Distribusi Penderita Abses Submandibula di Bagian T.H.T.K.L RSUP Sanglah Bali Periode 1 Januari 2012 sampai Desember 2014.
CLINICAL RESEARCH
DISTRIBUTION OF SUBMANDIBULAR ABSCESS
PATIENTS IN THE EAR NOSE THROAT DEPARTMENT
OF SANGLAH HOSPITAL
PERIOD OF JANUARY 2012 TO DECEMBER 2014
BY
I GUSTI AYU OKA SRI UTARI
SCIENTIFIC ADVISOR
dr. I DEWA GEDE ARTA EKA PUTRA Sp. T.H.T.K.L
INTRODUCTION
BACKGROUND
Submandibular abscess : inflammation with pus
in the submandibular space cause by infection
( bacteria, parasites or foreign body )
Origin of infection: tooth infection, floor of the
mouth, pharynx, submandibular lymph, trauma
and other neck spaces.
INTRODUCTION
BACKGROUND
Incidence : males > females
Predisposing factor : poor hygiene of orodental,
diabetes mellitus, immunodeficiency disease
Morbidity cause by complications of
submandibular abscess >>
descriptive research : distribution of
submandibular abscess patients in ENT
Department Sanglah hospital
INTRODUCTION
ISSUE
How is the distribution of submandibular abscess
patients in ENT Department Sanglah hospital
period of January 2012 to December 2014 ?
PURPOSES
General Purpose
To know the distribution of submandibular abscess
patients in ENT Department Sanglah hospital
period of January 2012 to December 2014
INTRODUCTION
PURPOSES
Specific Purpose
To know the distribution of submandibular abscess
patients according to age, sex, chief complaint,
location, origin of infection, results of bacteria
culture, antibiotic sensitivity, complications,
duration of treatment
INTRODUCTION
BENEFITS
Overview of distribution of submandibular abscess
patients in ENT Department Sanglah hospital
period of January 2012 until December 2014
The results can be used in the prevention and
management of submandibular abscess especially
in Sanglah Hospital prompt and accurate
Provide information for other researchers
LITERATURE REVIEW
ANATOMY
LITERATURE REVIEW
ETIOLOGY
aerob bacteria, anaerob or mix
culture results : Streptococcus viridans,
Staphylococcus epidermidis, Staphylococcus
aureus, Streptococcus β hemolytic, Bacteroides,
Fusobacterium, Peptostreptokokus species,
Neisseria, Klebsiella pneumoniae and
Pseudomonas
LITERATURE REVIEW
DIAGNOSIS
Anamnesis
Swelling under the jaw, pain, fever.
Other complaints difficulty in swallowing,
difficulty in mouth opening, dyspnea
• unilateral or bilateral edema in the submandibular
Physical
region, tenderness, hyperemi and fluctuating.
examination • swelling under the tongue and trismus.
Adjuvant
examination
• Soft tissue plain radiography of the neck
• complication ? chest x-ray
• CT scan, MRI, USG
• blood tests infection
LITERATURE REVIEW
Differential diagnosis
lymphadenitis, submasseteric abscess, buccal
abscess, sialadenitis and neoplasms in neck area
Complication
airway obstruction, mandibular osteomyelitis,
spreading of infection to the neck space,
mediastinitis and sepsis
LITERATURE REVIEW
Management
Intravenous antibiotics based on culture and
sensitivity test
Drainage of abscess : aspiration of abscess,
incision and exploration
CONCEPTUAL FRAMEWORK
Origin of infection: tooth infection,
floor of the mouth, pharynx,
submandibular lymph, trauma
and other neck spaces.
Inflammation and pus in the
submandibular space
submandibular abscess
- Age
- Sex
- Chief complaint
- Location
- Origin of infection
- Results of bacterial
culture
- Antibiotic sensitivity
- Complications
- Duration of treatment
METHODS
Design
Retrospective descriptive research
Place and
time
ENT Department Sanglah hospital
in June to August 2015
Population
Submandibular abscess patients who come
to ENT department Sanglah hospital in
January 2012 until December 2014.
