Retrospective analyses of the patients with oral floor flegmons

Actualitatea Datorită schimbărilor din ultimul timp a microorganismelor, apariţia noilor tulpini rezistente la antibiotice, creșterea virulenţei și toxicităţii lor, din partea macroorganismului scăderea forţelor de rezistenţă, micșorarea imunităţii datorită condiţiilor actuale în care trăeste populaţia, apar noi relaţii de simbioză sau agresie între microorganisme și macroorganisme. Aceste relaţii noi schimbă frecvenţa patologiei, manifestările clinice, diagnosticul și tratamentul. Astfel apare necesitatea studierii acestora, pentru ca diagnosticul și tratamentul actual să fie mai efectiv și respectiv să obţinem o frecvenţă mai mică a bolii și complicaţiilor ei. Materiale și metode Datele au fost colectate din arhiva Instituţiei medico–sanitară public, Institutul Medicină de urgenţă al Republicii Moldova. În perioada anilor 2011—2015 au fost spitalizaţi 132 pacienţi cu flegmoane ale planșeului bucal. Rezultatele obţinute în urma examinării au fost prelucrate și prezentate.Scopul: Analizarea și comparaea datelor obţinute în urma examinării fișelor medicale a pacienţilor cu flegmoane ale planșeului bucal. Rezultatele obţinute În urma analizei a 132 de fișe a pacienţilor cu flegmoane a planșeului bucal am observant următoarele: Bărbaţi au fost 74,5%, femei 24,5%. După etiologie: odontogene 88%, neodontogene 11%. Din zona urbană 35%, rural 65%. În dependenţă de dintele implicat: primii molari 24%, molarii doi 28%, molarii trei 46%, alţi dinţi 2%. Din totalul pacienţilor internaţi în acest interval numarul decedaţilor a constituit 9%. Patologia respectivă a fost complicată cu mediastinită în 4,5% și stare septică în 17%. În dependenţă de vîrstă am observant următoare incidenţă: intre 18 și 29 de ani 32%, 30 ani 31%, 40 ani 16%, 50 ani 12%, 60 ani 5%, 70 ani 3,5%, 80 ani 0%, 90 ani 0,8%. Concluzii 1. Rezultatele datelor statistice la pacienţii cu flegmoane ale planșeului bucal obţinute în urma examinării fișelor medicale se apropie de rezultatele prezentate de alte studii la nivel mondial. 2. Numărul complicaţiilor la pacienţii cu flegmoane a planșeului bucal este mare, această situaţie ne permite să conchidem că problema diagnosticului și traramentului la pacientii cu flegmoane al planșeului bucal este actuală și necesită a fi studiată.Actuality According to the changes of the microorganisms in the last period of time, appearance of the new types which have resistance to the antibiotics, increasing the virulence and its toxicity, from the macroorganism is decreasing of the resistance forces, of the immunity of the organism as a result of the vulnerable conditions of the life of the patients, appeared new relation of symbiosis and aggression between the microorganisms and macroorganism. These new relations change the frequency of pathology, clinical manifestations, diagnosis and treatment. As a result appear the necessity of studying it to make the diagnosis and treatment to be more effective and to obtain a lower frequency of this disease and its complications. Material and methods Were collected dates from the archives of the Medico– sanitar Public Institute, Institute of Emergency of Republic of Moldova. During 2011—2015 were hospitalized 132 of the patients with oral floor flegmons. The obtained results were examined and represented. The aim To analyze and compare the obtained dates during the examination of the patients diseases history with oral floor flegmons. Results During analyzes of the 132 diseases history of the patients with oral floor flegmons, we obtained the following results: males — 74,5%, females — 24,5%; according to the etiology: odontogenic factors — 88%, nonodontogenic — 11%; from the urban zone — 35%, village zone — 65%; by the caused tooth: first molars — 24%, second molars — 28%, third molars 46%, other teeth — 2%. From all the patient who were hospitalized the number of deaths were 9%. Appeared complications as mediastenitis were 4,5%, and septis — 17%. According to the age: 18–29 years old — 32%, 30 year old — 31%, 40 years old — 16%, 50 years old — 12%, 60 years old — 5%, 70 years old — 3,5%, 80 years old — 0%, 90 years old — 0,8%. Conclusions 1. The results of the statistics of the patients with oral floor flegmons obtained after examination of their disease history are almost close to the dates presented all over the world. 2. The number of complications of the oral floor flegmons is high, this situations let us to recognize that the problem of diagnosis and treatment of these patients is actual and need to be researched

