Clinical analysis of patients with oral and maxillofacial infections in oral emergency / 北京大学学报(医学版)

OBJECTIVE@#To analyze the composition, incidence and clinical characteristics of oral and maxillofacial infections in oral emergency.@*METHODS@#A retrospective study on patients with oral and maxillofacial infections who visited the Department of Oral Emergency in Peking University School and Hospital of Stomatology from January 2017 to December 2019 was conducted. General characteristics, such as disease composition, gender, age distribution and position of involved teeth were analyzed.@*RESULTS@#A total of 8 277 patients with oral and maxillofacial infections were finally collected, including 4 378 male patients (52.9%) and 3 899 female patients (47.1%), with gender ratio of 1.12:1. The common diseases were periodontal abscess (3 826 cases, 46.2%), alveolar abscess (3 537 cases, 42.7%), maxillofacial space infection (740 cases, 9.0%), sialadenitis (108 cases, 1.3%), furuncle & carbuncle (56 cases, 0.7%) and osteomyelitis (10 cases, 0.1%). Male patients were more easily affected by periodontal abscess, space infection and furuncle & carbuncle than female patients with the gender ratios 1.24:1, 1.26:1, 2.50:1 individually, while the incidence of alveolar abscess, sialadenitis, furuncle & carbuncle had no significant gender difference. Different diseases were prone to occur at different ages. The peak ages of alveolar abscess were 5-9 and 27-67 years, while the peak age of periodontal abscess was 30-64 years. Space infection tended to occur between 21-67 years. There were 7 363 patients with oral abscess (3 826 patients with periodontal abscess and 3 537 patients with alveolar abscess), accounting for 88.9% of all the patients with oral and maxillofacial infections, involving 7 999 teeth, including 717 deciduous teeth and 7 282 permanent teeth. Periodontal abscess usually occurred in permanent teeth, especially the molar teeth. Alveolar abscess may occur in both primary teeth and permanent teeth. In primary teeth, the most vulnerable sites were primary molar teeth and maxillary central incisors while in permanent teeth the most vulnerable sites were first molar teeth.@*CONCLUSION@#Understanding the incidence of oral and maxillofacial infection was conducive to the correct diagnosis and effective treatment of clinical diseases, as well as targeted education for patients of different ages and genders to prevent the occurrence of diseases.

Salivary Gland Disorders in Children and Adolescents: A 15-year Experience

Abstract Introduction Diseases of the salivary glands are rare in children and adolescents, with the exception of viral-induced infections. Objective To determine the clinical course of the disease, the diagnostic procedures, the treatment and the outcome of all children and adolescents affected with salivary gland diseases at our clinic over a period of 15 years. Methods A retrospective chart review including a long-term follow-up was conducted among 146 children and adolescents treated for salivary gland disorders from 2002 to 2016. Results Diagnosing acute sialadenitis was easily managed by all doctors regardless of their specialty. The diagnosis of sialolithiasis was rapidly made only by otorhinolar- yngologists, whereas diagnosing juvenile recurrent parotitis imposed difficulties to doctors of all specialties - resulting in a significant delay between the first occurrence of symptoms and the correct diagnosis. The severity-adjusted treatment yielded improve- ments in all cases, and a full recovery of 75% of the cases of sialolithiasis, 73% of the cases of juvenile recurrent parotitis, and 100% of the cases of acute sialadenitis. Conclusions Due to their low prevalence and the lack of pathognomonic symptoms, salivary gland diseases in children and adolescents are often misdiagnosed, resulting in an unneces- sarily long period of suffering despite a favorable outcome following the correct treatment.

