Phlegmon of the submandibular region is an accumulation of purulent substances that affect fatty tissue in an appropriate place. Pathology pretty quickly progresses and spreads to bone, muscle tissue, as well as tendons. The affected areas are hot, reddened, causing pain when pressed.
It differs from a simple abscess of the phlegmon of the submandibular region in a specific blurred border and affecting adjacent tissues.
Varieties of pathology
Considering how and for what reasons the disease developed, it is primary and secondary. The first variant of the disease is an independent pathology, which appears due to the ingestion of pathogenic microorganisms into the body. Bacteria are activated against a background of a weakened immune system. The secondary form of the disease manifests itself as a result of the spread of pus through the soft tissues of the internal systems due to an abscess, a bursting boil, and other accumulations.
In addition, phlegmon of the submandibular region is acute and chronic. The first form of the disease is characterized by a sharp deterioration in the well-being of the patient, an increase in body temperature up to 40 degrees. Chronic pathology has a sluggish character without obvious changes. In this case, the surface of the inflamed area noticeably turns blue and hardens.
The phlegmon code of the submandibular region according to ICD-10 (international classification of diseases) is K12.2. Pathology is also deep and superficial. The first form is characterized by inflammation of nearby tissues under the layers of the epithelium. With a superficial disease, the soft organs located under the muscles are affected.
By the way, this pathology can develop not only in the jaw, but also in any other part of the body.
Kinds
Specialists distinguish several types of phlegmon of the submandibular region:
- Serous. This is the initial stage of the disease. In injured places, exudate accumulates, while adipose tissue is infiltrated. Fiber in its structure resembles jellied meat. The boundary between healthy and diseased tissues is not distinct.
- Purulent. This stage is characterized by histolysis - the process of tissue fusion with the formation of pus in the future. In this case, the exudate becomes whitish, yellow or greenish, cloudy. Fistulas and sores appear. In the case of the spread of the inflammatory process, the pathology encompasses muscle and bone tissue, which is subsequently also injured.
- Putrefactive. This form is accompanied by the production of fetid gases. Tissues become loose, looking like a dark semi-liquid mass. Putrefactive phlegmon is necessarily accompanied by severe intoxication.
- Necrotic. With this form, necrotic foci occur, which subsequently melt and reject. As a result, wounds appear instead of them. In the case of a favorable course of pathology, the inflamed area is separated and exposed to an abscess, which is easily opened.
- Anaerobic. This is a serous disease with widespread necrotic foci. This form is characterized by the formation of gas bubbles. Injured tissues turn gray, get a terrible smell. When pressing on the injured area, you can hear a crunch that occurs due to gases.
All stages of the phlegmon of the submandibular region (the code according to ICD-10 is indicated above) have an acute course and often acquire a malignant character.
Pathogen
The direct prerequisite for the development of pathology are pathogenic microorganisms. Seeping through the wound, they penetrate the lymph and blood, and then spread throughout the body. As a rule, the pathogens of phlegmon of the submaxillary region become Staphylococcus aureus and Streptococcus aureus. However, the reasons may lie in the activity of other bacteria:
- Pseudomonas aeruginosa;
- clostridia;
- protea;
- peptococcus;
- Escherichia coli;
- pneumococcus;
- paratyphoid or diphtheria bacillus.
Typically, microorganisms enter the fiber through open wounds.
In some cases, bacteria enter the adipose tissue through biological fluids from an infectious source already in the body. A pathogenic focus can occur against a background of tonsillitis, furunculosis, as well as other diseases of the oral, nasal cavity, and larynx.
The spread of infection to nearby tissues is likely due to a breakthrough of purulent inflammation. Sometimes phlegmon of the submandibular region develops after various chemical compounds, for example, kerosene or turpentine, enter the subcutaneous tissue.
Etiology
The progression of the inflammatory phenomenon usually begins with periadenitis or adenitis, much less often as a consequence of the transition of infection from the nearest tissues or osteomyelitis of the lower jaw. As a rule, submandibular phlegmon is a consequence of odontogenic infections of the anterior teeth.
In other words, various complications of dental ailments are quite capable of leading to the development of this disease. It is the odontogenic phlegmon of the submandibular region that is considered the most common type of disease with a specific location.
Causes of pathology
Most often, its appearance is associated with difficulty in teething wisdom or is a consequence of the complicated course of periostitis, lymphadenitis and osteomyelitis. However, this list of causes of phlegmon of the submandibular region is not limited to. There are a number of additional factors.
The risk of phlegmon disease is significantly increased if a person suffers from such diseases:
- tuberculosis:
- diabetes;
- immunodeficiency;
- blood problems, such as thrombocytopenia or anemia;
- dependence on alcohol or drugs.
