Buccal Cellulitis Research Articles

A Case of Acute Cholecystitis and Sepsis with Severe Symptoms during Treatment of Buccal Cellulitis

A Case of Acute Cholecystitis and Sepsis with Severe Symptoms during Treatment of Buccal Cellulitis

Mandibular metastasis in a patient with undiscovered lung cancer: a case report

Metastatic tumors account for 1% of all oral malignancies. Jawbone metastasis is uncommon. The mandible is the most frequent site. It is rare in the oral soft tissues, accounting for only 0.1% of oral malignancies. The majority of metastatic cases (70%) reported in the literature have primary tumors located in the lung, breast, kidney and colon. The clinical presentation of metastatic tumors is variable. This may create diagnostic dilemma and may lead to erroneous diagnoses. In this work, we present the radiological monitoring and the diagnostic dilemma of a mandibular metastasis resulting from a lung cancer. We report a case of a 57-year-old man who was referred to our department for the treatment of a left buccal cellulitis. On extra-oral examination, the patient presented a non-painful mass on the left mandibular ramus. The panoramic radiography showed a radiolucent lesion in the ramus with enlargement of the mandibular foramen. After excision of the jaw mass, histology revealed a metastatic adenocarcinoma having a lung origin. Mandibular metastasis may be the first presenting feature of an underlying occult malignancy of another primary site. Clinicians should always maintain a high index of suspicion for the possibility that a radiolucent lesion could be a metastatic tumor. Lip and chin hypoesthesia is an important symptom for malignancy detection.

Buccal Cellulitis in 3 Infants

Three patients are reported with buccal cellulitis. All were between 4 months and 6 months of age. Two patients had received two sets of immunizations, the other patient had received three sets, but the third set was only three days prior to onset of illness. This is an age where protective maternal antibodies would be absent or at a low level. Active immunization with Pentacel is effective after three injections starting at two months of age. All infants were using a pacifier with this thin hard plastic “wings” that contacted the skin sites where cellulitis developed. A break in the skin surface predisposes to development of cellulitis. It is felt that their unprotected antibody status and probable minor skin abrasion from the pacifier wings contributed to their acquiring buccal cellulitis. Antibiotic selection, immunization schedules, and pacifier usage were discussed.

調節可能な新型気切カニューレを用いて気道管理しえた頸部蜂窩織炎の1例

Airway stenosis during surgery for oral diseases can result in serious complications, thus making airway management one of the most important aspects of perioperative care. A case of buccal cellulitis, in which airway management was performed using a new type of tracheal cannula, is reported. This new type of tracheal cannula is suitable for patients with physical characteristics, such as obesity and swollen cervical tissues that often result in repeated accidental extubation when using a conventional tracheal cannula. The present patient was a female in her 70’s with chief complaints of pain in the right jaw and difficulty breathing. She was examined at her local dental clinic in February, 201X for pain in the right mandibular first molar; however, her symptoms worsened, and she was subsequently examined in the emergency department of our institution. Her current medical history included angina pectoris and IgA nephropathy treated with hemodialysis. On initial examination, her temperature was 37.7°C, and SpO2 was 94%. Breathing difficulty was evident, and marked swelling was observed from the right buccal area to the neck. Right buccal cellulitis was diagnosed clinically, and she was admitted immediately for incisional drainage under general anesthesia. Tracheostomy was then performed. Following repeated accidental extubations of a conventional tracheal cannula, a new type of tracheal cannula was applied, with which good airway management was subsequently achieved.

Buccal Cellulitis Caused by Cutaneous Miasis in an 11-month-old Infant

Introduction: Myiasis is a parasitic infestation of the body by fly larvae. The common hosts of this larva are the animals, but in some cases it can also affect the human, which is rarely reported in children and commonly found in tropical and developing countries. Case Presentation: This study, presents a case of cutaneous myiasis in an infant. A 11-month-old girl with popular lesion on buccal area, she does not response to the initial anti-bacterial therapies and progress the buccal cellulitis. Retrieval of three larvae from the lesion led to definitive diagnosis of Calliphora vicina (Diptera: Calliphoridae) larvae infestation and treatment by occlusive ointment, resulted in complete cure. Conclusions: The myiasis is an uncommon disease in Iran and physicians should be aware of this disease, especially if there are nonhealing lesions on exposed skin and worm-like protruding lesion.