Septicemia as a complication of diffuse phlegmon of the mouth floor

Department of Oral and Maxillofacial Surgery and Oral Implantology Arsenie Gutan, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Despite all the steps made in recent decades in the knowledge of pathogenesis, in improving diagnosis and therapy of septicemia, this disease, regardless of the age at which it occurs, is a complex medical problem. We need a multidisciplinary team to solve it, which besides the infectious disease doctor, microbiologist, biochemist, and radiologist, often requires specialists in intensive surgery and surgeons of various profiles. Bacteriology of septic shock records: Gram-negative germs 50-60%, Gram-positive germs 6-24%. Aim of the study. The assessment of clinical and paraclinical picture in patients with phlegmon of the mouth floor, complicated with sepsis. Materials and methods. Analysis of 50 patients who suffered from phlegmon of the mouth floor, who were hospitalized in the Oral and Maxillo-facial Surgery department of IMSP IMU Chisinau between the 2016 and 2017 years. Patients were clinically and paraclinically investigated. Literature analysis of 17 articles, 5 PhD thesis, 3 books. Results. 6 % of all patients examined with phlegmon of the mouth floor were diagnosed with sepsis. Approximately two patients diagnosed with oral phlegmon and complications of this disease die each year in the Republic of Moldova, which accounts for approximately 7% of all patients with this diagnosis. The untreated septic shock lasts for several hours to 1-2 days, with a fatal outcome in 30-60% of cases. According to M. Balş, septicemia occurs in people with a reasonable defense capacity, which is strong enough to fight, develop a local and general inflammatory process, but insufficient to stop the infection from the beginning. In people with collapsed defense, the clinical picture of septicemia is not developed, the infection leads to septic shock violently. Conclusions. 1. There is an imbalance betweenpro-inflammatory vs anti-inflammatory, coagulation vs. anti-coagulation, oxidative vs anti-oxidative, apoptotic vs. anti-apoptotic systems in patients with severe sepsis. 2. Signs and general symptoms of sepsis are fever higher than 38.3 degrees Celsius; hypothermia lower than 36 degrees Celsius; heart rate higher than 90 beats/minute; tachypnea, hyperglycemia 7.7 mmol/l. 3. The cause of over 90% of the deaths of patients with inflammatory processes in the Oral and Maxillo-facial department is the septic shock resulting in polyorganic insufficiency

Antibioticotherapy used in the treatment of a phlegmon of oral floor

Rezumat Flegmonul planșeului bucal este o patologie inflamatorie gravă, cu risc major de răspândire a supuraţiilor în lojele învecinate și spre mediastin. Pentru evitarea eventualilor complicaţii este necesar ca diagnosticul sa fie stabilit cât mai timpuriu și de administrat un tratamentul complex. Prima prioritate în tratament este mereu salvarea vieţii. Tratamentul este orientat în 3 direcţii: menţinerea respiraţiei; terapie agresivă cu antibiotice; decompresia chirurgicală a spaţiilor submentonier, sublingual și submandibular[6]. Aceasta ne-a determinat să facem o analiză în această direcţie.Summary The phlegmon of oral of it’s a severe inflammatory disease with a high risk of spreading of the pus to the adjacent spaces and mediastinum. To avoid the complications it is necessary to put the earlier diagnosis and indicate the complex treatment of it. The main priority of the treatment is to save the life of the patient. The treatment is orientated in three directions: to maintain the breathing, aggressive antibioticotherapy, surgery decompression of the submental, sublingual and submandibular space. It’s determined us to make analyses in this direction

Surgical treatment complications to the pacients with infflamatory processes in oromaxilo-facial region

Rezumat. Pentru realizarea acestui studiu au fost selectati 12 pacienţii cu procese inflamatorii din sectia de chirurgie oro-maxilo-faciala, la care starea generala si locala s-a agravat cu toate că se aflau sub un tratament complex. Ne-am propus să observăm situaţiile în care procesele inflamatorii progresează după aplicarea unui tratament complex. În multe cazuri cînd procesele inflamatorii progresează după aplicarea unui tratament complex, sunt prezente doar manifestările clinice. Adesea leucocitele sunt în scădere, iar tomografia nu relevă colectii purulente. Pacientul poate prezenta o stare subfebrilă. Aceste situaţii pot crea confuzii medicului în legătură cu planul de tratament.Summary. For this research were selected 12 patients with inflammatory processes from maxilofacial-surgery section, whose general and local status were hard affected, although were being under the complex treatment. Were supposed to find out the situations of the progressing of the inflammatory processes after the complex treatment were applied. A lot of cases of progressing of inflammatory processes after the complex treatment, are presented just clinical manifestations. As usually the leukocytes are being decreased and the computer tomography doesn’t show any pus collections. The patient can have feverish condition. These situation can create confusion for the doctor to appreciate the plan of the following actions

