Abscess and phlegmon of the buccal area (cellular spaces of the cheek). Phlegmon of the maxillofacial area: floor of the mouth, neck, upper and lower jaw Phlegmon of the gums symptoms

Topographic anatomy

(Fig. 46): upper - the lower edge of the zygomatic bone, lower - the edge of the body of the lower jaw, anterior - the circular muscle of the mouth (m. orbicularis oris), posterior - the anterior edge of the masticatory muscle. masseter).

Layer structure. The buccal region is characterized by an abundance of subcutaneous fatty tissue. The last thin fascial plate (fascia buccopharyngea) is delimited by the fatty lump of the cheek (corpus adiposum), which lies on top of the buccal muscle and, in the posterior direction, penetrates into the deep zone of the lateral part of the face. The buccal-pharyngeal fascia covers the buccal muscle and forms a seal that is stretched between the hook of the pterygoid process and the mylohyoid line of the mandible. This seal is known as lig. pterygo-mandibulare, serves as the origin of the buccal muscle (m. buccinator). The thickness of the latter at the level of the middle of the anterior edge of the masticatory muscle is pierced by the duct of the parotid salivary gland. The facial artery and vein pass through the tissue, projecting in the direction from the middle of the lower edge of the jaw to the inner corner of the eye. The facial artery in the tissue anastomoses with other arteries of the face - a. buccalis, a. infraorbitalis (from a. maxillaris), a. transversa faciei (from a. temporalis) At the level of the middle of the anterior edge of the masticatory muscle there is a large vein - v. anastomotica, connecting the facial vein with the pterygoid venous plexus. The sensory nerves of the buccal region are n. infraorbitalis (from the second branch of the trigeminal nerve), n. buccalis, n. mentalis (from the third branch of the trigeminal nerve). Thus, in the buccal region, one can distinguish a superficial cellular space located above the buccal muscle, and a deep one - between the mucous membrane of the cheek and the buccal muscle (Fig. 47).

Main sources and routes of infection

Foci of odontogenic infection in the area of the upper and lower premolars, molars, infectious and inflammatory lesions, infected wounds of the skin and mucous membrane of the cheek. Secondary damage as a result of the spread of infection from the infraorbital, parotid-masticatory, zygomatic and infratemporal areas.

Characteristic local signs of abscesses and phlegmon of the buccal area

Superficial cellular space (between the skin and the buccal muscle) (Fig. 48, A):

Complaints for pain in the cheek area of moderate intensity, intensifying when opening the mouth and chewing.

Objectively. Sharply expressed facial asymmetry due to inflammatory infiltration of cheek tissue. The skin is tense and hyperemic. Palpation causes pain, fluctuation can be detected.

Deep cellular space (between the mucous membrane of the cheek and the buccal muscle (Fig. 48, B):

Complaints for pain in the cheek area of moderate intensity.

Objectively. Asymmetry of the face due to swelling of the cheeks. Her skin is of normal color. When examined from the oral cavity, swelling of the cheek is revealed due to infiltration, the mucous membrane above which is tense and hyperemic. Palpation causes pain. Sometimes fluctuation can be detected, and when the inflammatory process spreads to the anterior edge of the masticatory muscle (m. masseter), there may be some limitation in mouth opening.

Ways of further spread of infection

Parotid-masticatory, submandibular, infraorbital, zygomatic regions, pterygo-maxillary space.

Method of operation for opening abscesses of phlegmon of the buccal region

The choice of surgical access for opening an abscess, phlegmon of the buccal area is determined by the localization of the infectious-inflammatory process: for an abscess, phlegmon of the superficial cellular space, operative access is used from the skin, for an abscess, phlegmon of the deep cellular space - from the oral cavity.

Atabscess, phlegmon of the superficial cellular space of the buccal region The skin incision is made taking into account the localization, prevalence of the infectious-inflammatory process and the expected aesthetic effect after healing of the surgical wound. Thus, for an abscess of subcutaneous fat in the upper part of the buccal region, a skin incision is made along the nasolabial fold (Fig. 49, A, B), and for phlegmon and abscess of the lower part of the buccal area, an incision is used in the submandibular region along the lower edge of the jaw (Fig. 50, A, B, C).

1. Anesthesia - local infiltration anesthesia with premedication, anesthesia (intravenous).

2. A skin incision in the area of the nasolabial fold or in the submandibular region parallel to and 1-1.5 cm below the edge of the jaw (Fig. 49, 50). Hemostasis.

3. Opening the purulent focus by dissecting the subcutaneous tissue above the buccal muscle using a hemostatic clamp towards the center of the inflammatory infiltrate (Fig. 49, C, Fig. 50, D).

4. Insertion of tape drainage made from glove rubber or polyethylene film into the wound (Fig. 49, D, Fig. 50, E, F).

5. Applying an aseptic cotton-gauze bandage with a hypertonic solution and antiseptics.

For abscess, phlegmon of the deep cellular space of the buccal region:

1. Pain relief - local infiltration anesthesia accompanied by premedication.

2. An incision in the mucous membrane of the cheek parallel to the course of the excretory duct of the parotid salivary gland above or below it (taking into account the level of localization of the inflammatory infiltrate) (Fig. 51).

3. Fiber separation using a hemostatic clamp towards the center of the inflammatory infiltrate, opening of the purulent-inflammatory focus, evacuation of pus.

4. Insertion of tape drainage made of rubber gloves or polyethylene film into the wound.

As a rule, patients experiencing toothache or other dental problems turn to medical institutions for help. Not everyone knows that the object of treatment in dentistry is the maxillofacial area. The patient may experience inflammation, which is difficult to associate with tooth extraction, but this is where the whole problem lies.

What is phlegmon?

Phlegmon is a purulent-necrotic inflammation of soft tissues that does not have clear boundaries. Subcutaneous fat tissue is close to blood vessels, nerves and organs, which contributes to the rapid spread of the purulent process. Cellulitis of the maxillofacial area spreads to bone tissue, muscles, tendons and internal organs. The area of inflammation can be determined by a couple of centimeters or affect entire areas.

Localization

Any area of the body is not immune from the appearance of odontogenic phlegmon. Phlegmon of the maxillofacial area can develop due to the removal of the “eight”, inflammation of the pulp, soft tissues surrounding the tooth root, tonsils, adenoids, etc.

Most often the disease occurs due to:

glossitis, promoting the development of diffuse purulent inflammation in the glossopharyngeal space;
inflammation of the lower jaw, involving the chin area;
sialadenitis, glossitis, periostitis, spreading along the bottom of the oral cavity.

Causes

Diffuse purulent inflammations are infectious in nature. Waste products of pathogenic microorganisms, decomposed tissue of molars and anaerobic microflora of a filled tooth are the main sources of disease development and intoxication of the body.

In the maxillary region, the source of damage is most often the wisdom tooth and the frontal incisor group. In the lower jaw, any tooth can cause phlegmon of the floor of the mouth.

