MSCT评价颌面部颈部筋膜间隙感染及蔓延途径

Multi-slice computed tomography assessment of infection and its spread pathway in maxillofacial and neck fascial spaces

目的观察多层螺旋CT(multi-slice computed tomography,MSCT)评价颌面部颈部筋膜间隙感染及其蔓延途径。方法回顾性分析43例临床颌面及颈部感染患者资料,观察病变MSCT表现及蔓延途径。结果蜂窝织炎MSCT征象为筋膜间隙脂肪密度增高、积液及积气,肌肉肿胀增厚;脓肿为中央低密度周围壁强化。病变位于咀嚼肌间隙14例、颈深筋膜包裹肌群7例、口底间隙6例、内脏间隙6例、颈动脉间隙5例、咽后间隙4例、舌骨上下广泛间隙3例和扁桃体周围间隙1例;其中5例下行性纵隔炎,1例坏死性筋膜炎。感染可蔓延入与其相通连的筋膜间隙,可累及邻近毗邻结构及下行入纵隔和胸腔。结论 MSCT能准确诊断颌面部颈部筋膜间隙感染,显示蔓延途径。

Objective To assess the infection and its spread pathway in maxillofacial and neck fascial spaces by multi-slice computed tomography（MSCT）.Methods We conducted a retrospective analysis using the data of 43 clinical patients with maxillofacial and neck infections,and observed the MSCT manifestations and spread pathways of the infections.Results The MSCT signs of cellulitis included increased adipose tissue density,accumulated fluid,and accumulated gas in fascial spaces,as well as muscle swelling and thickening.Abscesses exhibited low density in the centers and enhancement in the peripheral walls.The lesions were found in masticator spaces（14 cases）,the spaces between muscles enveloped by deep cervical fasciae（7 cases）,the spaces of mouth floors（6 cases）,visceral spaces（6 cases）,carotid spaces（5 cases）,retropharyngeal spaces（4 cases）,suprahyoid and infrahyoid spaces 3 cases,and peritonsillar space（1 case of peritonsillitis）.Among the lesions,5 cases of descending necrotizing mediastinitis were observed.The infections could spread into communicated spaces and downward into the mediastinum and pleural cavity and could involve adjacent structures.Conclusion MSCT can be used to diagnose the infections of maxillofacial and neck fascial spaces accurately and to display the spread pathways.