ili kožu i izdrenirati formirajući sinus trakt. Infekcije podrijetla zuba gornje i donje čeljusti mogu formirati intraoralni vestibularni submukozni apsces. Ovisno o anatomskim pojedinostima bolesnika, upala koja potječe od zuba gornje čeljusti može formirati infraorbitalni, palatinalni ili bukalni apsces, apsces maksilarnog sinusa, apsces infratemporalnog i temporalnog prostora te pterigopalatinalnog prostora. Infekcije podrijetla zuba donje čeljusti mogu formirati apsces brade, sublingvalni, submentalni, submanbularni apsces, apsces parotidnog i submaseteričnog prostora, apsces pterigomandibularnog prostora, te zahvatiti parafaringealni i retrofaringealni prostor. Dijagnoza se postavlja definiranjem pacijentove glavne pritužbe i temeljitim prikupljanjem podataka o povijesti sadašnje bolesti, provjerom kliničkih simpotma i znakova, radiografskom analizom, kao i saznanjem informacija o pacijenotovom općem zdravstvenom stanju. Rizičnim bolesnicima pristupa se s posebnim mjerama opreza. Liječenje odontogene infekcije temelji se na uklanjanju uzročnika bolesti. Propisivanje antibiotika mora proći kroz filtar definiranih indikacija i kontraindikacija. Antibiotik izbora u liječenju endodontske infekcije je amoksicilin. Kirurški pristup terapiji apscesa odnosi se na vađenje zuba uzročnika i inciziju sluznice skalpelom u svrhu drenaže gnojnog sadržaja. Složene komplikacije odontogene infekcije mogu biti Ludwigova angina, odontogeni medijastinitis, osteomijelitis, upala orbite, tromboza kavernoznog sinusa, bakterijski meningitis, apsces mozga, tromboza unutarnje jugularne vene i erozija karotidne arterije te nekrotizirajući fascitis. |
Abstract (english) | Odontogenic infection originates from teeth and their supporting tissues and is one of the most common infections of the head and neck area. It mainly originates from the teeth of the back part of the jaw. Microbiologically, we are talking about a polymicrobial infection made up of facultative anaerobes, obligate anaerobes and aerobes. The infection spreads to the surrounding tissues depending on the number and virulence of the pathogen, the host's defense mechanism, lymphatic drainage, blood flow, and the anatomical position of muscle attachments, fascia, and tooth root tips. By not treating the disease, it affects the fascial spaces, which imply more serious symptoms and more complex treatment. Inflammatory contents can sometimes break through the mucous membrane or skin and drain forming a sinus tract. Infections of the origin of the teeth of the upper and lower jaw can form an intraoral vestibular submucosal abscess. Depending on the anatomical details of the patient, inflammation originating from the teeth of the upper jaw can form an infraorbital, palatal or buccal abscess, maxillary sinus abscess, infratemporal and temporal space abscess, and pterygopalatine space abscess. Infections of the origin of the teeth of the lower jaw can form chin abscess, sublingual, submental, submandibular abscess, parotid and submasseteric abscess, pterygomandibular abscess, and involve the parapharyngeal and retropharyngeal space. The diagnosis is made by defining the patient's main complaint and thoroughly collecting data on the history of the current illness, checking clinical symptoms and signs, radiographic analysis, as well as finding out information about the patient's general state of health. At-risk patients are treated with special precautions. The treatment of odontogenic infection is based on the removal of the causative agent of the disease. The prescription of antibiotics must pass through the filter of defined indications and contraindications. The antibiotic of choice in the treatment of endodontic infection is amoxicillin. The surgical approach to abscess therapy refers to the extraction of the causative tooth and incision of the mucous membrane with a scalpel for the purpose of drainage of purulent content. Severe complications of odontogenic infection can be Ludwig's angina, odontogenic mediastinitis, osteomyelitis, orbital inflammation, cavernous sinus thrombosis, bacterial meningitis, brain abscess, internal jugular vein thrombosis and carotid artery erosion, and necrotizing fasciitis. |