Jaw abscess. Abscess of the chin area. Treatment and clinical picture. Abscesses and phlegmons of the buccal area
![Jaw abscess. Abscess of the chin area. Treatment and clinical picture. Abscesses and phlegmons of the buccal area](https://i1.wp.com/krasotaimedicina.ru/upload/iblock/895/895b7312679f6b2bce1a2ced14ae1db2.jpeg)
Most patients go to the dentist because of toothache or any other dental problems, but they are not the only ones who can be treated in dentistry. The fact is that the maxillofacial area can present many unpleasant surprises associated with diseases of the neck, mucous membranes and soft tissues of the oral cavity. You may encounter an inflammatory process that will be difficult to associate with your teeth, but they may be the likely cause of the disease. Thus, knowing the signs of inflammatory processes in advance, you will be able to react to the situation in time and not bring the disease to a chronic form by contacting a specialist for treatment.
Causes
The most likely cause of a jaw abscess is mechanical damage, injury or periodontal pockets(cracks between the tooth and gum that can become infected). An abscess can be caused by any infection that enters the damaged area, either from the outside or through the body’s bloodstream. If a patient has chronic tonsillitis, the cause of inflammation may be streptococci and staphylococci, which constantly multiply in the hypertrophied palatine tonsils. In this case, the patient is recommended not only to treat the abscess itself and damaged soft tissues of the oral cavity, but also to remove the tonsils, if their treatment is not possible. Otherwise, infection may recur many times.
Symptoms and signs
To determine the presence of an inflammatory process, it is enough to know a number of general signs inherent in this disease:
- constant severe headaches, general malaise, chills;
- in some cases, an increase in body temperature, in particular hyperemia of the inflamed area;
- leukocytosis;
- the presence of fluctuation (accumulation of pus) under the mucosa in the form of a small reddened swelling.
If the above symptoms are present, the patient is advised to immediately consult a doctor for prompt treatment, otherwise the inflammation may intensify, spread to neighboring areas, develop into more serious diseases, or cause respiratory complications.
Kinds
Based on the presence of the upper and lower parts of the jaw in a person, these inflammatory processes can be divided into two types: abscess of the lower jaw (the same type can also include a submandibular abscess, since their sources of origin are the same) and the upper jaw.
Abscess of the upper jaw
The most common source of infection is the upper wisdom teeth. Causes difficulty opening the mouth and swallowing.
Abscess of the lower jaw
Most often, the infection spreads from the lower molars (molars and premolars). The patient's complaints are mostly related to pain when chewing and swallowing.
An abscess of the submandibular region is characterized by visually noticeable and painful swelling in the submandibular triangle, and the shape of the face may be distorted.
Treatment and prevention
Treatment for a jaw abscess involves opening an abscess And drainage of fluid, after which the damaged area is disinfected. In case of high temperature, the patient is prescribed antibiotics; in case of a general weakening of the immune status, immunomodulatory drugs are prescribed; the doctor also gives recommendations for taking analgesics. In rare cases, for better healing of the postoperative incision, physiotherapeutic procedures and ultraviolet radiation are prescribed.
To prevent inflammation of this kind, it is advisable to visit the dentist once every six months, heal periodontal pockets in a timely manner, adhere to a gentle diet enriched with vitamins, and also use appropriate medicated toothpastes.
Some adherents of alternative medicine believe that the above inflammations of the maxillofacial area can be easily cured without resorting to surgery. Of course, there is a possibility that the abscess will open on its own, but if it is not cleaned and the remnants of dead particles and pathogenic bacteria are not removed from the wound, there is a high probability of an acute condition becoming chronic or phlegmon, as well as intoxication of the body with decay products remaining in the untreated abscess .
Formation of an inflammatory purulent focus in the tissues of the maxillofacial area of the face. It manifests itself as local swelling, redness and fluctuation (fluctuation) of the skin over the source of inflammation, facial asymmetry, difficulty and pain in swallowing, and symptoms of intoxication. It can develop into diffuse inflammation - phlegmon, involving the peripharyngeal and infraorbital region, neck. Treatment is always surgical - opening and draining the abscess cavity.
General information
- this is a limited focus of purulent inflammation of the tissues of the maxillofacial area. If abscesses are left untreated, purulent decay and purulent melting of adjacent tissues begin.
