21:31,25,Nov,2008 | (521/0/0) | Original
Note: The trackback url will expire after 23:59:59 today
Note: The trackback url will expire after 23:59:59 today
The names of diseases retropharyngeal abscess retropharyngeal space diseases outlines filled with loose connective tissue, dense connective tissue in the midline to form the center seam, separated into right and left of its clearance, therefore, acute retropharyngeal abscesses and more to one side. Each side of the gap in the lymph nodes 3 to 8, with oropharynx, nasopharynx, nasal cavity, paranasal sinuses, Eustachian tube, tympanic region and parotid gland and other lymphoid import, after 3 to 5 years of age disappear gradually shrink, therefore, place infants and young children retropharyngeal abscess were more likely. Cause: (a) Retropharyngeal lymph node infection. (B) traumatic retropharyngeal space, retropharyngeal space cellulitis caused by foreign body, abscess formation. (C) of the cervical spine tuberculosis. Symptoms: Acute type are more acute onset, chills, fever, cough, sore throat, difficulty swallowing, sucking crying, choking, or poor feeding, talk or cry vague slept snoring, shortness of breath, the first the affected side often biased. Slower onset of tuberculous cold abscess, often afternoon fever, night sweats, coughing, weakness and other symptoms of TB, no sore throat, pharyngeal obstruction sensation and swallowing Jianjue inconvenience. Check: children first, and tend to the affected side often bend forward, saliva spills, ipsilateral cervical lymph nodes, there is tenderness. Of children with suspected retropharyngeal abscess should be used for checking the first low-lying supine. Cervical tuberculosis should not be thrown back over head, and suction ready just in case. Examination revealed posterior pharyngeal side of the uplift, mucous congestion, when the ipsilateral pharyngeal abscess larger arch palate and soft palate goes forward. Abscess of the soft touch, a sense of volatility, but the operation must be gentle. Cold abscess caused by cervical tuberculosis can be located in the central part, no significant local mucosa congestion, cervical spine X-ray can show a raised prevertebral soft tissue shadow, and sometimes that plane and cervical fluid signs of bone destruction, increased ESR. Treatment: acute abscess should be timely incision. Classification of Diseases, ENT diseases described as retropharyngeal abscess retropharyngeal suppurative inflammation gap, because of their pathogenesis can be divided into two types of acute and chronic. Cause of a disease, the most common type is acute retropharyngeal lymph nodes suppuration, occurs in children under 3 years old. The mouth, pharynx, nasal and sinus infection, inflammation caused by retropharyngeal lymph nodes, and then purulent, pus accumulation in the oropharynx after the gap of the rear side of the pharynx. In addition, pharyngeal injury (or other foreign body injury) after infection, or inflammation spread into the adjacent retropharyngeal gap, retropharyngeal abscess may also occur. Pathogens and quinsy similar. 2, chronic form caused more by cervical tub
The names of diseases (English) retropharyngeal abscess Chinese Pinyin YANHOUNONGZHONG alias: Meng gangrene, throat abscess, throat raw carbuncle, sore throat, carbuncle in the throat, fighting the end of carbuncle, Western diseases, disease classification codes Throat Western disease name Chinese Classification of Diseases codes defined retropharyngeal abscesses occurred in the retropharyngeal space in suppurative inflammation, sub-acute and chronic. Explaining the cause of a western medicine, acute retropharyngeal abscesses: mainly hemolytic streptococcus bacteria; because of the nasopharynx, nasal cavity, paranasal sinuses, Eustachian tube, tympanic cavity and other parts of the lymph into the gap, so acute pharyngitis, nasopharyngitis , tonsillitis, sinusitis, otitis media, influenza, diphtheria, measles, scarlet fever and other diseases may cause lymph nodes retropharyngeal space infection, abscess formation. Throat hurt foreign direct laryngoscopy, esophagoscopy, etc. can also be caused by trauma due to retropharyngeal abscess.