Acute postsurgical suppurative parotitis: current prevalence at Hospital das Clínicas, São Paulo University Medical School / Parotidite aguda pós-cirúgica: prevalência atual no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

Postsurgical acute suppurative parotitis is a bacterial gland infection that occurs from a few days up to some weeks after abdominal surgical procedures. In this study, the authors analyze the prevalence of this complication in Hospital das Clínicas/São Paulo University Medical School by prospectively reviewing the charts of patients who underwent surgeries performed by the gastroenterological and general surgery staff from 1980 to 2005. Diagnosis of parotitis or sialoadenitis was analyzed. Sialolithiasis and chronic parotitis previous to hospitalization were exclusion criteria. In a total of 100,679 surgeries, 256 patients were diagnosed with parotitis or sialoadenitis. Nevertheless, only three cases of acute postsurgical suppurative parotitis associated with the surgery were identified giving an incidence of 0.0028 percent. All patients presented with risk factors such as malnutrition, immunosuppression, prolonged immobilization and dehydration. In the past, acute postsurgical suppurative parotitis was a relatively common complication after major abdominal surgeries. Its incidence decreased as a consequence of the improvement of perioperative antibiotic therapy and postoperative support. In spite of the current low incidence, we believe it is important to identify risks and diagnose as quick as possible, in order to introduce prompt and appropriate therapeutic measures and avoid potentially fatal complications with the evolution of the disease.

A parotidite supurativa pós-cirúrgica é infecção bacteriana da glândula que ocorre poucos dias até algumas semanas após procedimento cirúrgico. Os autores analisam a prevalência desta complicação cirúrgica nos últimos 25 anos do Hospital das Clínicas de São Paulo. Foram analisados os prontuários das cirurgias realizadas pelos serviços de Cirurgia do Aparelho Digestivo e Cirurgia Geral da Faculdade de Medicina da Universidade de São Paulo no período de 1980 a 2005, num total de 106790 cirurgias. Todos os prontuários que apresentaram entre os diagnósticos das altas complicações cirúrgicas, parotidite ou sialoadenite foram avaliados. Foram identificados 256 prontuários. Pacientes com outras complicações, ou que já apresentavam sialolitíase ou parotidite crônica anterior à internação foram excluídos do estudo. Foram identificados apenas três casos de parotidite aguda supurativa pós-cirúrgica, revelando incidência de 0,0028 por cento. A parotidite supurativa pós-cirúrgica foi complicação relativamente comum de grandes cirurgias abdominais no passado, com acentuada redução atual da sua incidência decorrente da antibioticoterapia de amplo espectro, além de preparação pré-operatória adequada e suporte pós-operatório dos pacientes. Apesar da baixa incidência atual, consideramos importante identificar seus fatores de risco, assim como realizar diagnóstico precoce, conduta terapêutica apropriada para evitar complicações letais associadas a esta infecção.

Sialoadenite após terapia ablativa com altas doses de radioiodo no tratamento do carcinoma diferenciado de tireóide / Sialoadenitis post-ablative therapy with high dose of radioiodine for treatment of differentiated thyroid cancer

Oitenta e três pacientes que receberam 3,7GBq (100mCi) ou 7,4GBq (200mCi) de I-131 após a tireoidectomia total para carcinoma de tireóide foram avaliados clínica e laboratorialmente (dosagem da amilase sérica), seguida da varredura pós-dose. A sialoadenite foi definida na presença de hiperamilasemia (> 200U/L). Onze (13,25 por cento) pacientes referiram dor local espontânea ou à mastigação após o tratamento. Observou-se hiperamilasemia em 31 (37,3 por cento) pacientes no segundo dia pós-tratamento. No sétimo dia, houve normalização da amilase em todos. A sialoadenite sintomática foi maior nos pacientes com captação cervical residual que receberam 7,4GBq (70 por cento). A captação em topografia de glândulas salivares esteve presente em 93,5 por cento dos casos de sialoadenite (p < 0,05). Observou-se correlação estatisticamente significante entre ausência de metástase à distância e maior incidência de sialoadenite (p < 0,05). Não houve correlação entre sialoadenite e massa remanescente cervical ou com a dose de I-131 administrada, atribuída ao tamanho da amostra. A sialoadenite pós-terapia ablativa em altas doses é uma complicação relativamente comum, com baixa repercussão clínica, sendo a ausência de metástases à distância um fator diretamente relacionado com o seu aparecimento.