Causes of perimaxillary abscess
The abscess is caused by streptococcal and staphylococcal microflora; the most common cause is dental disease and inflammatory processes in the maxillofacial area. Furunculosis, tonsillitis, and tonsillitis in chronic cases are complicated by perimandibular abscesses. Damage to the skin and mucous membranes in the mouth, infection during dental procedures can provoke an abscess in the perimaxillary area.
Common infectious diseases of the sepsis type, as a result of the spread of microorganisms by blood and lymph, cause multiple abscesses in various organs and tissues, including abscesses of the perimaxillary area. An abscess in the maxillary area can occur due to facial trauma. During military operations and natural disasters, due to the lack of first aid, dislocations and fractures of the jaw are often complicated by abscesses. Periapical and pericoronal foci of inflammation and periodontal pockets during exacerbations can provoke a jaw abscess due to bone resorption.
Symptoms of perimandibular abscess
The formation of an abscess is preceded by toothache, as in periodontitis. Biting on the affected area increases the pain. Next comes dense swelling with the formation of a painful compaction. An abscess developing under the mucous membrane is characterized by bright hyperemia and protrusion of the affected area. Facial asymmetry is sometimes noted.
In the absence of therapy, the patient’s general condition worsens: body temperature rises, refusal of food is observed. After spontaneous opening of the abscess, the pain subsides, the contours of the face take on normal shape, and general health stabilizes. But due to favorable conditions for microorganisms in the oral cavity, the process becomes chronic, so its spontaneous opening does not indicate a cure. With short-term weakening of the immune system, perimaxillary abscesses worsen. Chronic suppuration from the fistulous tracts is possible; it is accompanied by an unpleasant odor from the mouth and ingestion of purulent masses. The body becomes sensitized by decay products, and allergic diseases worsen.
Abscesses of the floor of the mouth are characterized by hyperemia in the sublingual zone with rapid formation of infiltrate. Conversation and eating become sharply painful, and hypersalivation is noted. The mobility of the tongue decreases, it rises slightly upward so as not to come into contact with the forming abscess. As the swelling increases, the general condition worsens. Upon spontaneous opening, the pus spreads to the peripharyngeal region and neck, which leads to the appearance of secondary purulent foci.
Palate abscess most often occurs as a complication of periodontitis of the upper second incisor, canine and second premolar. During the formation of an abscess, hyperemia and soreness of the hard palate are observed; after the bulging, the pain becomes more intense, eating becomes difficult. Upon spontaneous opening, the purulent contents spread to the entire area of the hard palate with the development of osteomyelitis of the palatine plate.
If a cheek abscess occurs, then depending on the location and depth, swelling and redness may be more pronounced on the outside or on the oral mucosa. The soreness of the lesion is moderate; when the facial muscles work, the pain intensifies. The general condition is practically not affected, but an abscess of the cheek is dangerous if it spreads to neighboring parts of the face even before opening the abscess.
A tongue abscess begins with pain in the thickness of the tongue, the tongue increases in volume and becomes inactive. Speech, chewing and swallowing food are severely difficult and painful. Sometimes with an abscess there may be a feeling of suffocation.
Diagnosis and treatment of perimandibular abscess
The diagnosis is made based on a visual examination of the dentist and patient complaints. Sometimes during the survey it turns out that there have been boils in the facial area, or there are chronic infectious diseases. Before visiting a doctor, it is recommended to take analgesics and rinse the mouth with antiseptic solutions; self-administration of antibiotics is unacceptable. The ultimate goal of treatment is the complete elimination of the infectious process and restoration of impaired functions in the shortest possible time.
The treatment regimen depends on the stage of the disease, on the virulence of the microorganism and on the characteristics of the response from the macroorganism. The localization of abscesses in the perimaxillary area, the age of the patient and the presence of concomitant diseases significantly influence the principles of treatment. The more complicating factors, the more intense the therapy should be.
During the treatment of abscesses of the perimaxillary area, it is recommended to follow a diet with a predominance of pureed soups and purees. If there is a persistent refusal to eat, they resort to intravenous administration of protein solutions. If there is a formed abscess, its opening followed by drainage of the cavity is indicated. In other cases, antibiotic therapy is resorted to, and only if it is inappropriate, the question of surgical treatment is raised.
Antibiotics are prescribed by injection or in tablet forms, and an additional course of vitamin therapy is given. Immunostimulants and detoxification therapy are indicated. Rinsing the mouth with warm solutions of furatsilin and soda relieves swelling and prevents the spread of infection. In the presence of pronounced pain, analgesics are used. When complex therapy is started on time, the prognosis is usually favorable, recovery occurs within 6-14 days.