Etiology of non-odontogenic phlegmon:

external mechanical impact on soft and hard tissues and their subsequent infection;
violation of asepsis during injections;
infection from external sources of skin diseases (furuncle, carbuncle);
stomatitis of infectious etiology.

With a weakened immune system, a tendency to allergies and the presence of chronic diseases, phlegmon of the jaw is severe and long-lasting. This disease has an infectious etiology, but is not transmitted by contact.

Diagnostics

The doctor will be able to make a correct diagnosis by knowing the medical history, identifying disturbing symptoms and obtaining laboratory test data. Clinical studies will determine the extent of damage to the body and the effectiveness of the chosen course of treatment.

In case of deep spread of phlegmon of the maxillofacial area, to clarify the diagnosis, a tissue puncture is made and the composition of the extracted effusion is examined, and the sensitivity of the pathogenic microflora to medicinal drugs is determined. The duration and effectiveness of treatment depends on this.

Classification and symptoms

Cellulitis can be classified according to:

type of inflammatory exudate (serous, purulent, putrefactive-necrotic);
stages of the disease (acute, chronic);
location (superficial or deep).

The inflammatory process begins with compaction of soft tissues, the appearance of edema with its subsequent increase, redness of the inflamed area on the part of the mouth and skin. Severe pain radiates throughout the entire half of the face: in the ears, eye socket and neck. The patient's general condition worsens from intoxication.

A blood test reveals characteristic changes that indicate the extent of damage to the entire body. Phlegmon of the floor of the mouth is accompanied by a pronounced pain syndrome; the processes of eating, swallowing, and articulation are impaired. Various degrees of trismus are observed.

Depending on the location

Cellulitis, as seen in the photo, can affect the neck, cheeks, cheekbones and eye sockets. The inflammatory purulent process, depending on the location of localization, is conventionally divided into superficial and deep. In the presence of superficial odontogenic phlegmon, the disease proceeds intensively, and general symptoms quickly develop, indicating intoxication of the body. The body temperature can reach 38-40 degrees, the person shudders, and his general condition worsens.

If the patient develops deep phlegmon, then general symptoms will prevail over local ones. The patient's temperature rises sharply, up to 42 degrees. Intoxication leads to heart rhythm disturbances, decreased blood pressure, and shortness of breath. The excretory system suffers, the person may stop urinating.

According to the nature of the pathological process

The disease always develops in a different scenario. There are two main forms of the inflammatory purulent process of the maxillofacial area:

The acute stage is accompanied by a sharp increase in body temperature. The skin turns red and soft tissue swelling occurs. Signs of necrosis appear in the affected area. If help is not provided to the patient in a timely manner, there is a possibility of developing a fistula.
The chronic stage occurs with pain. At the site of inflammation, palpation can detect a compaction. Affected tissues may become bluish in color.

How to treat?

An experienced doctor can easily make a diagnosis. When prescribing treatment for phlegmon of the maxillofacial area, it is necessary to take into account the stage of inflammation. In the initial stage, you can limit yourself to taking anti-inflammatory drugs and antibiotics.

If the inflammatory process is at a late stage, then surgical treatment is necessary. The surgeon will excise the affected tissue and treat the open wound.

Drug therapy

Turning a patient to specialized medical institutions at the initial stage of the disease will avoid surgery. At the initial stage, phlegmon of the maxillofacial area can be cured using antibacterial drugs. Dry heat is applied to the affected area and treated with a calcium chloride solution.

The doctor prescribes rinsing the bottom of the mouth with antiseptic solutions and a course of physiotherapy. Drug therapy can help only if the source of infection has previously been eliminated (sanitation has been carried out, a diseased tooth has been removed, an injury has been treated, etc.).

Physiotherapy

To treat jaw phlegmon, different types of physiotherapy are used. This can be centimeter wave therapy, ultraviolet irradiation, UHF therapy used in the acute phase of inflammation. Laser irradiation of blood is used to enhance immunity.

Light therapy is used if there is a dense infiltrate in the affected area. When treating wounds with ultrasound, the treatment time can be reduced to 3-5 days. In case of severe disease, 3-4 hyperbarotherapy procedures are performed.

Surgical intervention

All phlegmons, including the floor of the mouth, are treated using the surgical method only in a hospital setting. Experienced, highly qualified surgeons perform the operation, monitor the patient in the postoperative period and provide comprehensive treatment.

During the operation, the patient may be under general anesthesia or local anesthesia. Depending on the size of the affected area, the doctor makes an incision in the skin and mucous membranes (as shown in the photo) with a scalpel, opening the affected area. If putrefactive-necrotic changes are observed, then the dead tissue is excised. Subsequently, the wounds are drained.

Plastic surgery

Surgical interventions to recreate the altered shape of the maxillofacial area are carried out for the following indications:

Folk remedies

Abscesses and phlegmons of the maxillofacial area can be treated using traditional medicine. Herbal cloves, mint basil, St. John's wort, propolis, blue eucalyptus, birch buds and leaves are a small list of herbs that are recommended for use in the treatment of inflammatory processes.

To treat phlegmon of the lower jaw, you can use a decoction. Pour 60 grams of herbal cloves into one liter of hot water, leave until cool and drink in small sips of 250 ml throughout the day. You can also take 40 g of St. John's wort, 25 g of propolis and 150 ml of alcohol-containing liquid, grind, and leave the combined components for 10 days. The strained infusion is used for rinsing in the proportion of a teaspoon per 250 ml of mineral water with gas.

Possible complications

Common complications of phlegmon in the maxillofacial area are: mediastinitis, thrombophlebitis of the facial veins, sepsis. With mediastinitis, a person experiences chest pain, which can radiate to the scapula area. The patient takes a forced position and finds it difficult to raise his head.

Thrombosis of the cavernous sinus is a common complication of odontogenic phlegmon. The patient experiences severe headaches and chills.

Sepsis is characterized by elevated body temperature, changes in the qualitative and quantitative composition of leukocytes. The prognosis is unfavorable, death is possible.

The concept of abscess of the maxillofacial area

An abscess of the maxillofacial area is an infectious formation on the mucous membranes of the oral cavity containing pathological fluid (pus). The disease can occur on both the upper and lower jaw; as a rule, the inflammatory process begins with the causative tooth. When palpating the affected area, the patient experiences pain; the skin at the site of inflammation is thinned.

Causes of the pathological process

An abscess may appear as a result of an odontogenic infection entering a wound resulting from a maxillofacial injury or a periodontal pocket.

The main pathogens are streptococci and staphylococci. The infection can enter the body from the outside or through the bloodstream. It is not uncommon for a submandibular abscess to occur at the site where chemicals enter the skin.

Symptoms

The disease is determined by a number of signs:

incessant headaches, loss of strength, chills;
there may be an increase in body temperature, hyperemia of the inflammation site is observed;
changes in the qualitative and quantitative composition of leukocytes;
fluctuation is detected by palpation.

If the patient experiences all of the above symptoms, he needs to seek specialized help. Odontogenic abscesses can affect neighboring areas and cause complications on the respiratory system.