Second, those with chronic tuberculosis occurred in the cervical or retropharyngeal lymph node tuberculosis, abscesses and cervical prevertebral fascia in between. TCM etiology of the disease etiology, those with the jets off carbuncle empirical roughly the same as the accumulated heat is known as lung spleen, multiple violations of the surge of heat cult poison; or too spicy food because of Sunburn??, Wine Atsumi; or foreign body from the throat, trauma, myofascial damage exposure and disease. Deficiency, the more the diet is not stressed as, malnutrition, dirty mouth, or TB Zhai, throat, ringworm caused by diseases such as chronic systemic. Seasonal population with infants under 3 years of age more common. Intensity and spread of the vast majority of both the incidence of clinical acute, according to statistics 95%. TCM pathogenesis of laryngeal empirical Zheyi carbuncle off similar attacks are evils, Yun-induced lung and stomach heat, heat stroke Results evils, through the throat by the end of the throat, leading to stagnation of qi and blood, knot together as swelling, smoked flesh burning heat toxin, which ultimately caused the meat rot into pus, that is, for the evils the initial invasion of toxic heat stroke Results; medium heat toxin trapped knot, the meat rot into a pus or blood heat into the camp; late collapse multiple abscess pus out, hot drug leakage and more. More than those from the lung and kidney deficiency or lung spleen deficiency, caused by lack of human righteousness, commits Cheng Xu cult poison jets at the end walls have appeared cold throat abscess. Diagnostic criteria for pathological pathophysiology Chinese medicine diagnosis of the disease is divided into two categories positive and deficiency. Early evidence for the wind-heat in the table; mid-cult poison or heat transfer into the camp in the blood; the late collapse of pus from abscess, toxic heat leakage. Spleen Qi Deficiency of lung and kidney and lung.
Evidence in the throat abscess: more common in children. Rapid onset of these patients, shorter duration, the more obvious symptoms, throat swelling and pain more severe end, Zeng Han Zhuang heat, speaking voice is not vague or Yang, hold the spit severe dampness, sound like a drag saw, and may have swollen neck , items strong. There are many children suffering from crying more than sound, irritability, bad breath, snoring sound when breathing. Throat examination showed swelling, throat swelling and uplift the bottom side of the obvious. The dialectical see "peritonsillar abscess" in TCM contents are divided into "wind-heat in the table," "Heat Transfer in evil," "heat penetrating the blood," "toxic heat leakage" IV. Note that the heat penetrating the blood off of a carbuncle-type is more common than the throat, carbuncle swollen due to a larger margin, so that the airway obstruction or occlusion of the sputum caused shortness of breath, lips black-faced black, sweating, irritability, and even appeared Shenhun delirium, pulse slightly stricken from the resolution of the signs of yin and yang. In addition, the "hot drug leakage" of a type, if the abscess pus in the throat as from the ulcer, or abscess check mishandling incision, pus choking choking and airway, can cause apnea and death.
Deficiency in the throat abscess: also known as cold in the throat abscess force, adult common.
1. Lung and kidney
Syndrome: more than a TB Zhai or throat diseases such as ringworm. The incidence of moderate, long duration of symptoms was gradual, slow increase. Performance of throat congestion, and low voice not Young, pharynx within the dry, less pain, swallowing unfavorable neck after the move is limited, increased pain with activity, the external carotid M. scrofulaceum often palpable spinal nucleus, check the throat or pink pale, swollen throat end of uplift, such as the touch of the soft, sense of volatility (to be fully prepared in the circumstances.) Such as carbuncles are pus ulcer is a long thin stream, breach refractory. See also cough, expectoration unhappy, bloody sputum, or have hot flashes, night sweats, zygomatic red, hand, foot and heart heat, weight loss, dizziness, tinnitus, weak waist, red and tender, pulse breakdown and so on.
