1, the relationship between diabetes and maxillofacial and cervical interstitial infections Diabetic patients are prone to various infections, which are more common and serious in patients with poor glycemic control. The mechanisms of susceptibility to diabetic infections are the body’s diminished cellular and humoral immune function; local factors, such as vascular and peripheral neuropathy; and other factors such as large fluctuations in blood sugar. Diabetic co-infections can form a vicious cycle in which infections lead to uncontrollable hyperglycemia, and hyperglycemia further aggravates infections. Oral and maxillofacial infections are one of the common sites of infection in diabetic patients. The risk of periodontal infections, caries, and apical abscesses is significantly higher in diabetic patients than in non-diabetic patients. Compared to non-diabetic patients with maxillofacial and cervical interstitial infections, diabetic patients tend to have more severe infections, a higher incidence of multiple interstitial infections, a higher rate of complications, and a higher mortality rate. Wong TY’s epidemiological survey of 2,790 patients hospitalized with oral maxillofacial neck infections in Taiwan, China, showed that 18 patients died, 14 of whom had impaired immune function and 12 (66.7%) had diabetes mellitus, suggesting that impaired immunity due to diabetes mellitus is an important cause of worsening maxillofacial neck infections and death. Glycemic control facilitates infection control, and effective control of infection facilitates improvement of glycemia. Therefore, for maxillofacial neck interstitial infections in diabetic patients, treatment should focus on both glycemic control and infection control in order to achieve the best outcome. For patients with severe maxillofacial neck infections, oral and maxillofacial surgeons often use glucocorticoids along with anti-infection in order to anti-inflammatory, reduce swelling and relieve symptoms. Glucocorticoids are the drugs that have the greatest effect on glucose metabolism. Long-term application or word application can promote or aggravate diabetes mellitus, and this effect is usually dose-dependent. Therefore, the use of glucocorticoids should be avoided as much as possible in patients with maxillofacial and cervical interstitial infections with diabetes mellitus. 2, pathogenic characteristics of maxillofacial neck interstitial infections in diabetic patients Oral maxillofacial neck infections are often mixed infections with a variety of pathogens, including aerobic, microaerobic and anaerobic bacteria. The most common pathogens are aerobic Streptococcus gramineus, Streptococcus β-hemolyticus, Staphylococcus spp. However, in maxillofacial and cervical interstitial infections with diabetes mellitus, Klebsiella pneumoniae was the most common pathogen (56.1% detection rate), regardless of the odontogenic or non-odontogenic origin of the infection. The possible reason for this is the increased colonization of the oropharynx by gram-negative bacilli when host defense mechanisms are impaired, especially in diabetic patients with impaired neutrophil function. Maxillofacial cervical interstitial infections are most commonly of dental origin, followed by upper respiratory tract sources of infection. For maxillofacial neck space infections of dental origin, the detection rate of anaerobic bacteria can be as high as 59.3%. Therefore, for patients with diabetic maxillofacial neck space infection, the empirical medication before the drug sensitivity results need to take into account the common dominant bacteria Klebsiella pneumoniae, for patients of dental origin, the empirical medication still need to add anti-anaerobic drugs. 3, prevention and control of complications (1) diabetes-related complications The proper management of diabetic patients in the perioperative period is a great challenge for health care providers. The potential large and small vessel complications of diabetes itself can significantly increase the risk of surgery [1], in addition, poor diabetic diet compliance in patients with maxillofacial and neck infections due to local pain, surgical fasting or feeding difficulties, surgical stress, fever, etc. can aggravate glucose metabolism On the one hand, surgical stress and insufficient insulin dosage can lead to a sharp increase in blood glucose in the short term, resulting in an increase in the incidence of acute complications of diabetes (such as ketoacidosis and non-ketotic hyperosmolar syndrome), which is also one of the main reasons for the increase in postoperative morbidity and mortality. The incidence of hypoglycemia increases. Therefore, during the perioperative period, patients need to strengthen blood glucose monitoring to maintain stable blood glucose. (2) Infection-related complications In diabetic patients with maxillofacial and cervical interstitial infections, once an abscess is formed, or once an abscess has not yet formed, but the disease progresses rapidly, the systemic toxic symptoms are obvious, and the airway is already compressed and affects breathing, incision and drainage should be performed as soon as possible, and if necessary, tracheotomy should be performed to keep the airway open. Surgery should not be conservative. For multi-interstitial infections, multiple incisions or extensive incisions should be performed, and each pus cavity should be fully separated to ensure adequate drainage. In the treatment, anti-infection, blood sugar control, systemic support and symptomatic treatment should be combined with local treatment to prevent the emergence of serious complications such as sepsis and septicemia due to the spread of infection. (3) Other complications For elderly diabetic patients, they are often accompanied by multi-system diseases, such as hypertension, heart disease, renal insufficiency, etc. Serious maxillofacial and cervical infections, surgical stress, and hyperglycemia often induce the deterioration of heart disease and renal function. For patients with combined cardiac and renal insufficiency, drugs with low nephrotoxicity should be selected, and the amount and rate of rehydration should be controlled, and changes in cardiac and renal function should be monitored. There is no absolute contraindication to incision and drainage. The immune deficiency caused by diabetes mellitus makes it difficult to control maxillofacial and cervical interstitial infections. For patients with poor systemic condition, if incision and drainage is indicated, incision and drainage is the primary method to control the infection. If the treatment is too conservative and the incision and drainage is not adequate, the infection is not well controlled and it is more likely to aggravate or induce the onset of systemic diseases in patients, while timely incision and adequate drainage can not only control the infection but also be beneficial for controlling diabetes mellitus. Although there are risks associated with abscess incision and drainage, it is generally not easy to damage important nerves, blood vessels or organs, and the surgical risks are relatively small compared with enlarged resection of malignant tumors and cervical lymphatic dissection; of course, for patients with certain systemic diseases and poor systemic conditions, the risk of incision and drainage increases, but if the infection is not well controlled, further development of sepsis, mediastinal infection, airway compression or induced The risk is even greater if serious complications such as cardiovascular accidents and ketoacidosis develop due to poorly controlled infection, further development of sepsis, mediastinal infection, airway compression or induced cardiovascular accidents. Weighing the pros and cons, it is not difficult to make a choice in treatment.