Types of abscesses

A person has an upper and lower jaw, based on this, odontogenic abscesses, depending on their location, are usually divided into maxillary and mandibular (this also includes submandibular). Doctors distinguish the following types of disease: abscess of the tongue, floor of the mouth, palate, gums, cheek, tongue (we recommend reading: cheek abscess: causes and methods of treatment).

Upper jaw

Often, inflammation in the upper jaw develops as a result of the eruption of the upper wisdom teeth. “Eights” injure the mucous membranes, the infection penetrates the fiber, which provokes the development of the inflammatory process. Once an abscess has formed in the jaw area, it becomes difficult for a person to open his mouth and swallow, and the pain in the inflamed area intensifies.

Lower jaw

The cause of the development of odontogenic abscesses in the submandibular region can be untreated molars. It is painful for the patient to chew food and swallow. A distinctive feature of inflammation localized in the lower jaw is painful swelling, which is visually noticeable. It affects the submandibular triangle, sometimes leading to distortion of facial shape.

How to treat an abscess?

To get rid of inflammation, odontogenic abscesses are opened, drainage is installed and the affected areas are treated with disinfectants. If the body temperature is elevated, the patient is prescribed antibiotics.

In case of weakened immunity, immunomodulatory drugs are indicated. In order to shorten the wound healing process, they resort to physiotherapeutic procedures and ultraviolet irradiation.

Prevention of phlegmon and abscesses

Prevention of odontogenic phlegmons and abscesses consists of following the rules of personal hygiene, timely dental treatment, and eating foods rich in vitamins and minerals. It is also recommended to visit the dentist at least once every six months. If the skin and mucous membranes of the oral cavity are damaged after the removal of molars, in order to avoid the development of phlegmon and abscesses, it is necessary to promptly carry out high-quality treatment with antiseptic agents.

Among the common diseases caused by uncontrolled reproduction naturally occurring bacteria in the body is phlegmon, the appearance of which can cause significant discomfort and unpleasant consequences in advanced forms.

Detecting signs of this disease requires immediate medical attention.

What is phlegmon of the jaw?

Phlegmon is purulent inflammation in the area of fatty tissue. Outwardly, it looks like a small swelling of a reddish hue; subsequently, pain occurs at the moment of touch, accompanied by headaches and weakness.

Inside the maxillofacial area spreads along the vessels located in the areas of the neck, pharynx, mediastinum, and esophagus. Swelling of soft tissues increases, leading to a distortion of the natural proportions in the face and neck.

With further progression of inflammation, the temperature may rise and the lymph nodes in the affected area will enlarge. It causes changes in tissue structure. The cause is the action of bacteria - staphylococcus (more often), and streptococcus; in children under the age of six years, hemophilus influenzae is possible.

Similar processes can occur with decreased immunity or patients with diabetes; as a result of a wound or injury, as well as on undamaged surfaces.

If the disease spreads too quickly, it is a sign of significant depletion of the body or chronic diseases.

Cellulitis cannot become infected in contact with the patient due to damage to too deep layers of the skin, while the top layer - the epidermis - serves as a natural barrier that prevents the spread of microbes.

Maxillofacial phlegmon can be defined as arising complication due to infection. As a rule, intoxication in this case occurs very quickly, preventing the body from creating a protective barrier.

The focus of the disease quickly passes from the stage of serous inflammation to a form with the release of pus, rot, and, soon, necrosis. This form is called acute. Accompanied by a jump in temperature to 40 degrees, the hot seal on the skin takes on a glossy appearance. Its softening is dangerous due to the appearance of fistulas.

Sometimes the development of phlegmon has chronic nature. In this case, the neoplasm acquires a bluish color and increased compaction. At the time of palpation, severe pain is felt.

The progression of phlegmon is dangerous due to the disruption of natural processes that serve as a barrier to the production of toxins, and then penetration into all internal organs.

Maxillofacial phlegmon covers not only the layers lying on the surface of both jaws - gums, oral cavity, tongue, but can go deeper and reach the chin, the front of the neck.

Look video about causes and treatment phlegmon:

Causes

Often the appearance of phlegmon is a consequence advanced oral diseases and emerging complications that require timely dental treatment, including osteomyelitis of the jaw.

In particular, affected teeth that have most developed root canals, which can become a source of infection (molars and wisdom teeth), as well as problems arising from their removal.

In some cases, the cause may be injury to the sublingual area.

Sometimes the cause is a damage to the skin, such as a boil, sialadenitis, pustular rashes, or ulcerative form.

The immediate causes of the development of phlegmon in the maxillofacial area are always bacteria: streptococci and staphylococci, causing the outflow of venous blood and lymph in the deep layers of the skin. For this reason, people with allergies are a particular risk group.

Phlegmon poses a danger of extremely severe consequences (sepsis, meningitis, etc.), which in exceptional cases lead to disability and even fatal outcome.

Symptoms of the disease

In dental practice, a system has been adopted for differentiating purulent-inflammatory anomalies using the topographic-anatomical method. Following him, maxillofacial phlegmon can be of the following types:

located near the upper jaw(infection will include areas of the hard and soft palate, temporal and infratemporal, infraorbital, pterygopalatine fossa, zygomatic and orbital);
located near the lower jaw(the area of infection will be the mental, buccal, submandibular, pterygomandibular, peripharyngeal and submasseterial, parotid salivary gland and fossa, behind the jaw).

Cellulitis of the upper and lower parts of the oral cavity, tongue and neck are located close to these zones.

Clinical manifestations of phlegmon in the vast majority of cases are preceded by having a bad tooth.

If the lesion becomes a lymph node, then development occurs slowly.

If the infection develops rapidly, the temperature rises, the source of pain pulsates, the skin turns pale, headaches and chills appear, and general weakness appears.

When the phlegmon is not too deep, a sudden facial asymmetry, natural folds are smoothed out, and the shine of the skin increases.

There may be difficulty breathing if the peripharyngeal area is affected, and difficulty eating due to inflammation of the masticatory muscles.

The main signs of the development of phlegmon can be noticed quite quickly:

swelling and limited mobility of the tongue, the appearance of a gray-brown coating on it;
changes in speech, disturbances in swallowing movements and chewing functions;
heaviness of breathing, increased salivation;
intoxication due to the release of toxins by microbes and poisoning of the body, causing weakness;
noticeable, associated with the activation of putrefactive processes due to the proliferation of microbes at incredible speed;
growing swelling on the face and extremely painful sensations when touched;
very high temperature.

Treatment of phlegmon

Phlegmon refers to the type of diseases that not susceptible to home exposure and require mandatory monitoring and action by a doctor.

Establishing a diagnosis of phlegmon from a qualified specialist cannot cause difficulties. Most often, it is immediately recognized during an external examination. If in doubt, your doctor can give you a referral for testing.

The treatment method is determined by the stage of inflammation. If this was done on time, then it is possible course of antibiotics. In advanced forms, immediate surgical intervention, removal of necrosis and therapy of the open wound will be required.