Sample
Submandibular abscess patients who come
to ENT department Sanglah hospital in
January 2012 until December 2014 that
appropriate the inclusion criteria
METHODS
Inclusion
criteria
- Patients who are diagnosed with submandibular
abscess.
- Patients who are willing to get treatment at
ENT department Sanglah Hospital
- Patients who do pus culture and antibiotic
sensitivity test.
- Patients who are not willing to get treatment.
Exclusion - Patients who don’t do pus culture and antibiotic
criteria
sensitivity test.
- Patients with incomplete medical records.
METHODS
Operational definition of variable
Submandibular abscess : inflammation with pus
in the submandibular space cause by infection
( bacteria, parasites or foreign body )
Age : the age since birth (years old)
Sex : male or female.
Main complaint : complaint that brings the patient
comes to the health service.
Location : submandibular region (unilateral or bilateral)
Germ culture : bacteriological examination to determine
type of bacteria.
METHODS
Operational definition of variable
Antibiotic sensitivity : antibiotics that are sensitive to
growth of germs.
Long of care : times (days) that are needed for
healing process.
Complications : conditions that arise caused by
submandibular abscess itself or performed after
incision and drainage.
METHODS
Medical records in Sanglah hospital period
Data
Collection of January 2012 to December 2014
Data
processing
Data tabulated
Presented descriptively tables and
narrative
RESULT
Distribution of submandibular abscess patients according to age
Age
Frequency
%
10-19
1
3,85
20-29
5
19,23
30-39
4
15,38
40-49
9
34,62
50-59
4
15,38
60-69
2
7,69
70-79
1
3,85
Total
26
100
RESULT
Distribution of submandibular abscess patients according to sex
Sex
Frequency
%
Male
21
80,77
Female
5
19,23
Total
26
100
RESULT
Distribution of submandibular abscess patients according to
chief complaint
Chief complaint
N = 26
%
26
100
Pain
25
96,15
Difficulty in mouth opening
10
38,46
Fever
16
61,53
Swelling under the jaw
RESULT
Distribution of submandibular abscess patients according
to location
Location
N
%
Unilateral
25
96,15
Bilateral
1
3,85
Total
26
100
RESULT
Distribution of submandibular abscess patients according
to origin of infection
Origin of infection
N
%
Tooth
26
100
Other infections
0
0
Total
26
100
RESULT
Distribution of submandibular abscess patients according
to results of germ culture
Germ culture
N
%
Streptococcus viridians
Streptococcus pirogens
9
34,62
1
3,85
Streptococcus β
2
7,69
Streptococcus α
2
7,69
Klebsiella pneumoniae
2
7,69
Enterococcus sp
1
3,85
No growth
9
34,62
26
100
Total
RESULT
Distribution of submandibular abscess patients according to
antibiotic sensitivity
Antibiotic
N=26
%
Ampicilin
7
26,92
Amoxicilin/Clavulanat acid
9
34,62
Cefalotin
22
84,62
Cefotaxim
18
69,23
Cefepime
21
80,77
Imipenem
18
69,23
Meropenem
22
84,62
Vancomycin
14
53,85
Erythromycin
12
46,15
RESULT
Distribution of submandibular abscess patients according to
antibiotic sensitivity
Antibiotic
N=26
%
Tetracycline
8
30,77
Clindamisin
15
57,69
Linezolid
21
80,77
Chloramphenicol
6
23,08
Amikacin
9
34,62
Gentamicin
9
34,62
Ciprofloxacin
13
50
Levofloxacin
17
65,38
RESULT
Distribution of submandibular abscess patients according
to complications
Complication
N
%
Parotid abscess
1
3,85
Mediastinitis
1
3,85
No complication
24
92,30
Total
26
100
RESULT
Distribution of submandibular abscess patients according
to duration of treatment
Duration of treatment (days)
N
%
4
4
15,38
5
12
46,15
6
4
15,38
8
1
3,85
10
3
11,54
15
1
3,85
20
1
3,85
Total
26
100
DISCUSSION
Submandibular abscess
can occur at any age
Huang et al. 52,4% of patients
over 50 years old.
Parhiscar et al. 50% third
to fourth decade of life
This research :
>> submandibular
abscess patients
group 40 – 49 years old
( 9 people or 34.6%)
Huang et al.
male : female ~ 3:2
Rizzo et al.
male 51.9% female 48.1%
This research:
Male 80.77%
Female 19.23%.