Discrimination, â‘ syndrome, more common in the certificate have TB Zhai, throat ringworm and other medical history, and a longer duration of symptoms was not clear, although the swelling of the throat bulge, but not quite the end of congestion, and throat pain, fever and other symptoms not directly proportional, as has been pus Qingxi collapse is difficult to heal, to cough and throat, expectoration bad mood, hot flashes, night sweats, hot hand, foot and heart, dizziness, tinnitus, weak waist, red and tender, pulse breakdown points for the syndrome. â‘¡ pathogenesis: longer duration, local swelling uplift, but less marked, indicating lack of righteousness, unable to fight with the cult poison for the deficiency of the characteristics of throat abscess. Lung Yin is throat cough, expectoration unhappy; kidney were seen dizziness, tinnitus, weak waist; liver and kidney, inflammation and therefore, false fire hot flashes, night sweats, zygomatic red, hand, foot and heart heat and weight loss; false fire Smoked contact burning lungs, so see bloody sputum; tongue Nenhong, pulse breakdown is Yin Huo-wang of the elephant.
2. Lung Qi Deficiency
Syndrome: the "lung-kidney" type, and see lazy words fatigue, shortness of breath sounds slightly, or spontaneous, looking Koushi white, poor appetite bloating, loose stools, pale tongue, thin coating, pulse How weak.
Analysis: â‘ syndrome: more common in tuberculosis of the card Zhai, throat, ringworm, or other systemic chronic disease, longer course, sore throat, congestion is not obvious, but the local swelling uplift, particularly in the pus Qingxi, breach refractory, fatigue lazy words, shortness of breath sounds slightly, or spontaneous, looking Koushi white, poor appetite bloating, loose stools, pale tongue, white coating, pulse How weak points for the syndrome. â‘¡ pathogenesis: long duration of local symptoms was not obvious, is the righteousness is empty, unable to fight with the evil of it; lung wasting, can not be declared lost hair and cloth qi essence, it is lazy words fatigue, shortness of breath sounds slightly, or spontaneous; temper weakness, loss of the transport of water and transport of wet food essence is looking Koushi white, abdominal distension and poor appetite, loose stools and pus Qingxi expansion flow, breach refractory; How pale tongue, weak pulse power of white deficiency of the card. Western diagnostic criteria (a) acute retropharyngeal abscess
1. More common in children under 3 years old, often from the mouth, pharynx, nasal and sinus infection, pharyngeal foreign bodies and trauma caused.
2. Chills, fever, sore throat, difficulty swallowing, voice clear, crying as duck-ming. Abscess has high congestion, low abscess or abscess can cause breathing difficulties and increased wheezing.
3. Acute tolerance, head to the affected side, neck, limited mobility, pharyngeal mucosa congestion uplift, often to one side. Cervical lymph nodes.
4. Blood leukocyte and neutrophil counts increased.
5.X line posterior pharyngeal lateral neck radiographs showed soft tissue shadow widening.
6. Pharyngeal puncture pus out for bacterial culture and sensitivity test.
(B) Chronic retropharyngeal abscess
1. Mostly cervical or retropharyngeal lymph node tuberculosis caused tuberculosis cold abscess. More common in young people.
2. Onset is slow, often afternoon fever, night sweats, weight loss and other TB symptoms.
3. No sore throat, with a throat abscess can increase the sense of obstruction and swallowing difficulties. Often caused by cervical tuberculosis can be complicated by paraplegia.
4. Pharynx posterior median eminence, no significant mucosal congestion.
Lateral cervical spine films showed 5.X line cervical vertebral body destruction, intervertebral space narrowing, physical protrusion disappeared and widened prevertebral soft tissue shadow.
6. Pharyngeal puncture out of thin cheese-like pus, culture or smear can be found in Mycobacterium tuberculosis.
According to Western medicine diagnosis is based on history, clinical presentation, physical examination and neck X ray can confirm the diagnosis. History of symptoms and signs of disease 1. Of onset of acute emergency, often the primary disease or a history of pharyngeal trauma, fever, irritability, body temperature as high as 39 â„ƒ ~ 40 â„ƒ, sore throat, poor feeding, difficulty swallowing.
2. Language is unclear, such as the mouth and cracked, shortness of breath, expressed as inspiratory dyspnea, difficulty falling asleep, hi lateral position, head to the affected side to reduce the ipsilateral retropharyngeal tension, reduce pain, inflammation of the throat when the invasion increased difficulty in breathing due to eating less, the performance of dehydration, fatigue.