Such forms may entail even plastic surgery. Under any circumstances, it is necessary to neutralize the source of inflammation, which may mean: treatment or removal of teeth, as well as tumors.

If breathing is difficult, the process is ensured by a tube inserted into the trachea, through which air will flow into the lungs.

Surgical intervention

First of all, when inflammation is detected in the soft tissues of the maxillofacial area, provided the general condition is close to normal, they begin local impact.

At this stage, the doctor will prescribe dry heat and rinsing the mouth with slightly warmed solutions. sulfa drugs, Sollux.

This method should stop the spread of the process.

To neutralize its re-development, it is necessary to examine the condition of the teeth and determine which one is the causative one. Run it treatment or completely remove.

In cases where all the measures taken did not give the required result and in the next two days there is a noticeable tendency to increase, despite the therapeutic effect, the stage begins surgical intervention.

It should be noted that warming with sufficient development of phlegmon is also extremely undesirable, because it will stimulate the intensity of purulent discharge.

The purpose of surgical opening of phlegmon is a number of significant aspects:

the operation not only drains the abscess, but also suppresses and sanitizes all possible directions of movement of purulent masses in the tissue;
dissection of facial tissue is carried out only along natural folds, must take into account cosmetic facial contours(sticking to the lower edge of the jaw);
the operation is performed both in the case of softening of the tissues, and also if there is a possible risk of the outbreak spreading to nearby areas, especially the neck;
the surgeon is attentive to the areas of the facial nerves that require increased caution.

At the first stage, it is considered highly effective to introduce full anesthesia, which will help prevent possible injuries to the patient, not only physical, but also mental, allows the doctor to conduct a full palpation of the entire area of the abscess, identifying closely spaced pockets filled with pus.

For preventive purposes, it can be carried out counter cut, to eliminate secondary activation of infection.

At the second stage there is cleansing cavities from purulent masses using a sharp spoon surgical instrument. Particles of dead tissue are removed using a scalpel. Thorough cleaning is followed by placing a drainage tube or rubberized strips.

The advantage of levomekol ointment is its property draw out fluid secretions, which significantly speeds up the cleansing process. If the tampon quickly absorbs pus and becomes dirty, change it more often than once a day.

At the third stage of treatment, repeated cleansing the cavity from purulent masses and dead particles. This is usually done after two or four days.

Effective also ultrasound treatment, which is applied to a cavity filled with a solution (furatsilin, sodium chloride, saline).

In this way, you can significantly reduce the number of bacteria, eliminate necrotic tissue, and normalize blood circulation.

Medicines

General principles for treating cellulitis include taking antibiotics. This could be penicillin, novobiocin, ceporin).

Treatment should be preceded by an analysis of purulent contents to determine whether microorganisms are susceptible to any type of antibiotic.

If such an analysis is not possible, use broad-spectrum medications, their combination is allowed.

For moderately severe infections, the antibiotic should be taken every 3-4 hours. In case of individual intolerance, you need to increase the dose of sulfonamides.

It will help to significantly alleviate the patient’s condition and reduce the duration of purulent processes. oxygen therapy. To do this, sessions of hyperbarotherapy are carried out: at a pressure of 2 atm with a frequency of compression and decompression of one minute, the total time of saturation of the wound lasts three quarters of an hour.

In cases of significantly severe pain, analgin is prescribed; sometimes it may be necessary to replace it with injections of 1-2% promedol.

The disease is of particular importance in severe forms diet due to difficulty chewing and swallowing. Liquid high-calorie foods are required (rich broths, sweet compote, heavy cream, milk).

Oral hygiene is of paramount importance. It should include a set of procedures:

rinsing 4 times a day with furatsilin or a pale pink solution of potassium permanganate. The process is carried out exclusively using a rubber bulb.
at the end of the rinsing, mandatory sanitization is performed;
Physiotherapy procedures may be prescribed as additional treatment methods. The course of treatment includes four or five procedures performed daily.

A noticeable effect appears immediately after they begin, there is a decrease in pain, swelling, and the amount of discharge. In the future it will be stimulated epithelialization. The treatment period is reduced by several days.

ethnoscience

Cellulitis is an extremely dangerous disease that can only be cured by a doctor. Attempts at self-treatment will lead to irreversible consequences and even result in death.

However, in addition to following the doctor’s recommendations, you can use some traditional medicine recipes to speed up the recovery process.

Traditional recipes use different herbs to treat phlegmon, these can be basil, St. John's wort, eucalyptus, cloves, buds and birch leaves.

You can take one tbsp. herbal cloves, add a glass of water and boil over low heat for about three minutes.

The resulting solution is infused for about an hour, it is decanted and applied as a lotion to the affected areas. Useful for internal use, two tablespoons each. several times a day.

Infusion of St. John's wort and propolis You can prepare it by taking 50 and 25 g of each, respectively, crushing it and pouring 150 ml of alcohol or vodka. Close the vessel with a tight lid, leave for up to a week, and decant. Use for rinsing up to five times a day.

For internal use, half a glass 2-3 times a day can be recommended eucalyptus blue, previously brewed in a thermos with boiling water.

Mixture St. John's wort, mint basil and birch leaves in a ratio of 3:4:2, boiled in two glasses of water and cooled, use 30 ml up to six times a day.

You can take 10 g of dried birch buds, boiled in 200 ml of water for about a third of an hour, and used as compresses and internal administration, a tablespoon up to four times a day.

Complications, consequences and prevention

The disease phlegmon poses a danger to the body because it can contribute to respiratory tract infection, causing complications such as asphyxia, when the patient begins to choke due to swelling of the nearby tissues of the throat and mouth.

In advanced forms, phlegmon can have extremely serious consequences for the body. Complications include phlebitis of the facial vessels, mediastinitis, meningitis, sepsis - blood poisoning, which causes the spread of pathogenic bacteria throughout the circulatory system.

It is much easier than detecting phlegmon in time to prevent its occurrence. Enough for this Visit your doctor regularly every six months and carry out treatment and prevention of all dental abnormalities.

Such a preventive complex is not particularly difficult and is absolutely necessary for every person. Only such measures can guarantee protection from unpleasant diseases such as phlegmon.

It is necessary to be vigilant, competently carry out a set of preventive procedures and undergo regular examinations by the dentist, which will definitely help avoid unwanted problems.

Abscess and phlegmon of the buccal area (cellular spaces of the cheek). The cause of purulent diseases of the cheek area is the spread of infection from the upper or lower large or, less commonly, small molars. Sometimes an abscess or phlegmon of the buccal area develops as a complication of acute purulent periostitis of the upper or lower jaw, as well as as a result of the spread of infection from the infraorbital, parotid-masticatory areas and the infratemporal fossa.