DISCUSSION
Rana et al. swelling and pain
are major complaints of neck
abscess patients.
swelling ( 96%), pain (92%)
fever(66%).
Rizzo et al. swelling (98.8%),
fever (23.5%), pain (24,7%),
trismus (17,3%).
Rizzo et al. unilateral
Submandibular abscess
(81,5%), bilateral (18,5%)
This research :
swelling under the jaw
(100%), pain (96,15%),
trismus (38,46%),
fever (61,53%)
This research :
unilateral (96.15%),
bilateral (3.85%)
DISCUSSION
Origin of infection :
Rizzo et al. odontogenic 46,9%
Rana et al. odontogenic 48%
Parhiscar et al. odontogenic 43%
Submandibular abscess
caused by tooth infection,
>>bacteria : Streptococcus
viridans and anaerob bacteria
This research :
Odontogenic 100%
This research :
Germ culture
• >>Streptococcus viridans
34.62%
• no growth of germs 34,62%
DISCUSSION
Complication :
airway obstruction,
mandibular osteomyelitis,
spreading of infection to
neck space, mediastinitis
and sepsis
This research :
Complication
• parotid abscess:
1 person or 3.85%
• mediastinitis:
1 person or 3.85%
• no complications
24 people or 92.30%.
CONCLUSION
Submandibular abscess patients in ENT Department
Sanglah hospital period of January 2012 to
December 2014 26 of patients
Most of patients 40-49 years old (34.6%)
Chief complaint : swelling under the jaw (100%),
pain (96,15%), trismus (38,46%), fever (61,53%)
Most patients with submandibular abscess was
unilateral (96.15%) and odontogenic 100%
Complications : parotid abscess 1 person (3.85%),
mediastinitis 1 person (3.85%) and no complications
24 people (92.30%).
SUGGESTION
Descriptive retrospective research to
determine distribution of submandibular
abscess patients in ENT Department Sanglah
hospital longer period we get more
samplesrepresentative result.
The results guidelines for management of
submandibular abscesses more effective,
especially in ENT department Sanglah Hospital
DISTRIBUTION OF SUBMANDIBULAR ABSCESS
PATIENTS IN THE EAR NOSE THROAT DEPARTMENT
OF SANGLAH HOSPITAL
PERIOD OF JANUARY 2012 TO DECEMBER 2014
BY
I GUSTI AYU OKA SRI UTARI
SCIENTIFIC ADVISOR
dr. I DEWA GEDE ARTA EKA PUTRA Sp. T.H.T.K.L
INTRODUCTION
BACKGROUND
Submandibular abscess : inflammation with pus
in the submandibular space cause by infection
( bacteria, parasites or foreign body )
Origin of infection: tooth infection, floor of the
mouth, pharynx, submandibular lymph, trauma
and other neck spaces.
INTRODUCTION
BACKGROUND
Incidence : males > females
Predisposing factor : poor hygiene of orodental,
diabetes mellitus, immunodeficiency disease
Morbidity cause by complications of
submandibular abscess >>
descriptive research : distribution of
submandibular abscess patients in ENT
Department Sanglah hospital
INTRODUCTION
ISSUE
How is the distribution of submandibular abscess
patients in ENT Department Sanglah hospital
period of January 2012 to December 2014 ?
PURPOSES
General Purpose
To know the distribution of submandibular abscess
patients in ENT Department Sanglah hospital
period of January 2012 to December 2014
INTRODUCTION
PURPOSES
Specific Purpose
To know the distribution of submandibular abscess
patients according to age, sex, chief complaint,
location, origin of infection, results of bacteria
culture, antibiotic sensitivity, complications,
duration of treatment
INTRODUCTION
BENEFITS
Overview of distribution of submandibular abscess
patients in ENT Department Sanglah hospital
period of January 2012 until December 2014
The results can be used in the prevention and
management of submandibular abscess especially
in Sanglah Hospital prompt and accurate
Provide information for other researchers
LITERATURE REVIEW
ANATOMY
LITERATURE REVIEW
ETIOLOGY
aerob bacteria, anaerob or mix
culture results : Streptococcus viridans,
Staphylococcus epidermidis, Staphylococcus
aureus, Streptococcus β hemolytic, Bacteroides,
Fusobacterium, Peptostreptokokus species,
Neisseria, Klebsiella pneumoniae and
Pseudomonas
LITERATURE REVIEW
DIAGNOSIS
Anamnesis
Swelling under the jaw, pain, fever.
