CLINICAL RESEARCH
SCIENTIFIC ADVISOR
dr. I DEWA GEDE ARTA EKA PUTRA Sp. T.H.T.K.L I GUSTI AYU OKA SRI UTARI
BY
DISTRIBUTION OF SUBMANDIBULAR ABSCESS PATIENTS IN THE EAR NOSE THROAT DEPARTMENT
OF SANGLAH HOSPITAL
INTRODUCTION
BACKGROUND
Submandibular abscess : inflammation with pus
in the submandibular space cause by infection
( bacteria, parasites or foreign body )
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
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
INTRODUCTION
PURPOSES
Specific Purpose
To know the distribution of submandibular abscess
patients according to age, sex, chief complaint,
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
LITERATURE REVIEW
LITERATURE REVIEW
ETIOLOGY
aerob bacteria, anaerob or mix
culture results : Streptococcus viridans,
Staphylococcus epidermidis, Staphylococcus
aureus
, Streptococcus β hemolytic,
Bacteroides,
Fusobacterium, Peptostreptokokus species,
LITERATURE REVIEW
DIAGNOSIS
Swelling under the jaw, pain, fever.
Other complaints difficulty in swallowing, difficulty in mouth opening, dyspnea
• unilateral or bilateral edema in the submandibular region, tenderness, hyperemi and fluctuating.
• swelling under the tongue and trismus.
• Soft tissue plain radiography of the neck
• complication ? chest x-ray
• CT scan, MRI, USG
• blood tests infection
Anamnesis
Physical
examination
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,
LITERATURE REVIEW
Management
Intravenous antibiotics based on culture and
sensitivity test
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
Retrospective descriptive research
ENT Department Sanglah hospital in June to August 2015
Submandibular abscess patients who come to ENT department Sanglah hospital in
January 2012 until December 2014.
Design
Place and
time
Population
METHODS
Sample
Submandibular abscess patients who come to ENT department Sanglah hospital in
- 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. - Patients who don’t do pus culture and antibiotic sensitivity test.
- Patients with incomplete medical records.
Inclusion
criteria
Exclusion
criteria
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.
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.
Operational definition of variable
Medical records in Sanglah hospital period
of January 2012 to December 2014
Data
tabulated
Presented descriptively
tables and
narrative
Data
Collection
Data
processing
Distribution of submandibular abscess patients according to age
RESULT
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
Distribution of submandibular abscess patients according to sex
RESULT
Sex Frequency %
Male 21 80,77
Female 5 19,23
Distribution of submandibular abscess patients according to chief complaint
RESULT
Chief complaint N = 26 %
Swelling under the jaw
26 100
Pain 25 96,15
Difficulty in mouth opening 10 38,46
Distribution of submandibular abscess patients according to location
RESULT
Location N %
Unilateral 25 96,15
Bilateral 1 3,85
Distribution of submandibular abscess patients according to origin of infection
RESULT
Origin of infection N %
Tooth 26 100
Other infections 0 0
Distribution of submandibular abscess patients according to results of germ culture
RESULT
Germ culture N %
Streptococcus viridians 9 34,62
Streptococcus pirogens 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
Distribution of submandibular abscess patients according to antibiotic sensitivity
RESULT
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
Distribution of submandibular abscess patients according to antibiotic sensitivity
RESULT
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
Distribution of submandibular abscess patients according to complications
RESULT
Complication N %
Parotid abscess 1 3,85
Mediastinitis 1 3,85
No complication 24 92,30
Distribution of submandibular abscess patients according to duration of treatment
RESULT
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
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
DISCUSSION
This research :
>> submandibular abscess patients
group 40 – 49 years old ( 9 people or 34.6%)
This research:
Male 80.77%
Female 19.23%.
Huang et al.
male : female ~ 3:2
Rizzo et al.
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%).
DISCUSSION
This research :
swelling under the jaw (100%), pain (96,15%), trismus (38,46%),
fever (61,53%)
Rizzo et al. unilateral Submandibular abscess (81,5%), bilateral (18,5%)
This research :
Origin of infection :
Rizzo et al. odontogenic 46,9% Rana et al. odontogenic 48%
Parhiscar et al. odontogenic 43%
DISCUSSION
This research :
Odontogenic 100%
This research :
Germ culture
• >>Streptococcus viridans 34.62%
• no growth of germs 34,62% Submandibular abscess
Complication :
airway obstruction,
mandibular osteomyelitis,
spreading of infection to
neck space, mediastinitis
and sepsis
DISCUSSION
This research :
Complication
•
parotid abscess:
1 person or 3.85%
•
mediastinitis:
1 person or 3.85%
•
no complications
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%).
Descriptive retrospective research to
determine distribution of submandibular
abscess patients in ENT Department Sanglah
hospital
longer period
we get more
samples
representative result.
The results
guidelines for management of
submandibular abscesses more effective,
especially in ENT department Sanglah Hospital