The boundaries of the buccal region are: upper - the lower edge of the zygomatic bone, lower - the lower edge of the body of the lower jaw, anterior - the orbicularis oris muscle, posterior - the anterior edge of the masticatory muscle. Fiber is located between the laughter muscle, the subcutaneous muscle of the neck on the outside and the body of the lower jaw, the buccal muscle on the inside. The buccal muscle is covered by fascia. The subcutaneous fatty tissue is adjacent to it on the outside, and the submucosa on the inside. Together they form superficial and deep cellular spaces. In the buccal region there are subcutaneous fatty tissue, the zygomaticus major muscle, the muscular plexus of the corner of the mouth, the muscles that depress the angle of the mouth and the lower lip, buccal lymph nodes, submucosal tissue, and also the facial vein, artery, and parotid duct. The buccal region includes the fatty lump of the cheek, which is enclosed in a fascial sheath and communicates with the parotid region, the infratemporal fossa, and the pterygomandibular space.

The fatty body of the cheek, being limited by the fascial sheath, has processes penetrating into the parotid-masticatory, infratemporal, temporal, pterygomandibular and other adjacent spaces. These processes serve as pathways through which infection enters both from these spaces to the buccal region and in the opposite direction.

Patients with an abscess of the buccal area complain of minor local pain that increases with palpation. A purulent focus can form in the superficial cellular space between the skin and the buccal muscle. In such cases, the presence of a limited, often rounded infiltrate is characteristic, located, depending on the tooth that served as the source of infection, in the upper or lower part of the buccal region. Slight swelling in the tissues adjacent to the lesion. Quite quickly, the infiltrate adheres to the skin, which becomes intensely pink or red. On palpation, fluctuation is clearly noted. Often the purulent process proceeds slowly and sluggishly. The formation of an abscess can last 1-2 weeks or more. After opening the abscess, the discharge is scanty, the abscess cavity is filled with flaccid granulations. The location of the abscess in the deep cellular space between the buccal muscle and the mucous membrane is characterized by swelling of the tissues of the buccal area. When palpated, a dense infiltrate is detected in the thickness of the cheek, often fused with the alveolar process of the upper jaw. The mucous membrane of the cheek is sharply hyperemic, swollen, teeth marks are visible on it, and pain is noted. After 2-3 days from the onset of the disease, softening and fluctuation appear in the central parts of the infiltrate. Sometimes several interconnected foci of softening are formed.

With phlegmon of the buccal area, patients complain of sharp spontaneous pain that intensifies when opening the mouth and chewing. There is a significant infiltration in the buccal area, pronounced swelling of the surrounding tissues, spreading to the lower and upper eyelids, as a result of which the palpebral fissure narrows or completely closes. The swelling involves the upper, sometimes lower lip, and submandibular triangle. The skin in the cheek area is red, infiltrated, and does not fold. Swelling and hyperemia of the mucous membrane of the cheek, upper and lower vault of the vestibule of the mouth are observed. Often the mucous membrane bulges and imprints of the outer surfaces of the upper and lower teeth are visible.

A superficially located abscess of the buccal region is opened at the site of the greatest fluctuation on the part of the skin. When the abscess is localized closer to the mucous membrane or in the thickness of the cheek, an incision is made in the oral cavity from the side of the upper, less often the lower arch of the vestibule of the mouth, as well as in the place of greatest pain and fluctuation parallel to the duct of the parotid salivary gland and bluntly pass into the cavity of the abscess. For aesthetic reasons, with phlegmon, they also try to create an outflow of exudate from the oral cavity, making an incision in the vestibule of the mouth, and, stratifying the fiber, penetrate to the center of the purulent focus. If there is insufficient outflow of discharge from such a wound, a surgical approach from the skin is indicated, taking into account the direction of the branches of the facial nerve, in the infraorbital region or nasolabial groove. The fiber is stratified and sometimes they resort to bilateral emptying of purulent foci with intraoral and extraoral incisions.

A purulent process from the buccal area can spread to the zygomatic and parotid-masticatory areas, the infratemporal fossa, and the pterygomandibular space.

Abscess of the infratemporal fossa, phlegmon of the infratemporal and pterygopalatine fossa. The cause of inflammatory processes in the infratemporal and pterygopalatine fossae is the upper wisdom tooth, less often - the second or first upper molar. The infection penetrates into the tissue adjacent to the tubercle of the upper jaw, and from here it can spread to the infratemporal and pterygopalatine fossa. Inflammation in the infratemporal fossa is possible due to infection during tuberal anesthesia, in particular with improper technique and injuries to the pterygoid venous plexus, resulting in a hematoma and its suppuration. In addition, purulent diseases of the infratemporal and pterygopalatine fossae develop as a result of the spread of the process from the pterygomandibular and peripharyngeal spaces. The close anatomical connection between the cellular formations in the infratemporal and pterygopalatine fossae often makes it impossible to accurately determine the localization of purulent inflammatory processes.

The infratemporal fossa is located at the base of the skull and is delimited by the infratemporal crest from the temporal region located above and lateral to it. Its boundaries are: the upper - the temporal surface of the greater wing of the sphenoid bone, the inner - the lateral plate of the pterygoid process of the sphenoid bone and the posterior part of the buccal muscle, the anterior - the tubercle of the upper jaw, the outer - the branch of the mandible and the lower part of the temporal muscle. The infratemporal fossa is adjacent to the temporopterygoid space, which is limited externally by the lower part of the temporal muscle and internally by the lateral pterygoid muscle. In these spaces there are the pterygoid venous plexus, the maxillary artery and its branches, and the mandibular nerve. Posterior and downward from the infratemporal fossa is the interpterygoid space, which is limited by the lateral and medial pterygoid muscles extending in this area. At the top, the infratemporal fossa communicates with the temporal region, behind and outside - with the retromandibular region, below and outside - with the pterygomandibular and peripharyngeal spaces.

Inward from the infratemporal fossa there is a pterygopalatine fossa communicating with it. Its boundaries are: anterior - infratemporal surface of the body of the upper jaw; posterior - maxillary and orbital surface of the greater wing of the sphenoid bone, lower - the mouth of the pterygoid canal, internal - maxillary surface of the perpendicular plate of the palatine bone. The pterygopalatine fossa is filled with fiber, which contains the maxillary artery, maxillary nerve, and pterygopalatine ganglion of the maxillary nerve. Through the lower orbital fissure it communicates with the orbit, through the round hole - with the cranial cavity, which causes the spread of infection through the venous system, including into the bone marrow cavity.

There are abscess of the infratemporal fossa, phlegmon of the infratemporal fossa and phlegmon of the infratemporal and pterygopalatine fossae.

With an abscess of the infratemporal fossa, in most cases the abscess is located in the tissue near the infratemporal surface of the body of the upper jaw and between the lateral and medial pterygoid muscles. Characterized by spontaneous pain and limited mouth opening. With this localization there are no external changes in the facial configuration. Sometimes a slight inflammatory swelling of the buccal area is noticeable. As a result of the proximity of the pterygoid muscles, the opening of the mouth is limited, sometimes significantly. When examining the vestibule of the mouth (the cheek is pulled slightly outward), swelling and hyperemia of the mucous membrane of the upper fornix of the vestibule of the mouth at the level of the large molars is detected. By palpation, it is possible to establish an infiltrate in the area of the upper arch, and often in the area between the upper jaw and the middle edge of the lower jaw branch. However, often only pain in a limited area is determined here.