Other complaints difficulty in swallowing,
difficulty in mouth opening, dyspnea
• unilateral or bilateral edema in the submandibular
Physical
region, tenderness, hyperemi and fluctuating.
examination • swelling under the tongue and trismus.
Adjuvant
examination
• Soft tissue plain radiography of the neck
• complication ? chest x-ray
• CT scan, MRI, USG
• blood tests infection
LITERATURE REVIEW
Differential diagnosis
lymphadenitis, submasseteric abscess, buccal
abscess, sialadenitis and neoplasms in neck area
Complication
airway obstruction, mandibular osteomyelitis,
spreading of infection to the neck space,
mediastinitis and sepsis
LITERATURE REVIEW
Management
Intravenous antibiotics based on culture and
sensitivity test
Drainage of abscess : aspiration of abscess,
incision and exploration
CONCEPTUAL FRAMEWORK
Origin of infection: tooth infection,
floor of the mouth, pharynx,
submandibular lymph, trauma
and other neck spaces.
Inflammation and pus in the
submandibular space
submandibular abscess
- Age
- Sex
- Chief complaint
- Location
- Origin of infection
- Results of bacterial
culture
- Antibiotic sensitivity
- Complications
- Duration of treatment
METHODS
Design
Retrospective descriptive research
Place and
time
ENT Department Sanglah hospital
in June to August 2015
Population
Submandibular abscess patients who come
to ENT department Sanglah hospital in
January 2012 until December 2014.
Sample
Submandibular abscess patients who come
to ENT department Sanglah hospital in
January 2012 until December 2014 that
appropriate the inclusion criteria
METHODS
Inclusion
criteria
- Patients who are diagnosed with submandibular
abscess.
- Patients who are willing to get treatment at
ENT department Sanglah Hospital
- Patients who do pus culture and antibiotic
sensitivity test.
- Patients who are not willing to get treatment.
Exclusion - Patients who don’t do pus culture and antibiotic
criteria
sensitivity test.
- Patients with incomplete medical records.
METHODS
Operational definition of variable
Submandibular abscess : inflammation with pus
in the submandibular space cause by infection
( bacteria, parasites or foreign body )
Age : the age since birth (years old)
Sex : male or female.
Main complaint : complaint that brings the patient
comes to the health service.
Location : submandibular region (unilateral or bilateral)
Germ culture : bacteriological examination to determine
type of bacteria.
METHODS
Operational definition of variable
Antibiotic sensitivity : antibiotics that are sensitive to
growth of germs.
Long of care : times (days) that are needed for
healing process.
Complications : conditions that arise caused by
submandibular abscess itself or performed after
incision and drainage.