Controversies on the surgical treatment of patients with Ludwig’s angina

Rezumat. Flegmonul difuz al planșeului bucal este un proces infecţios gangrenos, hipertoxic, care cuprinde spaţiile submandibulare, sublinguale și spaţiul submentonier, cu tendinţa de răspândire în spaţiile învecinate. Studiul de faţă își propune scopul de a face o incursiune/ analiză a literaturii care reflectă tratamentul chirurgical al flegmoanelor planșeului bucal. În cadrul studiului, au fost utilizate surse care conţin informaţii relevante la tema în discuţie, 62 surse în total, dintre care au fost selectate 24. În tratamentul pacienţilor cu flegmon al planșeului bucal se va respecta cu stricteţe ordinea priorităţilor: 1) Protejarea căilor respiratorii. 2) Administrarea de antibiotic. 3) Tratamentul chirurgical. Aceasta este ordinea manipulărilor prioritare descrisă în cele mai multe surse. Tratamentul chirurgical va fi diferit, în funcţie de fiecare pacient în parte. Inciziile mici prezintă o serie de avantaje, dar și de dezavantaje, care trebuie luate în calcul la fiecare intervenţie. Tratamentul complex al pacienţilor cu flegmon al planșeului bucal trebuie iniţiat în timpul cel mai scurt posibil.Summary. Ludwig’s angina is a gangrenous, hypertoxic infectious process, including submandibular, sublingual and submental space, which tends to spread to the surrounding areas. The purpose of the study is to conduct a literature reviewon the surgical treatment of Ludwig’s angina. Topic–related literature was studiedby using reference sources containing relevant data. A total amount of 62 sources wasanalyzed, whereas 24 were selected. The main priorities in the treatment of patients with Ludwig’s angina are as following: Airway protection. Antibiotic administration. Surgical treatment. This priority order is being described in a series of sources. The method of surgical treatment differs, depending on each individual case. Surgical small incisions might exhibit a number of both advantages and disadvantages that should be considered, prior to each intervention. Patients with phlegmon of the oral floor should be subjected to a complex treatment as soon as possible

Differential diagnosis difficulty between deep chronic carria and fibrous chronic pulpitis

Catedra Stomatologie terapeutică USMF “Nicolae Testemiţianu”This study includes some diagnosis difficulties in the therapeutic stomatology. It is based on literature and clinic observation. The paper consists of differential diagnosis between deep chronic carria and fibrous chronic pulpitis, including at the sometime diagnosis mistakes and their preventions. Lucrarea î-şi propune să aducă în atenţie unele din dificultăţile diagnosticului în stomatologia terapeutică. Acest articol este bazat pe studiul de literatură şi observaţii clinice. Lucrarea include criterii de diagnostic diferenţial între caria cronică profundă şi pulpita cronică fibroasă, elucidează unde pot fi comise erori de diagnostic, cum pot fi preîntîmpinate şi evitate

Evolution of the comparative treatment in the postextractional alveolitis

Catedra Chirurgie Oro-Maxilo-Facială USMF „Nicolae Testemiţanu”The paper includes obtained treatment results in the same time with different drugs. During 2007 years in the stomatological service of T.D.M.C.A.C. postextractional complications in alveolitis form in 28 patients have been observed. There were used the following preparations in this treatment metronidazolum and levomecol. The study consists of local status description comparative with different patients group in the treatment dinamica with different drugs, fips improvement of symptoms after clinical examination, distinction among patient who were divided depending of age, treatment results in the postextractional alveolitis according to season. Lucrarea î-şi propune să aducă în atenţie rezultatele tratamentului obţinute în paralel cu diferite medicamente. Pe parcursul anului 2007 în serviciul stomatologic C.C.D.A.M.T. sau întâlnit complicaţii postextracţionale sub formă de alveolită la 28 de pacienţi. În scopul tratamentului au fost aplicate local următoarele preparate: metronidazol şi levomecol. Studiul include: descrierea statusului local în comparaţie la diverse grupe de pacienţi, la tratamentul în dinamică cu diferite medicamente, ameliorarea simptoamelor depistate în urma examenului clinic, deosebiri între pacienţii repartizaţi pe vârstă, rezultatele tratamentului în alveolita postextracţională în dependenţă de anotimp

