魚刺引起的Ludwig氏咽峽炎

Ludwig's Angina Caused by Fish Bone

10.6320/FJM.2005.9(3).05

邱楠超(Nan-Chao Chiu)；陳玉祥(Yuh-Shyang Chen)

口腔底峰窩性組織炎 ； 異物 ； Ludwig's angina ； foreign body

台灣醫學

9卷3期（2005 / 05 / 01）

339 - 343

繁體中文

Ludwig氏咽峽炎(Ludwig's angina)是一種病程進展十分快速的深層頸部感染，有高死亡率，臨床上不可不小心。Ludwig氏咽峽炎病因以齒源性(odontogenic)疾病最為常見，其它如呼吸道感染、傷口感染、下頷骨斷裂等亦曾被提出發表過。本篇報告一例在文獻上尚無記載的由魚刺引起的Ludwig氏因峽炎病例。病人為一名80歲女性，因有下頷部疼痛腫脹，發燒(37.7℃)，吞嚥困難及吞嚥疼痛等症狀一天而後至本院急診部求診。檢查發現有下颔部腫脹，皮膚略為紅腫及雙舌病徵(double tongue sign)，初步診斷為Ludwig氏咽峽炎。頸部電腦斷層掃描發現左側舌下部有一環狀顯影(ring enhancement)的膿瘍，往後的切面可看到膿瘍內有一高密度訊號(high density)的異物，於下颔的空間有明顯的皮下組織腫脹。經緊急清創引流手術發現一根2.4公分的魚刺埋於左下颔舌骨肌(mylohyoid muscle)內。經膿瘍引流及抗生素治療後，傷口癒合良好也無併發症產生，病人於術後5天出院。

Ludwig's angina is an aggressive form of deep neck infection involving the bilateral submandibular spaces. The etiology of this disease is most often odontogenic or periodontal in origin. Ho ever, the condition has been reported as a complication of sublingual lacerations, sialoadenitis, compound mandibular fractures, and infected malignancy. We report an unusual case of Ludwig's angina induced by a fish bone. The patient as an 80-ear-old woman ho visited our emergency department with fever, tender submental swelling, and progressive dysphagia for one day. Computed tomography (CT) of the neck revealed a ring enhanced abscess formation with a small high density lesion in the left submaxillary space, and marked swelling of bilateral surrounding neck spaces ere found. At surgery, a fish bone about 2.4cm in length under mylohyoid muscle as found and removed. Post pus drainage and antibiotic therapy, the woman as discharged 5 days after operation. About an old aged patient, foreign body as an etiology of Ludwig's angina should be considered.