How to treat oral, maxillofacial and cervical interstitial infections?

  Maxillofacial interstitial infection is a general term for an enlarged purulent inflammation of the soft tissues of the oropharynx, face and neck. Purulent inflammation is called cellulitis when diffuse and abscess when confined. There are potential fascial gaps between the layers of normal maxillofacial tissues, and when infection invades these gaps, the purulent inflammation dissolves and liquefies the loose connective tissue and fills them with inflammatory products.  Differential diagnosis: Based on medical history, clinical symptoms and signs, combined with knowledge of local anatomy, total leukocyte count and classification count, etc., together with methods such as puncture and pus aspiration, the correct diagnosis can usually be made. Note the differentiation from local malignant tumor with infection.  Treatment design: Systemic treatment is mainly to improve the condition of the body, enhance the resistance, and choose antibacterial drugs to control the infection. If the disease is serious, more than two kinds of antibacterial drugs can be used in combination, if necessary, intravenous administration. The preferred drugs are macrolides, cephalosporins and quinolones, and the dose is large enough to control and dissipate the inflammation in the plasma phase. Because the current team penicillin-resistant strains increase, so after 1-2 days of medication, the condition does not see significant improvement, should promptly change antibiotics, or according to the results of bacterial culture and drug sensitivity test to adjust antibiotics. Chinese herbs can also be given according to the principle of dialectical treatment to help eliminate evil, clear heat and detoxify, and dissipate swelling and blood stasis.  Local treatment of inflammation in the early stage of inflammation can be local physical therapy, external application of herbs to promote the absorption of inflammation. Commonly used topical herbs include Jinhuang San and Liuhe Dan. Abscess formation should be promptly incised and drained. When incising and draining, the incision should be made at a site conducive to drainage to avoid damaging important nerves, blood vessels, ducts and other important structures, and the site should be hidden and consistent with the skin pattern as much as possible. After the acute inflammation is controlled, further treatment is applied to the pathogenic tooth.  1, suborbital space infection incision and drainage points: Generally, a transverse incision is made at the bottom of the vestibular groove in the intraoral maxillary cuspid area, deep to the bone surface, and separated to the concave bone surface of the cuspid to reach drainage.  2, subincisal space infection incision and drainage points: 1.5-2cm below the angle of the mandible to make an arc-shaped incision parallel to the mandible about 3-5cm long. The lower edge of the mandible is then exposed upward, taking care to avoid damaging the mandibular branch of the facial nerve and the parotid gland. The occlusal muscle attachment at the lower edge of the mandible is incised, and the pus is separated and drained upward with a long curved vascular clamp against the lateral side of the mandible, and drainage is placed.  3, submandibular space infection incision and drainage points: At about 2 cm of the lower edge of the mandible, make an incision parallel to the lower edge of the mandible to cut the skin, subcutaneous tissue and broad neck muscle, and then use a vascular clamp to separate and drain. Pay attention to prevent damage to the mandibular margin branch of the facial nerve.  The main threat of this disease is the systemic poisoning and local impact on the respiratory tract patency. If not treated correctly in time can endanger the life of the patient, so we should actively take comprehensive treatment measures. The systemic application of high-dose antimicrobial agents to maintain water-electrolyte balance and enhance the resistance of the patient, local incision should be made in a timely manner to reduce pressure and drainage, generally from one side of the submandibular to the opposite side of the submandibular, and if necessary, an auxiliary chin incision can be made, layer by layer, cutting off part of the floor of the mouth muscle to open the pus cavity and place drainage. Corrosive cellulitis of the floor of the mouth can also be flushed and wet compresses applied to the wound with oxygenators such as 1-35 hydrogen peroxide solution or 1:5000 potassium permanganate solution. If there is severe respiratory distress, a tracheotomy should be performed promptly to ensure unobstructed breathing.