3. There were more chronic symptoms of tuberculosis, often slow onset and long duration hidden. Weeks or months later evolving abscess. Symptoms similar to those with acute type, but to a lesser extent.
Examination 1. Examination in patients with involuntary head extension, to reduce pain, breathing can have wheezing or shortness of breath, saliva outflow of cervical lymph nodes. Check the pharyngeal side of the uplift seen after the posterior pharyngeal wall, congestion, and the soft palate and palatal pharyngeal arch onward; such as TB caused by, bulging at the center of the mucosal surface without congestion, the time when the natural rupture of the posterior pharyngeal wall with granulation swollen.
2. Finger palpation posterior pharyngeal bulge when the Ministry of soft, sense of volatility, but special attention should be, do not easily line palpation examination, as may promote abscess rupture, pus suction throat causing suffocation, if this happens, immediately will bring children back, head down.
3. Needle aspiration with thick pus can be drawn. Electrical diagnostic imaging diagnosis of a neck X-ray examination of acute who can show thickening of posterior pharyngeal soft tissue air or fluid levels visible.
Second, those with chronic lateral neck X-ray position than widened prevertebral soft tissue shadows outside, and a cervical bone resorption, destruction, or the spacing of disc space narrowing and other symptoms. Laboratory diagnosis of acute were significantly higher white blood cells, pus culture as hemolytic streptococcus bacteria or staphylococcus. Mycobacterium tuberculosis smear can be found, caused by trauma or foreign body of retropharyngeal abscess may see foreign matter. Blood in urine other diagnostic cerebrospinal fluid immunological fecal histological examination Western differential diagnosis 1. Peritonsillar abscess: more common in adults, trismus, abscess in the tonsils before the top of the tonsils and the uvula is pushed to the center line.
2. Parapharyngeal abscess: more common in older children or adults, neck swelling pressure significantly, and the pharyngeal tonsil pharyngeal side is pushed, almond swelling is not obvious.
3. Acute laryngitis: a hoarse voice for performance-based, can be serious breathing difficulties, vocal cord congestion, edema.
4. Note that with the abnormal cervical retropharyngeal tumors and identification. Identification of traditional Chinese medicine evaluation standard class 1 license. Cure, sore throat, in addition, temperature is normal, abscess disappeared, wound healing, clinical symptoms and signs disappeared. No abnormal laboratory for various tests.
2. Improvement: reducing sore throat, body temperature decreased, abscess narrow lead abscess fluid, clinical symptoms and signs were improved. Laboratory examinations showed some improvements.
3. Invalid: no improvement of clinical symptoms and signs, sore throat increased, heat reclaim, infection extended, causing serious complications. Laboratory examinations were abnormal. Western medicine treatment of complications of a prognosis, were diagnosed soon after acute abscess pus. Method:
â‘ equipment: open devices, long-handled knife, long-handled forceps, headlights, air needle puncture to attract, suction, tracheotomy equipment, oxygen, intubation.
â‘¡ preoperative morphine and atropine is disabled, no anesthesia and local anesthetic.
â‘¢ children position: supine head-down, or direct laryngoscopy with a spatula tongue soft reduction, exposure to the posterior pharyngeal wall. First with coarse needle puncture site in the abscess pus, if the puncture is followed to attract better and try to pus net absorption, and then with a knife make a slit in the abscess to open lower, then a long stretch incision forceps, adequate drainage . Intraoperative suction net absorption at any time with pus into the larynx to avoid. Such as the hypopharynx abscess, should not be exposed with a spatula, use direct laryngoscopy abscess.
â‘£ After maintaining oral hygiene, broad-spectrum antibiotics to control infection, daily observation of the wound, found the posterior pharyngeal wall and bulging, poor drainage, can be softened and then forceps inserted into the wound, drainage of abscess.
â‘¤ conditions may simply not cut pus, also repeated several times all the more pumping.
