Spilled purulent inflammation of fiber. Unlike an abscess, it tends to spread throughout the cellular spaces, along the fiber along the vessels of the neck, pharynx, mediastinum, and esophagus.
Etiology of phlegmon of the maxillofacial region
The reason is odontogenic (96%). However, the infection can be carried by lymph, blood during injection. Possible as a complication of osteomyelitis, stomatitis, salivary stone disease, periodontitis, boils, tonsillitis, trauma, etc. Flora with odontogenic phlegmon is usually mixed; in 80 – 90% of cases, anaerobes ( non-spore forming ) are present . The most commonly represented are staphylococci, which are associated with streptococci and other pyogenic bacteria (Pseudomonas aeruginosa, Escherichia coli, etc.).
Phlegmon develops rapidly (unlike an abscess), is accompanied by a sharp violation of microcirculation, biochemical and neurotrophic processes that contribute to the formation of toxic substances. High intoxication is due to the fact that at the site of the rapid development of inflammation, the body does not have time to create a restrictive barrier. This also explains the rapid spread of phlegmon to surrounding tissues. It goes along the fiber, including along the vessels up to the distant parts of the head and neck. In the focus, the process begins with serous inflammation, which, depending on the microflora, acquires a purulent, putrefactive or necrotic form. By the nature of development, acute and chronic phlegmon is distinguished, prone to progression or delimitation.
According to localization, phlegmon of the face, periandibular, the bottom of the oral cavity, tongue and peri-pharyngeal.
Phlegmon in the lymph node.
Clinic phlegmon maxillofacial area
Typically, the onset of phlegmon is preceded by pain in the causative tooth (96-98%). Phlegmon of the lymph node is characterized by slow development. With rapid development, a rapidly increasing infiltrate occurs, the body temperature rises sharply to 39-40 ° C, severe pain becomes pulsating; the skin of the face is pale; headache, chills, malaise.
With a shallow phlegmon, a sharp asymmetry of the face occurs, the natural folds of the face are smoothed, the skin over the infiltrate glistens, hyperemic, is not going to fold.
With phlegmon of the bottom of the oral cavity, tongue and periopharyngeal, the leading symptom is increasing difficulty in breathing, eating, and speech, which leads patients to a state of fright, fear. High intoxication can cause a disturbance in cardiac activity and consciousness. Involvement in the inflammation of the masticatory muscles determines the development of their contracture.
With the anaerobic nature of phlegmon, the severity of the course is aggravated. On the part of the blood, leukocytosis (10-12-10 9 / L), an increase in ESR, a decrease in the number of eosinophils, a shift of the formula to the left are observed. In the urine, as a result of toxic damage to the kidneys, protein, sometimes cylinders and red blood cells, is observed.
The course and complications of phlegmon of the maxillofacial region
Phlegmon of the maxillofacial region rapidly progresses, with a tendency to spread, leading to serious complications of the disease (mediastinitis, eye phlegmon, osteomyelitis of the base of the skull, erosive damage to the walls of large vessels, brain abscess, meningitis, thrombophlebitis of the face veins, cavernous sinus, etc. .). Emergency hospitalization of patients with phlegmon of the maxillofacial region is mandatory.
The development of phlegmon can go in two ways. The most rare way is opening an abscess through the skin or mucous membrane of the oral cavity, which can lead to self-healing. Another way is the progression of the process and its spread to surrounding and distant tissues. In this case, general complications may appear, such as asphyxia, a fall in cardiac activity, sepsis. It is necessary to take into account the peculiarities of the course in elderly people, patients with diabetes.
The diagnosis of phlegmon of the maxillofacial region
The diagnosis usually does not cause difficulties, except for phlegmon, localized in the near-pharyngeal region and in other deep sections, including the neck. It should be differentiated