Signs of an inflammatory process
Symptoms of phlegmon of the submandibular region:
- increase in body temperature to 39-40 degrees;
- nausea and vomiting;
- noticeable lethargy, reduced performance;
- migraine;
- heart rhythm disturbances;
- intense thirst;
- intoxication;
- a decrease in the amount of urine when the bladder is empty.
Clinical picture
The submandibular triangle loses its features, a painful swelling occurs. The pathological site noticeably reddens and swells. Lymph nodes located near the affected area increase significantly. In the case of unilateral pathology, this usually applies only to one side. For example, in a patient with odontogenic phlegmon of the submandibular region on the left, as a rule, the lymph node only increases on this side. The injured area tactilely seems hot, the epithelium glistens on it. Pain syndrome manifests itself during movement.
As the pathological condition progresses, hyperemia occurs, the tension constantly increases, the skin ceases to fold. Palpation becomes more painful every time. Collateral edema is manifested. It is painful for the patient to open his mouth, while the jaw can be reduced in different ways. In some cases, swallowing is also accompanied by pain. A terrible smell is heard from the oral cavity, excessive saliva production is observed. The face may be skewed, the tissues become swollen in the neck and chin. The general well-being of the patient is determined by the virulence of the infection.
Diagnosis of phlegmon of the submandibular region
Superficial pathology is detected with ease. A qualified specialist will easily recognize this disease during a visual examination. But the deep forms of phlegmon of the submandibular region require additional research:
- radiography;
- puncture of the injured area;
- ultrasound examination;
- magnetic resonance or computed tomography.
Probable complications
Progressing and spreading throughout the body, pathogenic bacteria can cause other diseases:
- funny faces;
- purulent meningitis;
- thrombophlebitis;
- blood poisoning;
- lymphadenitis.
If the pathological process covers nearby tissues, the lungs, joints are injured, ostomyelitis appears.
The most dangerous consequence of the disease is purulent arteritis. With this disease, the walls of the vessels are affected, resulting in extensive bleeding.
Treatment of phlegmon of the submandibular region
This disease threatens an infected person with a fatal outcome, therefore, therapy is carried out exclusively in stationary conditions. In the initial stages of the pathology, the patient can do without surgical intervention. A patient with a confirmed diagnosis of “phlegmon of the submandibular region” is prescribed:
- UHF;
- warming manipulations using infrared radiation, compresses and heating pads;
- special compresses with mercury ointment, but together with UHF this method cannot be used.
Surgical intervention
If an infiltrate has already formed on the inflamed area, then surgery is necessary, especially at the purulent stage of the pathology. Intervention is performed under general anesthesia. The doctor makes a large incision covering the deep and superficial layers of the epithelium.
After removing pus, the remaining wound is treated with water and disinfectants. Drainage is carried out by means of tubes, rubber graduates and semi-tubes. After surgery, patients feel much better.
After the manipulations, a compress with Levomekol ointment and a hypertonic solution is applied to the wound.
Rehabilitation period
Patients should keep in mind that in any case it is impossible to use dressings with the addition of tetracycline ointment or liniment according to Vishnevsky immediately after the operation. After all, these drugs interfere with the necessary outflow of pus. To accelerate the process of rejection of damaged cells, you can use necrolytic drugs such as "Terrilitin" or "Trypsin".
After removing the contents of the inflamed area, medical dressings from gauze are applied.
For faster healing, you can take Troxevasin ointment or methyluracil. To improve local immunity, oily ointments are great: streptocid, synthomycin, neomycin. To prevent re-infection, you can use water-based medicines: deoxidine ointment or Levosin.
Some recommendations
To alleviate the general condition of the patient, other therapeutic procedures can be used:
- To speed up the process of tissue scarring, sea buckthorn or rosehip oil is used, as well as Troxevasin.
- In the case when the wounds are too deep or do not heal for a long time, dermoplasty is performed.
- In acute phlegmon, the patient must be prescribed antibiotics, the most effective of which in this situation are Erythromycin, Gentamicin, and Cefuroxime. The patient should take these medicines until the inflammation has completely disappeared.
- At the anaerobic stage, the patient is given antigangrenous serum.
- A solution of calcium chloride is used to neutralize toxins and stabilize the acid-base balance of the blood. This substance is also used to tone vessels.
- To enhance the functioning of the heart muscles, a glucose solution is injected intravenously.
- To maintain the immune system, the patient is prescribed vitamin complexes like Alphabet and Vitrum.
Prevention
To prevent the development of such an unpleasant ailment as phlegmon of the submandibular region, it is necessary:
- Treat all open wounds with antiseptics.
- In the event of the first signs of pathology, you should immediately contact a dermatologist.
- Twice during the year it is necessary to visit the dentist.
- Avoid contact of the skin with household chemicals and penetration of aggressive chemicals into its deeper layers.