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Komplikationen bei odontogenen und nichtodontogenen Infektionen

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Komplikationen in der Kranio-Maxillofazialen und Oralen Chirurgie

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Zusammenfassung

Infektionen im Kopf- und Halsbereich haben meist einen odontogenen (zahnmedizinischen) Ursprung, können aber auch von nicht odontogenen Quellen wie Mandeln, Nasennebenhöhlen, Mittelohr, Speicheldrüsen, Entwicklungszysten und Haut ausgehen. Schwere Zahnkaries, Perikoronitis, Parodontitis, zahnärztliche Eingriffe, Tonsillitis, Sinusitis, penetrierende traumatische Verletzungen, Otitis media oder Otitis interna, Sialadenitis und Gesichtsakne können schwere Infektionen verursachen, die sich bis in die tiefen Halsabschnitte ausbreiten und manchmal zu schweren Komplikationen und gelegentlich zum Tod führen können. Die klinischen Manifestationen der Infektionen und der damit verbundenen Komplikationen variieren je nach anatomischem Ursprung der Infektion und Ausbreitungsweg der Infektion. Häufig suchen Personen mit systemischen Begleiterkrankungen wie Diabetes, anderen immunsuppressiven Erkrankungen und Drogenmissbrauch sowie Personen, die aus sozioökonomischen Gründen nur eingeschränkten Zugang zur Gesundheitsversorgung haben und über eine geringe Gesundheitskompetenz verfügen, erst mit Verzögerung eine Behandlung auf und weisen dann schwerere Infektionen auf. Bei dieser Patientengruppe sind lebensbedrohliche Komplikationen wie Atemwegsobstruktion, zervikale nekrotisierende Fasziitis, deszendierende nekrotisierende Mediastinitis, Lemierre-Syndrom (Thrombose der Vena jugularis interna), Perikarditis, thorakales Empyem, Endokarditis, Thrombose des Sinus cavernosus, Orbitaspitzensyndrom, Hirnabszess, Osteomyelitis, Sepsis und septischer Schock und gelegentlich Tod wahrscheinlicher. Glücklicherweise sind derartige Komplikationen heute seltener geworden. Heutzutage können wir Infektionen mit Hilfe fortschrittlicher bildgebender Verfahren genauer diagnostizieren, die Atemwege mit Hilfe der endoskopischen Beurteilung der Atemwege und indirekter Visualisierungsinstrumente für die Intubation besser betreuen und eine frühzeitige chirurgische und medizinische Behandlung mit geeigneten intravenösen Antibiotika, Flüssigkeiten und Nahrungsmitteln durchführen. Trotz dieser Verbesserungen kommt es immer wieder zu lebensbedrohlichen Komplikationen, die häufig auf eine verspätete Vorstellung, eine verspätete Diagnose oder eine verspätete Behandlung zurückzuführen sind. Auch eine unzureichende Behandlung oder ein Ausbleiben des Ansprechens auf die Behandlung kann zu erheblicher Morbidität und Mortalität führen. In diesem Kapitel haben die Autoren die Informationen aus ihren Erfahrungen und den zahlreichen veröffentlichten retrospektiven Fallserien und Fallberichten zusammengetragen, um dem Leser das Wissen und die Instrumente zur Vermeidung und zum Umgang mit schwerwiegenden lebensbedrohlichen Komplikationen von Infektionen zu vermitteln. Sie erörtern die Literatur zu prädisponierenden Risikofaktoren und zur Ätiologie und geben einen Überblick über die angewandte Anatomie, die klinischen und röntgenologischen Merkmale, die Diagnose, das Management und die Prävention einiger Komplikationen von odontogenen und nicht odontogenen Infektionen.

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  1. Abteilung für Mund-, Kiefer- und Gesichtschirurgie, Boston University, Boston, USA

    Radhika Chigurupati

  2. Mund-, Kiefer- und Gesichtschirurg, Quincy, USA

    Michael Shemkus

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Correspondence to Radhika Chigurupati .

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  1. Department of CMF and Oral Surgery, Medical University of Innsbruck, Innsbruck, Österreich

    Robert Gassner

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Chigurupati, R., Shemkus, M. (2023). Komplikationen bei odontogenen und nichtodontogenen Infektionen. In: Gassner, R. (eds) Komplikationen in der Kranio-Maxillofazialen und Oralen Chirurgie. Springer, Cham. https://doi.org/10.1007/978-3-031-32354-6_5

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