Local anesthetic solutions in dentistry: a comparative study

Department of Oral and Maxillofacial surgery and Oral Implantology „Arsenie Guțan“, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction. Pain control requires the study of local anesthesia. Local anesthetics have been available in dentistry since 1884 and today lidocaine and articaine are most often used. The main question is which one is more suitable and presents more advantages. Material and methods. In order to carry out the study, there were studied a large number of dental books – 14 and foreign clinical studies from PubMed – 7, researchgate – 4, emedicine – 5 and US Library – 6. Purpose: Analysis of specialty literature to determine if articaine or lidocaine is more effective. Results. The chemical and pharmacologic properties of a local anesthetic can give valuable information about the clinical effects . The most important ones for both articaine and lidocaine are listed in Table 1. The dissociation constant (pKa) affects the onset of action. Lower pKa, means that more molecules are present to diffuse through the nerve, thus the onset time is decreased. Lipid solubility affects the anesthetic potency. Increased lipid solubility enhances diffusion through the nerve, which itself is 90 % lipid (Malamed 2013), more easily. Articaine differs from lidocaine,because it contains both ester and amide linkages. As a result, it is more lipid soluble (Isen 2000). Protein binding affects the duration. Increased protein binding allows anesthetic cations to be more firmly attached to proteins located at receptor sites. Thus the duration of action is increased. Approximately 70 % of lidocaine undergoes liver biotransformation . Patients with poor liver function are unable to biotransform it at a normal rate. This leads to increased toxicity. The extra ester linkage in articaine alows it to be 90-95 % metabolized with the help of the cholinesterase enzyme in blood, and only 5-10 % in the liver. This feature is clearly demonstrated when the half-life between articaine and lidocaine is compared, 27 min versus 90 min. Malamed & al conducted a study to compare the safety between articaine 4 % with adrenaline 1:100 000, and lidocaine 2 % with adrenaline 1:100 000. A total of 1325 subjects participated in these study, 882 in the articaine group, and 443 in the lidocaine. These are the most common adverse effects: Conclusion. Lidocaine is considered to be more safe, being administrated to children under 4, pregnant woman and allergic pacients, but articaine has a 1,5 times bigger potency, it diffuses faster, binds better with the plasmatic proteins and also is better for pacients with liver problems. Paraesthesia is the most common side effect of articaine (Jacques A. Baart), but lidocaine also can cause adverse events, which must be taken in consideration. If we have a standard patient, then articaine will be more suitable to use

Preoperative assessment of patients with inflammatory processes in the maxillo-facial region: a minireview

The statistical data show the continuosly increasing number of patients with chronic diseases and this fact has a significant impact on the workload of all clinicians, including maxillofacial surgeons. On the other hand, inflammatory processes in the maxillofacial region are an important problem for maxillofacial surgeons due to the high number of patients who present with this diagnosis, but also because of the life-threatening complications that may occur. Besides the usual complications, a maxillofacial surgeon has to be aware of other comorbidities of the patients diagnosed with inflammatory processes, falling into the category of medically complex patients. The preoperative assessment main purpose is to identify those patients for whom the perioperative period may present an increased risk of morbidity and mortality, aside from the known complications already associated with inflammatory processes. This article aims to emphasize the importance of performing a complete and meticulous preoperative assessment of every single patient, even the apparently healthy ones, since the patient himself may be unaware of a comorbidity he might have. In order to facilitate this process, the use of standardized questionnaires for different groups of patients is encouraged for the prompt assessment of the patient’s condition. Another suggestion is the use of standardized protocols for emergency situations that may occur with these patients, including the use of tables with possible drug interactions between the medication used for the management of their chronic disease with the medication administered in the maxillofacial surgery unit

Phlegmon of the oral floor. Contradictions in diagnosis and treatment

Arsenie Gutsan Department of Oro-Maxillo-Facial Surgery and Oral Implantology, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Although the symptoms of oral phlegmon have been described before Hippocrates and Galen, there have been discrepancies in the diagnosis and treatment plan appreciation in patients with phlegmon of the mouth floor until now. Ludwig’s angina accounts for less than 1% of all pathologies of maxillofacial surgery. In the pre-antibiotic era, 50% of patients died. At the moment, the mortality rate is below 10%. If the pathology is not treated, patients die in 100% of cases. Data sources: This study was conducted on specialty literature analysis. We analyzed 45 books and 8 articles. The aim of the study is to compare different sources in which the phlegmon of the oral floor is described. Discussion: The phlegmon of the mouth floor can involve only the unilateral spaces of the mouth floor, and the diffuse phlegmon of the mouth floor, also called Ludwig’s angina, compulsory involves bilateral spaces of the mouth floor. Two bilateral incisions in the submandibular regions and one in the submental region is the most practiced surgical treatment. The infection is poly microbial, with a mixed flora: aerobic alpha and beta hemolytic streptococci, staphylococci and gram-negative bacilli, anaerobic bacteroides and peptostreptococcus. Usually, the flora is from the oral cavity and pharynx. Conclusions: Patient intubation is the method of choice when it is possible. Aggressive antibiotic treatment needs to be taken as early as possible. Surgical treatment is required to be performed as early as possible. The number of incisions and their location are chosen depending on the situatio