In patients with phlegmon of the infratemporal fossa, the pain intensifies (often when swallowing), radiating to the temple and eye.

On external examination, an inflammatory swelling is observed in the lower part of the temporal and upper part of the parotid-masticatory region in the form of an hourglass, as well as collateral edema in the infraorbital and buccal areas. The tissues are soft, painful, the skin is difficult to fold, its color has not changed. Significantly expressed inflammatory contracture of the masticatory muscles (III degree). In the oral cavity, the same changes are observed as with an abscess, but sometimes only swelling and hyperemia of the mucous membrane and pain along the upper vault of the vestibule of the mouth.

Phlegmon, developing in the infratemporal and pterygopalatine fossa, is characterized by significant headache, pain in the upper jaw, radiating to the eye and temple. Swelling appears in the buccal, lower part of the temporal, upper part of the parotid-masticatory areas, spreading to the eyelids. With phlegmon of the infratemporal and pterygopalatine fossae, the condition of patients is severe or moderate, body temperature rises to 40 0C, and chills occur. When palpating the swollen tissues, infiltration and pain are noted in the lower part of the temporal region, sometimes pain when pressing on the eyeball on the side of the inflammatory process. Mouth opening is limited. The mucous membrane of the upper fornix of the vestibule of the mouth is hyperemic and edematous; upon palpation in the depths of the tissue, a painful infiltrate is determined, extending to the anterior edge of the coronoid process. In some patients, the initial manifestations of phlegmon of the infratemporal and pterygopalatine fossae may go unnoticed. Damage to the infratemporal and pterygopalatine fossae can be suspected if there is an increasing deterioration in the patient’s general condition, an increase in edema and the appearance of infiltration in the lower part of the temporal region, and swelling of the eyelids on the affected side.

Surgical intervention for an abscess of the infratemporal fossa is performed from the side of the upper fornix of the vestibule of the mouth, corresponding to the molars, making an incision 2-3 cm long. After dissecting the mucous membrane bluntly using a grooved probe or a curved hemostatic clamp, they pass upward and inward, thus bypassing the tubercle of the upper jaw , and open the abscess.

The phlegmon of the infratemporal fossa is sometimes opened with the same incision with tissues moving apart, including the bundles of the external pterygoid muscle, and the lateral plate of the pterygoid process of the sphenoid bone is bluntly reached. In other cases, surgical access may depend on concomitant purulent lesions of the cellular spaces adjacent to the infratemporal and pterygopalatine fossae. If the temporal region is affected, an incision is made through the skin corresponding to the anterior edge of the temporal muscle. The skin and subcutaneous fatty tissue, the temporal fascia are dissected, the fibers of the temporal muscle are pulled apart, they penetrate to the scaly part of the temporal bone and, bending around the infratemporal crest with a curved instrument, they enter the infratemporal fossa. V.P. Ipolitov and A.T. Toktunov A991) consider it advisable to combine such an operative approach with an intraoral incision along the superoposterior fornix of the oral vestibule. When making an incision along the zygomatic arch, a section of it is resected and the coronoid process of the mandible is crossed, then bluntly passed into the infratemporal fossa. Phlegmon of the infratemporal and pterygopalatine fossae can be opened with an external incision made in the submandibular region. Having separated the attachment of the medial pterygoid muscle from the pterygoid tuberosity of the branch of the lower jaw, they bluntly penetrate upward, forward and, pushing apart the tissue between the tubercle of the upper jaw and the branch of the lower jaw, open the abscess.

Often, the results of surgical intervention (obtaining inflammatory exudate, areas of necrotic tissue from the infratemporal and pterygopalatine fossa) are the basis for the final topical diagnosis of phlegmon.

From the infratemporal and pterygopalatine fossae, the purulent inflammatory process can spread to the temporal, parotid-masticatory areas, pterygomandibular and peripharyngeal spaces. Phlegmon of the infratemporal and pterygopalatine fossae can also be complicated by the spread of infection to the tissue of the orbit, facial veins and thrombosis of the dural sinuses.

Phlegmon of the temporal region. The inflammatory process in the temporal region occurs secondary. Patients' complaints about the usual pain for phlegmon and general pain associated with intoxication are intensifying. A swelling appears above the zygomatic arch, involving the temporal fossa. Collateral edema extends to the parietal and frontal regions. You can often observe swelling of the zygomatic region, the upper and less often the lower eyelid. With purulent processes developing under the temporal muscle or between the bundles of this muscle, the restriction of mouth opening increases, a dense, painful infiltrate is palpated, usually spreading from the lower or anterior parts of the temporal region upward. The skin over it is fused to the underlying tissues, does not form a fold, but is not always changed in color. An area of significant pain is identified, fluctuation occurs later. Superficial melting of tissue is characterized by increased swelling of neighboring areas, cohesion and bright red coloration of the skin, and the appearance of fluctuations.

For abscesses and phlegmon of the temporal region, surgical interventions are first performed to ensure the free outflow of pus from the lesions in the cellular spaces of the head and neck. Phlegmon of the temporal region with a focus of inflammation in the subgaleal space is opened from the skin of the temporal region with a radial incision parallel to the branches of the superficial temporal artery and vein, ligating them. If necessary, a vertical incision can be made [Fedyaev I.M., 1990]. The temporal aponeurosis is dissected and bluntly penetrated into the space. Sometimes several fan-shaped incisions are made, placing them parallel to the course of the arterial trunks. If there is a deep accumulation of exudate in the interaponeurotic space, a wide arcuate incision is made along the edge of the temporal muscle, the aponeurosis and the edge of the temporal muscle are dissected and bluntly penetrated under the temporal muscle. This surgical approach can be combined with an incision above the zygomatic arch.

Phlegmon of the temporal region, especially when the tissue deep under the muscle is affected, can be complicated by secondary cortical osteomyelitis of the squamous part of the temporal bone, as well as penetration of infection into the meninges and brain (meningitis, meningoencephalitis, brain abscess), which makes the prognosis for such complications life-threatening sick.

Abscess and phlegmon of the zygomatic region (zygomatic space). These processes develop secondarily with the spread of purulent exudate from neighboring areas of the face - infraorbital and buccal.

The boundaries of the zygomatic region correspond to the location of the zygomatic bone: upper - the anterior-inferior section of the temporal region and the lower edge of the orbit, lower - the anterosuperior section of the buccal region, anterior - the zygomatic-maxillary suture, posterior - the zygomatic-temporal suture. Between the zygomatic bone and the superficial layer of the temporal fascia there is a cellular space of the zygomatic region. It continues the interaponeurotic cellular space of the temporal region. More often phlegmons are observed here, less often - abscesses.

Patients with an abscess complain of moderate pain in the affected area. The limited inflammatory infiltrate that appears in the zygomatic region softens quite quickly. The skin over it fuses with the underlying tissues and acquires a bright red color.