Topographic anatomy
(Fig. 75): upper internal - mylohyoid muscle (m. mylohyoideus), external - internal surface of the body of the lower jaw, anteroinferior - anterior belly of the digastric muscle (venter anterior m. digastrici), posterior inferior - posterior belly of the digastric muscle (venter posterior m . digastrici).
Layer structure(Fig. 76). The skin is mobile, in men it has hair. The subcutaneous tissue is loose and well defined. It may contain the marginal branch of the facial nerve (ramus marginalis mandibulae nervi facialis), innervating the muscles of the lower lip and chin, since in 25% of cases it forms a loop that descends below the edge of the body of the jaw by 4-8 mm (F. Henru, 1951; V. G. Smirnov, 1970).
Deeper is the subcutaneous muscle of the neck (m. platysma), covered outside and inside with layers of the superficial fascia of the neck (fascia colli superficialis). Between it and the superficial layer of the neck's own fascia (lamina superficialis fasciae colli propriae) there is a thin layer of fiber in which the vessels are located: the facial vein (v. facialis), the external jugular vein (v. jugularis externa), and in the upper section at the level of the anterior edges of the masticatory muscle (m. masseter) - facial artery (a. facialis). The submandibular cellular space itself (spatium submandibularis) is located even deeper. It is bounded above by a deep layer of the neck's own fascia (lamina profunda fasciae colli propriae), covering the mylohyoid (m. mylohyoideus) and hyoglossus (m. hyoglossus) muscles. From below, the space is closed by the superficial layer of the neck's own fascia (lamina superficialis fasciae colli propriae). Between the named sheets of fascia a closed capsule (saccus hyomandibularis) is formed, in which the submandibular salivary gland (gl. submandibularis) is located. The duct of the gland goes into the gap between the mylohyoid and mylohyoid muscles. This gap is one of the ways to connect the submandibular space with the adjacent cellular spaces of the floor of the mouth. Around the gland, inside its fascial capsule, there are numerous submandibular lymph nodes (nodi lymphatici submandibulares). The facial artery (a. facialis) runs along the posterosuperior surface of the gland, bending over the edge of the lower jaw, approximately halfway between the chin and the angle of the jaw. The facial vein is located on the lower surface of the submandibular salivary gland. Under the gland on the surface of m. hyoglossus are located the hypoglossal nerve (n. hypoglossus), lingual vein (v. lingualis) and closer to the posterior corner of the submandibular triangle - the lingual nerve (n. lingualis). The lingual artery is located somewhat deeper, under the fibers of the hyoglossus muscle (m. hyoglossus), within the so-called Pirogov’s triangle. Thus, in the submandibular region, different localization of the purulent-inflammatory process is possible (Fig. 77).
Main sources and routes of infection
Foci of odontogenic infection in the area of lower premolars and molars, infected wounds of the submandibular region. Secondary damage as a result of the spread of infection along the sublingual, submental, parotid-masticatory areas, from the pterygo-maxillary space; and also by the lymphogenous route, since in the submandibular region there are lymph nodes, which are collectors for lymph flowing from the tissues of the entire maxillofacial zone.
Characteristic local signs of abscess, phlegmon of the submandibular space
Complaints for pain in the submandibular region, aggravated by swallowing and chewing.
Objectively. Asymmetry of the face due to swelling, infiltration of tissues of the submandibular region, the severity of which depends on the localization of the infectious and inflammatory process. When a purulent-inflammatory focus is localized in the subcutaneous tissue, the infiltrate is of significant size, the skin over it is hyperemic, and fluctuation can be detected. When the purulent-inflammatory focus is localized under the superficial fascia of the neck, swelling of the tissues of the submandibular region and hyperemia of the skin are expressed to a lesser extent, and with deep localization (under the fascia of the neck, in the tissue located between the submandibular salivary gland and the maxillary-hyoid, hyoid-lingual muscles ) may be practically absent. In such cases, it is necessary to carry out bimanual palpation, which makes it possible to clarify the localization of the inflammatory infiltrate and to exclude the spread of the purulent-inflammatory process to the sublingual area.