â‘¥ tuberculous abscess pus should puncture, and then injected into the anti-TB drugs in the abscess, such as streptomycin, if still not all the more should the external carotid incision and drainage, method: flat posterior border of sternocleidomastoid for all mouth, the sternocleidomastoid forward traction, separation and exposure to arterial sheath, and then pull forward to the cervical separation, to abscess, the abscess the size of a finger probe, scope, whether sequestrum. If granulation may try scraping, the last article in the abscess drainage in the home. Postoperative drainage strip out gradually, so that the wound healing from the inside out. Systemic anti-TB drugs, such as the cervical vertebrae are saboteurs should cooperate with the orthopedic treatment. TCM treatment of this disease, should be inside and outside of, flexibility in the use, in particular, has become in the case of carbuncle swollen, pus or pus immediately, not let the self-collapse, which can speed recovery, and prevent pus sudden influx of fluid the risk of the airway.
A dialectical election party
Evidence in the throat abscess:
See "peritonsillar abscess," the Chinese "dialectical election party" section, all divided into four types. If you are children, the dose should reduce it.
Deficiency in the throat abscess: avoid using the bitter cold and hot Xin drugs, so as not to cut cutting strength and Shangyin.
1. Lung and kidney
Governing Law: nourish lung and kidney, heat transfers.
Recipe: Lily solid impregnable ("medical side Annals") addition and subtraction. Rehmanniae 18g, Radix 18g, Asparagus 18g, Lily 15g, white peony root 12g, paeonol 12g, Fritillaria 12g, licorice 3g, Scrophulariaceae 15g, Campanulaceae 8g, melon Ren 30g, horn stab 10g. If the neck were M. scrofulaceum, plus Prunella 18g, red peony peony root easily; sputum with blood, then add Agrimony; kidney was who to Radix, white peony root, add Shan Yu, Ligustrum lucidum, Alisma .
2. Lung Qi Deficiency
Governing Law: Spleen Qi, earth generates metal.
Recipe: Four Gentlemen Decoction ("Taiping Benevolent Dispensary Bureau") flavor. Codonopsis 18g, Bai Zhu 12g, Poria 15g, Beiqi 30g, tangerine peel 89, Health yi 30g, melon Ren 30g, Rehmannia 18g, white peony root 12g, licorice 3g. If deficiency symptoms are evident, plus ginseng 10g, Ophiopogon japonicus fry a little independence; poor appetite bloating add more fraudulent claims Chunsharen (later); breach Beiqi can increase the amount of refractory and Zhuojia Angelica tail, white Lian, Angelica, and so on.
Second, other therapies
1. External treatment: the flute medicine, mouthwash, and topical and release of the pus and other methods, see "peritonsillar abscess" Chinese relevant content. But the need to emphasize that once formed boils, put one of pus is the preferred method should be implemented immediately. With peritonsillar abscess is different is that in patients with laryngeal abscess should be well prepared before surgery, such as equipment, lighting and suction, and supine head-down, to prevent sudden boils ulceration, blocking the airway and cause suffocation. Evidence in the throat carbuncle carbuncles Outburst first stab at the defensive pus, and then a small vertical incision knife; deficiency in the throat abscess pus aspiration only, but not cut to prevent the wound fester, unhealed prolonged .
2. Acupuncture: In immature abscess in the throat when the carbuncle, also this method, there Xiere detoxification, swelling and pain of the work. See "peritonsillar abscess" Chinese relevant content, but the lesion should be carefully bled. Evidence of Chinese medicine in the throat abscess: see "peritonsillar abscess" in the "proprietary" part.
Deficiency in the throat abscess:
1. Zhibai Dihuang Wan (or citrate Ju Di Huang Wan): Each 10g, 3 times a day, light salt delivery service. Nourishing the liver and kidney function, clear down virtual fire for liver and kidney or lung and kidney were.
2. Bu Zhong Yi Qi Wan: Each 8 ~ 10g, 3 times a day. Tune up the spleen and stomach function, Qi Sun, who for lung spleen deficiency.
3. Six Gentlemen Pill: Each 8 ~ 10g. 3 times a day. Functional spleen Qi, qi and phlegm, for Lung Qi Deficiency and see cough, sputum, shortness of breath sounds were low.