Patients with phlegmon are bothered by spontaneous pain in the zygomatic region, radiating to the infraorbital and temporal region. They increase the pain associated with primary purulent foci in neighboring areas. Inflammatory swelling is pronounced, spreading to the infraorbital, temporal, buccal and parotid-masticatory areas. Upon palpation, a dense infiltrate of varying length is determined according to the location of the zygomatic bone. Mouth opening is somewhat limited as a result of the involvement of the upper section of the masticatory muscle in the inflammatory process. Often, when opening the mouth, the pain intensifies. In the vestibule of the mouth, along the upper fornix at the level of the large molars, a swollen and hyperemic mucous membrane is found. Gradually, the infiltrate softens, thinning of the soft tissue occurs, purulent exudate comes out under the skin or can spread to the outer canthus, where spontaneous opening of the purulent focus occurs.

Surgical intervention for abscesses and phlegmon of the zygomatic region is performed at the site of the most pronounced fluctuation, making a skin incision parallel to the course of the branches of the facial nerve. A purulent process from the zygomatic area can spread to the parotid-masticatory area. With prolonged course of abscesses and phlegmon, secondary cortical osteomyelitis develops.

Abscess and phlegmon of the orbit. A purulent inflammatory process develops in the tissue of the orbit with the spread of odontogenic purulent diseases from areas adjacent to the upper or, less commonly, lower jaw. With phlegmon of the infraorbital region and infratemporal, pterygopalatine fossa, less often with acute osteomyelitis of the upper jaw, acute inflammation of the maxillary sinus, a transition of the purulent process to the orbit is observed. The inflammatory process in the orbit can also occur as a result of purulent thrombophlebitis, spreading from the infraorbital region along the angular vein, from areas adjacent to the lower jaw, through the pterygoid venous plexus and ophthalmic veins.

The boundaries of the orbit correspond to its walls. Fiber is evenly distributed around the circumference of the eyeball. The orbital septum, in the form of a dense fascia, divides the orbital area into a superficial section, or the eyelid area, and a deep section, the actual area of the orbit. The latter contains the eyeball, optic nerve, and orbital artery. In the distal part of the orbit there is the largest accumulation of fiber, communicating through the lower orbital fissure with the pterygopalatine and infratemporal fossa tissue, through the maxillary - with the middle cranial fossa, through the upper wall of the orbit - with the anterior cranial fossa and frontal air sinus, through the lower - with the sphenoid sinus and cells of the ethmoid labyrinth.

An abscess in the orbit is accompanied by increased pulsating pain in the area of the eyeball, headache and complaints associated with visual impairment. Inflammatory swelling appears in the eyelid area. Skin color may not change; sometimes the skin of the eyelids is bluish due to congestion. Palpation of the eyelids is painless, they are not infiltrated and soft. The mucous membrane of the conjunctiva is hyperemic, edematous, and often bluish in color. Pressure on the eyeball is painful, exophthalmos, blurred vision (appearance of “spots”, double vision) are noted.

Complaints with phlegmon of the orbit are intense. There are pulsating pains in the orbital area with irradiation to the temple, forehead, infraorbital region, and a sharp headache. The mobility of the eyeball is limited, often in one direction. Inflammatory phenomena increase, infiltration of the eyelids intensifies, the conjunctiva swells and bulges between half-closed eyelids (chemosis), diplopia appears, and vision loss further progresses. When examining the fundus, dilation of the retinal venules and severe visual impairment are revealed.

The development of thrombosis of the cavernous sinus of the dura mater is characterized by an increase in collateral edema of the eyelids, the development of these phenomena in the area of the eyelids of the other orbit, a deterioration in the general condition and an increase in signs of intoxication.

In case of inflammatory diseases in the orbital area, surgical intervention is performed immediately. The purulent focus in the upper part of the orbit is opened with a 2 cm long incision of the skin and subcutaneous fat in the upper outer or upper inner edge of the orbit. They pass bluntly along the bone wall until exudate accumulates. When the purulent process is localized in the lower part of the orbit, the skin and subcutaneous fatty tissue are similarly dissected along the lower outer or

the lower inner edge of the orbit, retreating downward from it by 0.7 cm. After dissecting the orbital septum, the tissue is bluntly separated along the lower wall of the orbit and the abscess is emptied.

A surgical approach is possible through the maxillary sinus by trephination of the lower wall of the orbit. This approach makes it possible to penetrate the lower, lateral and distal parts of the orbit and is advisable for primary lesions of the maxillary sinus. In case of diffuse damage to the orbit, the abscess is opened with surgical access at the upper and lower walls of the orbit, and sometimes two external incisions are also made through the maxillary sinus, creating the best outflow of exudate (Fig. 9.1, b). Some authors recommend exenteration of the orbit (removal of contents) in cases of complications with panophthalmitis. This allows for a good outflow of purulent exudate and prevents the development of purulent meningitis.

Phlegmon of the orbit can be complicated by further spread of infection into the meninges, sinuses of the dura mater, and brain. Frequent complications are optic nerve atrophy and blindness.
Abscesses and phlegmons of tissues adjacent to the lower jaw
Abscess and phlegmon of the submandibular region (submandibular space). Odontogenic inflammatory processes in the submandibular region occur more often than in other parts of the maxillofacial region. They develop as a result of inflammatory processes spreading from the lower small and large molars, less often - from the pterygomandibular space, the sublingual region, including the maxillary lingual groove, and the submental triangle. Possible lymphogenous spread of infection and damage to the lymph nodes of the submandibular triangle with subsequent involvement of fiber in the inflammatory process.

Boundaries of the submandibular region (submandibular triangle, submandibular space): superior internal - mylohyoid muscle, leaf of the fascia of the neck, posteroinferior - posterior belly of the digastric muscle and superficial layer of the fascia of the neck, external - internal surface of the body of the lower jaw, anteroinferior - anterior belly of the digastric muscle , superficial layer of the cervical fascia.

The submandibular salivary gland, lymph nodes, the facial artery and vein, the marginal and cervical branches of the facial nerve, the hypoglossal nerve, the lingual vein and nerve are localized in the submandibular triangle. It contains a significant amount of loose fiber; in the anterior section it is much greater than in the posterior section [Gusev E.P., 1969]. Fiber is located in three successive layers: between the skin and the subcutaneous muscle of the neck, between this muscle and the layer of the superficial fascia of the neck and above the superficial layer of the fascia proper of the neck; Even deeper is the submandibular cellular space itself, in which the salivary gland is localized. Its size varies depending on the shape of the lower jaw. If the lower jaw is high and wide, then the transverse size of the gland is maximum, and the longitudinal size is minimum. On the contrary, with a narrow and long lower jaw, the gland has the greatest length and the smallest width. Accordingly, the adjacent fiber is located. At the bottom of the trigon there are three sagittal slits: median, medial and lateral, which allows communication with the sublingual, parapharyngeal spaces and facial tissue [Smirnov V.G., 1990]. In the distal part of the region, on the surface of the hyoglossus muscle, there is a Pirogov triangle. Accordingly, the purulent process can develop superficially in the subcutaneous fatty tissue, the middle space under the subcutaneous muscle of the neck and deep tissues - the submandibular tissue space itself.

