Phlegmon peremaxel

Phlegmon maxillary - purulent diffuse inflammation of the subcutaneous, submucosal and interfascial cellular tissues of the maxillofacial region.

Etiology: streptococci, staphylococcus, dental spirochete, anaerobes. Pathogenesis is associated with the state of the lymph drainage and venous bed of tissues, ingress into the deep layers of the soft tissues of the infection and the state of allergic and nonspecific reactivity of the organism. The development of phlegmon is often preceded by osteomyelitis of the jaw, acute peri-vertebral diseases, lymphadenitis, etc.

Symptoms. Sharp tenderness when chewing, impaired mobility of the jaw (trism), breathing, speech, difficulty swallowing, drooling, facial asymmetry. Spilled, dense, painful at palpation swelling of the face on the side of the lesion, the skin shiny, does not fit into the fold. Expressed the phenomenon of intoxication, weakness, sweating, chills, increased pulse and respiration. In the blood shift left, neutrophilic leukocytosis, ESR increased dramatically. Body temperature is 39-40 g. C. The course can be complicated by asphyxia, thrombosis of the veins of the face, meningitis, mediastinitis, sepsis, etc.

Surgical treatment: wide incisions and dissection of a deep focus in a blunt way. Anesthesia is general or injectable, novocaine in combination with the administration of 1 ml of a 1% solution of morphine, omepon or promedol. The purulent focus is drained by rubber or gauze strips. Enter large doses of broad-spectrum antibiotics, sulfonamides, haemodes, I / O glucose solution, anti-streptococcal serum, gamma globulin, polyglucin, Ringer's solution. In putrefactive process - antigangrenous polyvalent serum (introduced by Besedka); With phlegmon neck, bottom of the oral cavity, okologlotochnoy - sometimes tracheotomy. Conservative treatment (antibiotics, dry heat, UHF therapy) is prescribed in the initial stages of the process with a relatively satisfactory overall condition.

The prognosis for radical autopsy and intensive antibiotic therapy is usually favorable, with putrefactive phlegmon and delayed treatment is questionable.

Prophylaxis is the same as with an abscess with a maxillipedial.