4. Shiquandabu pills: Each 10g, 3 times a day. Function replenishing qi and blood, eventually becoming used to heal after the collapse boils refractory persons. Acupuncture massage to relieve sore throat, sore throat where the impact of swallowing eaters, can be used. Details, see "flat body abscess," the contents. Integrative Medicine retropharyngeal retropharyngeal space abscess is a purulent inflammation, is divided into acute and chronic, the former is closed suppurative retropharyngeal caused by leaching, which was caused by cervical tuberculosis. Western Treatment is antibiotics, infection control, implementation of incision to prevent complications; while tuberculous retropharyngeal abscess should be the body with anti-tuberculosis treatment. Oral puncture the abscess, mostly the result of such cervical tuberculosis patients caused by orthopedic surgeons treating the primary disease. Traditional means that the throat abscess occurred in and around the throat area between the sore carbuncle in general. Mainly in detoxification, swelling the abscess, the abscess before the formation of disinfection of drinking flavored flavors available, Qingyan Lee diaphragm Decoction, as pus is available after the subtraction Xian Fang Huo Ming Yin. Although Chinese wind, detoxification and the reduction of swelling. But the effect is slow, difficult solution needs, Integrative Medicine retropharyngeal abscess is incision basis. Use of supportive therapy of antibiotics, hormones, and traditional Chinese medicine treatment to improve efficacy. Preventive care and rehabilitation of historical research "articles Lingshu ulcer" as described in the "fierce gangrene" disease and the disease is quite similar: "Development in the Essentials of carbuncle, it is called Meng gangrene, gangrene Meng died, into a septic, pus is not diarrhea, plug pharynx, half-dead. "" the sequel to all the key cards Building Jade Addendum "especially when describing the throat abscess that:" there throat swelling and pain, no other forms were "part of this and the disease low, generally difficult to observe the situation to the affected area are very consistent. The cause of the disease, those with positive throat abscess off roughly the same as the accumulated heat is known as lung spleen, multiple violations of the surge of heat cult poison; or due to excessive eating spicy broiled Bo, wine Atsumi; or by the throat foreign bodies, trauma, muscle membrane damage and the incidence of exposure. Therefore, "San Franciscans overall record of 122 volumes," said: "The Insufficiency of obstruct heat, smoked hair on the coke, attack at the throat, knot poly swelling, pain, not dissipation, heat flaming, To form a carbuncle." "Sore experience in book Volume 1 "also said:" The accumulated heat pipes carbuncle, the stomach subjected to heat, Wei Qi through the throat, so the risk of throat abscess. "" You Shi throat Secretary "also said," throat carbuncle, the result of over eating spicy broiled Bo , Atsumi wine, feeling hot and raw, is a lung disease. "
Condition Description: cough, sore throat, difficulty swallowing
Acute abscess should be timely incision. Should be fully prepared before surgery equipment, lighting and suction devices. Supine patients to avoid surgery in the head-down into the lower respiratory tract secretions caused by suffocation. Spatula or direct laryngoscopy with the pharyngeal posterior wall of the bump in the abscess puncture the pus, and then the lowest in the abscess to make a longitudinal incision Department to expand the wound long forceps, smooth drainage. daily review, if empyema, and then cut distraction forceps drainage, until cured.
Preoperative and postoperative intravenous antibiotics should be given a lot to control the infection, parallel support therapy.
Cold tuberculous abscess without cervical lesions, pus should be held after the intramuscular injection of streptomycin, 1 g daily and oral isoniazid, 100 mg daily. If cervical lesions, should the external carotid incision, scraping In addition to lesions, fixed head and neck, and the anti-tuberculosis treatment.
1, the implementation of acute retropharyngeal abscess incision. Supine head-down, with the spatula or tongue into the soft reduction then exposed to oropharyngeal posterior wall of the laryngoscope, that long thick needle puncture and pus. Then with a knife in the abscess the lower part to make a vertical incision
2, tuberculous retropharyngeal abscess in addition to anti-tuberculosis treatment, can puncture the mouth pus, abscess fluid injection 0.25g streptomycin, but not in the throat cut. Concurrent cervical tuberculosis, should be in by the orthopedic surgeons treatment of cervical tuberculosis at the same time, take the external carotid incision abscess.