For the spread of infection from the teeth to the soft tissues adjacent to the lower jaw, communications between the submandibular triangle and other cellular spaces are important. Thus, behind the posterior edge of the mylohyoid muscle there is the submandibular duct. Through the tissue surrounding it, the infection penetrates into the sublingual area. In this way, inflammatory processes from the sublingual region spread to the submandibular triangle. The posterior sections of the region communicate with the pterygomandibular and anterior sections of the peripharyngeal space. The subcutaneous fatty tissue of the submandibular region is intimately connected with the tissue of the submental triangle.

There are abscesses of the anterior and posterior sections of the submandibular region, phlegmon of this area [Vasiliev G.A., Robustova T.G., 1981]. With an abscess, patients complain of spontaneous aching pain.

An external examination reveals a limited infiltrate in the anterior or posterior part of the submandibular triangle, anterior or posterior to the submandibular salivary gland. On palpation, the infiltrate is dense, the skin over it is fused with the underlying tissues, changed in color (from bright pink to red), and thinned. In its center, an area of fluctuation can be noted, especially when tissue is damaged in the anterior part of the submandibular triangle. Mouth opening is free. There are no changes in the oral cavity.

Phlegmon of the submandibular triangle is accompanied by more intense pain. A diffuse swelling is characteristic, which within 2-3 days from the onset of the disease spreads to the tissues of the submandibular triangle and the adjacent submental and retromandibular areas. The skin over the swelling is infiltrated, does not fold, and sometimes turns red. A dense painful infiltrate is palpated in the center. Swelling is noted in the buccal and parotid-masticatory areas. Mouth opening is often not limited. If the process spreads to the submandibular triangle from the maxillary-lingual groove, mouth opening may be limited due to infiltration of the internal pterygoid muscle at its attachment at the internal angle of the lower jaw (inflammatory contracture of the first degree). In cases of deep location of the abscess and its spread into the sublingual region and the pterygomandibular space, the lowering of the lower jaw is significantly limited and pain occurs when swallowing.

In the oral cavity itself, with phlegmon of the submandibular triangle, one can find on the affected side a slight swelling and hyperemia of the mucous membrane of the sublingual fold on the corresponding side.

Surgical intervention consists of making an incision from the side of the skin in the submandibular triangle, below the edge of the lower jaw 2 cm downwards in order to avoid injury to the marginal branch of the facial nerve and parallel to it. In case of an abscess, a 1.5-2 cm long incision is made at the site of the greatest fluctuation, spreading the tissue apart with a peen. In case of phlegmon, the incision should be 5-7 cm long. In case of phlegmon, the skin, subcutaneous tissue, subcutaneous muscle of the neck, superficial and proper fascia of the neck are cut layer by layer, be sure to insert a finger deep into the surgical wound [Vasiliev G.A., 1972] and, carefully moving submandibular salivary gland, penetrate into all parts of the affected area, especially behind and above the gland. By exfoliating the tissue, the facial artery and vein are discovered and ligated. Evacuation of pus, necrotomy and antiseptic and antibacterial treatment of the wound, as well as its drainage, are performed.

Phlegmon of the submandibular triangle can be complicated by the spread of infection into the pterygomandibular and peripharyngeal spaces, sublingual region, submental triangle and other areas of the neck, including the neurovascular sheath. Especially dangerous are the involvement of the deep parts of the neck and the downward spread of infection into the anterior mediastinum, which can pose a threat to the patient’s life.

Cellulitis of the maxillofacial region is a diffuse purulent melting of the subcutaneous layer of tissue due to inflammation of the jaw.

Most often, phlegmon of the maxillofacial area is odontogenic (96%). Sometimes it can occur as a result of complications of osteomyelitis, stomatitis, sialolithiasis, or abscess of the floor of the mouth.

Based on localization, the following types of facial phlegmon are distinguished: perimandibular, floor of the mouth, tongue, peripharyngeal.

Symptoms of phlegmon of the maxillofacial area

The occurrence of phlegmon in the maxillofacial area is preceded by pain in the damaged tooth (96-98%). With rapid development, an increasing infiltrate occurs, redness of the skin over the swelling in the maxillofacial area, accompanied by intense pain of a pulsating nature, fever of 39-40 ° C. There is paleness of the facial skin, headache, chills, malaise, lack of appetite, sleep disturbance.

With the development of the inflammatory process, a sharp asymmetry of the face appears, the skin above the infiltrate is shiny, hyperemic, and does not fold. Palpation in the area of inflammation is sharply painful.

With phlegmon of the floor of the mouth, tongue and peripharynx, the main symptoms are increasing difficulty in breathing, speech, and eating.

Cellulitis of the maxillofacial area quickly spreads to neighboring organs and can cause life-threatening complications: asphyxia, impaired cardiac activity and consciousness, thrombosis of the neck and other veins, brain abscess, mediastinitis, sepsis.

Diagnostics

Complete blood count (leukocytosis, shift of the leukocyte formula to the left, decreased eosinophils, increased erythrocyte sedimentation rate).
General urine analysis (protein determination, increased content of cylinders, red blood cells).
X-ray of the jaw.

Differential diagnosis:

Osteomyelitis of the jaw.
Inflammatory diseases of the ENT organs.

Treatment of phlegmon of the maxillofacial area

Treatment is prescribed only after confirmation of the diagnosis by a medical specialist. Under general anesthesia, the phlegmons are opened with wide incisions, conditions for drainage are created, and bandages with antiseptic and hypertonic solutions are applied. Antibiotic therapy, antipyretics, analgesics, detoxification, and a special diet are indicated.

Essential drugs

There are contraindications. Specialist consultation is required.

(third generation cephalosporin antibiotic). Dosage regimen: for adults and children over 12 years of age, the dose is 1-2 g 1 time / day. or 0.5-1 g every 12 hours. The maximum daily dose is 4 g. The drug is administered intramuscularly and intravenously (stream or drip). The duration of treatment is determined individually.
(antibacterial agent). Dosage regimen: intravenous infusion, lasting at least 60 minutes, at a dose of 0.5 g every 6 hours or 1 g every 12 hours.
(antiprotozoal, antibacterial agent). Dosage regimen: intravenous administration is indicated for adults at a dose of 30 mg/kg per day for 2-4 administrations; children at a dose of 10 mg/kg 3 times a day. The duration of treatment is determined individually.
(detoxification, anti-shock, anti-aggregation agent). Dosage regimen: administered intravenously in a single dose of 500 to 1200 ml (in children 5-10 ml/kg) for 60-90 minutes. In the following days, the drug is administered dropwise, for adults - at a daily dose of 500 ml, for children at a rate of 5-10 ml/kg.