METHODS
Medical records in Sanglah hospital period
Data
Collection of January 2012 to December 2014
Data
processing
Data tabulated
Presented descriptively tables and
narrative
RESULT
Distribution of submandibular abscess patients according to age
Age
Frequency
%
10-19
1
3,85
20-29
5
19,23
30-39
4
15,38
40-49
9
34,62
50-59
4
15,38
60-69
2
7,69
70-79
1
3,85
Total
26
100
RESULT
Distribution of submandibular abscess patients according to sex
Sex
Frequency
%
Male
21
80,77
Female
5
19,23
Total
26
100
RESULT
Distribution of submandibular abscess patients according to
chief complaint
Chief complaint
N = 26
%
26
100
Pain
25
96,15
Difficulty in mouth opening
10
38,46
Fever
16
61,53
Swelling under the jaw
RESULT
Distribution of submandibular abscess patients according
to location
Location
N
%
Unilateral
25
96,15
Bilateral
1
3,85
Total
26
100
RESULT
Distribution of submandibular abscess patients according
to origin of infection
Origin of infection
N
%
Tooth
26
100
Other infections
0
0
Total
26
100
RESULT
Distribution of submandibular abscess patients according
to results of germ culture
Germ culture
N
%
Streptococcus viridians
Streptococcus pirogens
9
34,62
1
3,85
Streptococcus β
2
7,69
Streptococcus α
2
7,69
Klebsiella pneumoniae
2
7,69
Enterococcus sp
1
3,85
No growth
9
34,62
26
100
Total
RESULT
Distribution of submandibular abscess patients according to
antibiotic sensitivity
Antibiotic
N=26
%
Ampicilin
7
26,92
Amoxicilin/Clavulanat acid
9
34,62
Cefalotin
22
84,62
Cefotaxim
18
69,23
Cefepime
21
80,77
Imipenem
18
69,23
Meropenem
22
84,62
Vancomycin
14
53,85
Erythromycin
12
46,15
RESULT
Distribution of submandibular abscess patients according to
antibiotic sensitivity
Antibiotic
N=26
%
Tetracycline
8
30,77
Clindamisin
15
57,69
Linezolid
21
80,77
Chloramphenicol
6
23,08
Amikacin
9
34,62
Gentamicin
9
34,62
Ciprofloxacin
13
50
Levofloxacin
17
65,38
RESULT
Distribution of submandibular abscess patients according
to complications
Complication
N
%
Parotid abscess
1
3,85
Mediastinitis
1
3,85
No complication
24
92,30
Total
26
100
RESULT
Distribution of submandibular abscess patients according
to duration of treatment
Duration of treatment (days)
N
%
4
4
15,38
5
12
46,15
6
4
15,38
8
1
3,85
10
3
11,54
15
1
3,85
20
1
3,85
Total
26
100
DISCUSSION
Submandibular abscess
can occur at any age
Huang et al. 52,4% of patients
over 50 years old.
Parhiscar et al. 50% third
to fourth decade of life
This research :
>> submandibular
abscess patients
group 40 – 49 years old
( 9 people or 34.6%)
Huang et al.
male : female ~ 3:2
Rizzo et al.
male 51.9% female 48.1%
This research:
Male 80.77%
Female 19.23%.
DISCUSSION
Rana et al. swelling and pain
are major complaints of neck
abscess patients.
swelling ( 96%), pain (92%)
fever(66%).
Rizzo et al. swelling (98.8%),
fever (23.5%), pain (24,7%),
trismus (17,3%).
Rizzo et al. unilateral
Submandibular abscess
(81,5%), bilateral (18,5%)
This research :
swelling under the jaw
(100%), pain (96,15%),
trismus (38,46%),
fever (61,53%)
This research :
unilateral (96.15%),
bilateral (3.85%)
DISCUSSION
Origin of infection :
Rizzo et al. odontogenic 46,9%
Rana et al. odontogenic 48%
Parhiscar et al. odontogenic 43%
Submandibular abscess
caused by tooth infection,
>>bacteria : Streptococcus
viridans and anaerob bacteria
This research :
Odontogenic 100%
This research :
Germ culture
• >>Streptococcus viridans
34.62%
• no growth of germs 34,62%
DISCUSSION
Complication :
airway obstruction,
mandibular osteomyelitis,
spreading of infection to
neck space, mediastinitis
and sepsis
This research :
Complication
• parotid abscess:
1 person or 3.85%
• mediastinitis:
1 person or 3.85%
• no complications
24 people or 92.30%.
CONCLUSION
Submandibular abscess patients in ENT Department
Sanglah hospital period of January 2012 to
December 2014 26 of patients
Most of patients 40-49 years old (34.6%)
Chief complaint : swelling under the jaw (100%),
pain (96,15%), trismus (38,46%), fever (61,53%)
Most patients with submandibular abscess was
unilateral (96.15%) and odontogenic 100%
Complications : parotid abscess 1 person (3.85%),
mediastinitis 1 person (3.85%) and no complications
24 people (92.30%).
SUGGESTION
Descriptive retrospective research to
determine distribution of submandibular
abscess patients in ENT Department Sanglah
hospital longer period we get more
samplesrepresentative result.
The results guidelines for management of
submandibular abscesses more effective,
especially in ENT department Sanglah Hospital