870 Effect of Early Tooth Extraction on the Duration of Hospitalization in Facial Cellulitis of Odontogenic Origin in Children

PurposeTo investigate the clinical characteristics of pediatric facial cellulitis of odontogenic origin and the impact of early tooth extraction on the length of hospitalization in children.MethodsMedical records of all patients...

大胸筋皮弁による再建を要した頸部壊死性筋膜炎例

In an immuno-compromised host with systematically disordered immuno-function, a mild infectious disease of the head and neck occasionally becomes severe, developing to cervical necrotizing fasciitis (CNF). We reported a case of CNF in a 74-year-old woman with chronic nephritis, who had been taking adrenocorticosteroids for about 20 years. Conservative therapy using intravenous antibiotic agents, based on the initial diagnoses of buccal cellulitis and acute tonsillitis, was ineffective for cheek and tonsil symptoms. Consequently, a large clot originating from tonsillar hemorrhage led to respiratory arrest after 6 days in hospital. Intensive medical care in the ICU improved her respiration and consciousness level. However, the progressive lesion of the cheek and tonsil, which was finally diagnosed as CNF and treated by surgical debridement, formed a large pharyngocutaneous fistula after 9 days in hospital. The pathogenic bacteria were Streptococcus milleni, Prevotella oris and Pseudomonas aeruginosa. Two weeks later, the pharyngocutaneous fistula was closed by reconstructive surgery using a pectoralis major myocutaneous (PMMC) flap, indicating that this flap is appropriate to reconstruct a large pharyngeal and cervical defect with a poor environment for wound healing because of the rich muscle volume and stability of local blood flow.

Cellulitis resulting from infection by Haemophilus influenzae type b: report of two cases

Cellulitis resulting from infection by Haemophilus influenzae type b (Hib) is uncommon but may be a characteristic of such infection. Especially in the post-Hib vaccine era, such infection represents a potentially life-threatening infectious process due to the relatively high incidence of accompanying bacteremia and meningitis. Here, we report on two apparently previously healthy children who developed Hib cellulitis, one of whom revealed lower-leg cellulitis while the other exhibited buccal cellulitis associated with an oral ulcer. To the best of our knowledge, there have been no formal reports pertaining to buccal cellulitis following infection by Hib yet published in Taiwan, and reports of Hib cellulitis of the extremities still appear to be rare, hence we report on these two cases.

A Case of Buccal Cellulitis Caused by Haemophilus influenzae Type b in an Immunocompetent Child

A Case of Buccal Cellulitis Caused by <i>Haemophilus influenzae</i> Type b in an Immunocompetent Child

正誤表

正誤表

A nationwide survey of deaths from oral and maxillofacial infections: The Taiwanese experience

Purpose: This study investigated the incidence of deaths from oral and maxillofacial infections encountered in a 3-year period. Patients and Methods: A survey was conducted nationwide. Questionnaires were constructed and sent to dental or OMS Departments of all medical centers, regional hospitals, and provincial and municipal hospitals in Taiwan. Only those infections severe enough for hospital care were studied. More than half of the departments replied, including all major hospitals. Results: A total of 2,790 cases were admitted to OMS or dental inpatient services because of oral and maxillofacial infections in the 3-year period. Eighteen deaths were reported by 9 departments during this period. The mortality rate in southern Taiwan was significantly higher than that in northern Taiwan ( P = .017). All deaths were in patients older than 40 years of age, and 66.7% had diabetes. In the 18 cases, there were deep neck infections (5 cases), necrotizing fasciitis (3 cases), Ludwig's angina (2 cases), brain abscess (2 cases), infected osteoradionecrosis (1 case), mucormycosis (1 case), buccal cellulitis (1 case), and unknown infection (3 cases). Sepsis was the most common cause of death. Conclusions: The estimated rate of death was approximately 1 in 150 cases admitted for oral and maxillofacial infections. Most of the patients who died were diabetics with deep or necrotizing infections. Particular attention should be paid to patients with these features.

