Infeksi Leher DalamPresentan:YUKO ADE WAHYUNI030.01.281

Pembimbing:Dr.ASNOMINANDA,Sp.THT-KL

Infeksi Leher DalamAnatomi Fascia Cervical

Anatomi Rongga leher dalam

Infeksi Rongga leher dalam

Cervical FasciaLap.Superficial

Lap. DalamSuperficialTengahDalam

Cervical FasciaSuperficial LayerPlatysmaMuscles of Facial Expression

Cervical FasciaLap. Superficial dari Fascia Cervical DalamMusculusSternocleidomastoidTrapeziusKelenjarSubmandibularParotidRonggaTrigonum PosteriorSuprasternal space

Cervical FasciaLap. Tengah dari Fascia Cervical DalamMuscular DivisionInfrahyoid Strap Muscles (Sternohyoid, Omohyoid, Tyrohyoid)Visceral DivisionPharynx, Larynx, Esophagus, Trachea, ThyroidBuccopharyngeal Fascia

Cervical FasciaLap. Dalam dari Fascia Cervical DalamLap.AlarPosterior dr visceral layer of middle fasciaAnterior dr prevertebral layerLap.PrevertebralCorpusVertebralDeep muscles of the neck

Cervical FasciaCarotid SheathDibentuk oleh ketiga lapisan fascia dalamFormedTerdiri dari carotid artery, internal jugular vein, and vagus nerveLincolns Highway

Rongga Leher DalamSuprahyoid: Peritonsillar SpaceMedialcapsule of palatine tonsilLateralsuperior pharyngeal constrictorSuperioranterior tonsil pillarInferiorposterior tonsil pillar

Rongga Leher DalamSepanjang leher: Retropharyngeal SpacePosterior dr pharynx dan esophagusAnterior dr alar layer of deep fasciaBerawal dari basis cranii ke T1-T2

Rongga Leher DalamSuprahyoid: Parapharyngeal SpaceSuperiorskull baseInferiorhyoidAnteriorptyergomandibular raphePosteriorprevertebral fascia Medialbuccopharyngeal fasciaLateralsuperficial layer of deep fascia

Rongga Leher DalamSuprahyoid: Parapharyngeal SpacePrestyloidMedialtonsillar fossaLateralmedial pterygoidContains fat, connective tissue, nodesPoststyloidCarotid sheathCranial nerves IX, X, XII

Rongga Leher DalamSuprahyoid: Submandibular SpaceAnterior/LateralmandibleSuperiormucosaInferiorsuperficial layer of deep fasciaPosterior/Inferior--hyoid

Rongga Leher DalamSuprahyoid: Submandibular SpaceSublingual SpaceHypoglossal and lingual nervesSublingual glandWhartons ductSubmylohyoid SpaceAnterior bellies of digastricsSubmandibular gland

Infeksi Rongga Leher DalamPresentation/Origin of InfectionMicrobiologyTreatmentComplication

PresentationPeritonsillar SpaceFever, malaiseDysphagia, odynophagiaHot-potato voice, trismus, bulging of superior tonsil pole and soft palate, deviation of uvulaSebab- komplikasi dari tonsillitis

PresentationRetropharyngeal Abscess96% terjadi pada anak di bwh usia 6Anak--demam, lymphadenopathy, torticollis, oral intake kurang, nyeri menelan, droolingDewasa--nyeri, dysphagia, anorexia, snoring, nasal obstruction, nasal regurgitationDyspnea and respiratory distressOedem pd ddg Lateral posterior oropharyngeal

PresentationPediatrics Causesuppurative process in lymph nodesRiw. ISPANose, adenoids, nasopharynx, sinusesAdultsCausetrauma, instrumentation, extension from adjoining deep neck space,batuk kronis

PresentationParapharyngeal SpaceDemam,menggigil, malaisenyeri, dysphagia, trismusOedem Medial dr lateral pharyngeal wallsebabinfection of pharynx, tonsil, adenoids, dentition, parotid, mastoid, suppurative lymphadenitis, extension from other deep neck spaces

PresentationSubmandibular SpacePain, drooling, dysphagia, neck stiffnessAnterior neck swelling, floor of mouth edemaCause70-85% have odontogenic originFirst molar and anteriorSecond and third molarsSialadenitis, lymphadenitis, lacerations of the floor of mouth, mandible fractures

PresentationLudwigs angina1. Cellulitis, bkn abscess2. terbatas pd SM space3. Foul serosanguinous fluid, jarang purulence4. Fascia, muscle, connective tissue involvement, sparing glands5. Direct spread (fascia) daripada lymphatic spreadTender, firm anterior neck edema without fluctuanceHot potato voice, droolingTachypnea, dyspnea, stridor

MicrobiologyEra PreantibioticS.aureusSaat iniaerobic Strep species and non-strep anaerobesGram-negatives jarangHampir selalu polymicrobial

TreatmentAirway protection

Antibiotic therapy

Surgical drainage

TreatmentAirway protectionObservationIntubationDirect laryngoscopy: kemungkinan resiko rupture dan aspirationFlexible fiberopticTracheostomyIdeally = elektif, sadar, local anesthesiaAbscess mungkin menutupi tracheaDistorsi anatomy and penampang jaringan

TreatmentAntibiotic Therapymedikamentosaantibioticpemberian secara parenteral yang harus diberikan secepatnya tanpa perlu menunggu hasil kultur pus.Pilihan antibiotic spectrum luas yang dapat mencakup kuman aerob dan anaerob, gram + dan -simptomatispemberian rehidrasi untuk memperbaiki keseimbangan cairan dan elektrolit

TreatmentAntibiotic TherapyPolymicrobial infectionsAerobic Strep, anaerobesAmpicillin/sulbactam with metronidazoleAlternativesThird generation cephalosporinsclindamycinCulture and sensitivity

TreatmentSurgical DrainageTransoralCruciate mucosal incision, blunt spreading through superior pharyngeal constrictor

Externaldrainase external dengan insisi transversal sepanjang batas anterior dan posterior M. Sternocleido mastoideus. Abses dibuka diantara selubung karotis, yang terletak di lateral dan M. Konstriktor inferior , yang terletak di medial.

TreatmentSurgical DrainageExternalEXPOSURE, EXPOSURE, EXPOSURELevitt: anterior vs. posterior approachSubmandibular incisionSubmental incisionT-incision

Treatment

Treatment

ComplicationsAirway obstructionEndotracheal intubationTracheostomy

Ruptured abscessPneumoniaLung Abscess