Discussion by John P. Whitcher, MD, MPH

As the authors have clearly documented in this retrospective study, the widely accepted dictum that Haemophilus sp. is the most common cause of preseptal and orbital cellulitis in young children must be reappraised. Since the introduction of Haemophilus influenzae type-B (HiB) vaccine in the United States in 1985, it is a fact that cases of nonophthalmic Haemophilus-associated infections in childhood such as epiglottitis, buccal cellulitis, and otitis media have been strikingly reduced. This study, however, is the first to document a corresponding reduction in ocular complications associated with this virulent pathogen.

Serious bacterial infections in children

Several studies now support outpatient treatment of many serious bacterial infections in children, such as periorbital or buccal cellulitis, urinary tract infection, pneumonia, and abscess. However, an appropriate agent, that is, a third-generation cephalosporin with a long half-life, must be available and its effectiveness properly researched. In addition, children must be free of other illnesses and able to ingest fluids and maintain hydration, and their parents must be willing and able to cooperate with an outpatient treatment regimen. Family physicians can maintain the close patient and family contact needed to facilitate this form of therapy.

Buccal cellulitis reevaluated.

We studied 72 children (17 prospectively) with acute buccal cellulitis. The median age was 11 months. Fifty-five percent of patients were bacteremic, and three children without meningeal signs or symptoms had concomitant meningitis. Cellulitis aspirate cultures (eight of 35 positive) and urine bacterial antigen tests (13 of 27 positive) were useful in making an etiologic diagnosis. Infections due to other bacteria were clinically indistinguishable from those due to Haemophilus influenzae type b. The right cheek was affected more often than the left, and only 23 (32%) of 72 patients had otitis media ipsilateral to the involved cheek. The pathogenesis of buccal cellulitis likely involves direct mucous membrane invasion rather than spread from the ipsilateral middle ear.

Cefuroxime Therapy for Bacteremic Soft-Tissue Infections in Children

Although it is used extensively in Europe, there is a limited amount of published data concerning pediatric clinical experience with cefuroxime in the United States. Thirty-six children, ranging from 3.5 to 57 months of age, received intravenous cefuroxime (75 mg/kg/day in three divided doses) for soft-tissue infections of the face or epiglottis. Infections treated included preseptal (19 patients) and buccal (13 patients) cellulitis and epiglottitis (four patients). Blood cultures were positive in 22 patients, yielding Haemophilus influenzae type b in 17 (four were beta-lactamase-positive), Streptococcus pneumoniae in four; and beta-lactamase-positive, nontypable H influenzae in one. An additional five patients with buccal cellulitis had negative blood cultures but H influenzae type b antigenuria. A satisfactory clinical response was noted in all patients, and repeated blood cultures performed in initially bacteremic patients were sterile. Cefuroxime therapy was well tolerated, and abnormal laboratory results were infrequent, except for absolute granulocytopenia (granulocytes, less than 1,500/cu mm), which occurred in six patients but could not be ascribed to a drug effect because of the uncontrolled design of our study. Treatment with cefuroxime appears to be a safe and effective therapy for pediatric soft-tissue infections due to H influenzae and S pneumoniae.

1063 CEFUROXIME (CXM) THERAPY OF POTENTIALLY BACTEREMIC SOFT TISSUE INFECTIONS IN CHILDREN

Although used extensively in Europe, there is limited pediatric clinical experience with CXM in the United States. Thirty children, 4-43 mo in age received CXM, 25 mg/kg IV every 8 hr for potentially bacteremic soft tissue infections of the face, or epiglottitis. Infections treated included pre-septal (16) and buccal (12) cellulitis and epiglottitis (2). Blood cultures were positive in 18 patients: H. influenzae type b-13 (2 β-lactamase positive); S. pneumoniae-4; and β-lactamase positive, nontypable H. influenzae-1. An additional 5 patients with buccal cellulitis had negative cultures but H. influenzae type b antigenuria. All isolates were susceptible to CXM. The median MBC for the blood culture isolates was 0.5 μg/ml (range 0.008-2.0 μg/ml). A good clinical response was noted in all patients and repeat blood cultures performed on initially bacteremic patients were sterile. The mean duration of CXM therapy was 4.6±1.2 days. All patients were discharged on an appropriate oral antibiotic to complete a 10 day course of therapy. There were no clinical adverse effects or breakthrough meningitis experienced during therapy with CXM. Lab abnormalitis encountered included absolute granulocytopenia (4); thrombocytosis (3); and elevated liver functions (2). CXM appears to be a safe and effective therapy of pediatric soft tissue infections due to H. influenzae and S. pneumoniae.

Etiology and treatment of facial cellulitis in pediatric patients.

By a retrospective chart review patients with buccal cellulitis were divided into groups with and without a probable portal of entry of infection at the time of diagnosis. Tooth abscesses or breaks in the skin were the usual portals of entry. Patients with a portal of entry were significantly older (P less than 0.001), had lower white blood cell counts on admission (P less than 0.01) and recovered more rapidly (P = 0.001). Haemophilus influenzae type b was recovered only from those with no portal of entry. Staphylococcus aureus and Streptococcus pyogenes caused infection in both groups but were more frequent in those with a portal of entry. Bacteremia was proved only in the group with no portal, and H. influenzae b grew from 14 to 15 positive blood cultures. All cultures of cerebrospinal fluid yielded no growth. We suggest that patients with no portal of entry on presentation receive initial parenteral therapy for H. influenzae b and Gram-positive cocci. Our current regimen is a combination of a semisynthetic penicillinase-resistant penicillin such as oxacillin and chloramphenicol. Oxacillin alone is indicated for those with a break in the skin leading to infection, whereas penicillin is appropriate for patients with dental infection. This initial therapy should be altered depending upon culture results when available.

Hemophilus influenzae type B buccal cellulitis.

During a 10-year period there were seventy-two cases of buccal cellulitis caused by Hemophilus influenzae type b (HIb). Patients ranged in age from 3 months to 3 years; 72% were less than 2 year of age. Most children had a poorly demarcated, violaceous discoloration of one cheek. Sixty-eight percent of patients had an associated otitis media, and HIb was isolated from middle ear aspirates of twenty-two of twenty-three children. Bacteremia was present in 86% of patients, and five (7.6%) had associated meningitis. Ampicillin, chloramphenicol, cephamandole, or a combination of ampicillin and chloramphenicol, all proved effective for therapy of this condition. The duration of fever was more prolonged after cephamandole or ampicillin than after a combination of ampicillin and chloramphenicol or chloramphenicol alone. Recommendations for diagnosis and treatment are made.

The role of cefamandole in the treatment of Haemophilus influenzae infections in infants and children

Forty patients with suspected non-CNS Hib infections were treated with cefamandole at a dosage of 100 to 150 mg/kg/day. Hib was isolated from 19 patients; three of the isolates were Blac+. All patients responded well without complications except for two children, both infected with Blac+ organisms, who subsequently developed meningitis, one three weeks following treatment for buccal cellulitis and bacteremia, the other while being treated with cefamandole for empyema. All strains of Hib were uniformly susceptible to cefamandole regardless of beta-lactamase production when tested with an inoculum of 10(4) cfu/ml. With 10(7) cfu/ml an inoculum effect was seen which was more pronounced with Blac+ strains. Moreover, "heavy" inoculum of Blac+ strains inactivated cefamandole in four to eight hours resulting in bacterial overgrowth. Similar results were obtained for ampicillin; chloramphenicol killed all strains regardless of inoculum size or beta-lactamase production. We conclude that cefamandole may be hydrolyzed by Blac+ organisms when present in large numbers, resulting in treatment failure. Extreme care should be taken in the choice of cefamandole for young infants with Hib infections, since this antibiotic neither cures nor prevents meningitis.

Periosteal Reaction of the Femur in an Infant With Fever

History A 5-month-old infant was admitted to the hospital for evaluation of a firm, tender, nonerythematous leftcheek swelling. Three weeks previously, she had been re-treated with antibiotics for a left buccal On the day of admission, her temperature was 38 °C rectally, WBC count was 23,000/cu mm, and ESR was 60 mm/hr. At this time, treatment with intravenous ampicillin sodium and chloramphenicol sodium succinate was started for recurrent buccal cellulitis. Swelling and tenderness of the right thigh developed on the second day. Initial roentgenograms of the right femur showed only soft-tissue swelling. A film of the right femur obtained on the eighth day (Fig 1) demonstrates considerable periosteal reaction with cortical hyperostosis limited to the diaphysis. A radionuclide scan using technetium Tc 99m medronate (anterior view of the pelvis and lower extremities) demonstrates considerable uptake in the right femur and adjacent soft tissues (arrow) (Fig 2). The area of