Ways of further spread of infection
In the sublingual, submental region, in the peripharyngeal space (from where further spread to the posterior mediastinum is possible!), in the retromandibular fossa, in the fascial sheath of the neurovascular bundle of the neck (from where further cervical spread to the anterior mediastinum is possible!), as well as to all of the above cellular spaces of the suprahyoid neck and deep zone of the lateral face of the opposite side (Fig. 78).
Method of operation for opening an abscess, phlegmon of the submandibular region
1. Anesthesia - anesthesia (intravenous, inhalation) or local infiltration anesthesia in combination with conduction anesthesia according to Bershe-Dubov, V.M. Uvarov, A.V. Vishnevsky against the background of premedication.
2. When opening abscesses, phlegmons of this localization (Fig. 79, A), an external approach is used with a skin incision in the submandibular region along the line connecting the center of the chin with a point located 2 cm below the apex of the angle of the mandible, which ensures the preservation of the marginal branch of the facial nerve even if it is located below the edge of the jaw (Fig. 79, B, C).
3. Detachment of the upper edge of the wound (skin along with subcutaneous fat) from the superficial fascia of the neck (fascia colli superficialis), covering the subcutaneous muscle of the neck (m. platysma), using Cooper scissors, a hemostatic clamp, a gauze swab until an edge appears in the wound lower jaw. In this case, together with the subcutaneous fatty tissue, the marginal branch of the facial nerve moves upward.
4. Dissection of the subcutaneous muscle of the neck (m. platysma) with the superficial fascia of the neck covering it for 8-10 mm (Fig. 79, D).
5. Detachment of the subcutaneous muscle from the underlying superficial layer of the neck’s own fascia (lamina superficialis fasciae colli propriae) using a hemostatic clamp inserted through an incision in this muscle. When the infectious-inflammatory process is localized between the superficial and intrinsic fascia of the neck, this achieves the opening of a purulent focus.
6. Intersection of the subcutaneous muscle of the neck over the separated branches of the hemostatic clamp along the entire length of the skin wound (Fig. 79, D). Hemostasis.
7. In case of abscess of the submandibular tissue space itself - dissection of the superficial layer of the neck’s own fascia (lamina superficialis fasciae colli propriae) for 1.5-2 cm, delamination using a hemostatic clamp of the tissue surrounding the submandibular salivary gland, opening of the purulent-inflammatory focus, evacuation pus (Fig. 79, I, K). Hemostasis. In case of phlegmon of the submandibular cellular space, especially putrefactive-necrotic, the superficial layer of the neck's own fascia is dissected along the entire length of the skin wound, the facial artery (a. facialis) and the facial vein (v. facials) are isolated, ligated and crossed in the interval between the submandibular salivary gland and edge of the lower jaw (Fig. 79, E, G, 3).
8. The submandibular salivary gland is retracted downward with a hook and the submandibular tissue space is inspected, stratifying the tissue surrounding the salivary gland using a hemostatic clamp. The purulent-inflammatory focus is opened and the pus is evacuated (Fig. 79, I, J).
9. Final hemostasis.
10. Insertion of tape drainages made of glove rubber and polyethylene film into the area of the opened purulent-inflammatory focus through the surgical wound (Fig. 79, L).
11. Application of an aseptic cotton-gauze bandage with a hypertonic solution and antiseptics.
Abscess of the maxillofacial area - occurs due to damage or inflammation of the skin of the face, mucous membrane of the oral cavity, lips, nose, eyelids. Less commonly, abscesses occur due to the spread of infection from an odontogenic focus. If abscesses are left untreated, purulent decay and purulent melting of adjacent tissues begin.
Etiology and pathogenesis. The abscess is caused by streptococcal and staphylococcal microflora; the most common cause is dental disease and inflammatory processes in the maxillofacial area. Furunculosis, tonsillitis, and tonsillitis in chronic cases are complicated by perimaxillary abscesses. Damage to the skin and mucous membranes in the mouth, infection during dental procedures can provoke an abscess in the perimaxillary area.
Common infectious diseases that occur as sepsis, as a result of the spread of microorganisms by blood and lymph, cause multiple abscesses in various organs and tissues, including abscesses of the perimaxillary area.
An abscess in the maxillofacial area can occur due to facial injuries. During military operations and natural disasters, due to the lack of first aid, dislocations and fractures of the jaw are often complicated by abscesses.
Periapical and pericoronal foci of inflammation and periodontal pockets during exacerbations can provoke a jaw abscess due to bone resorption.
Clinical picture. The formation of an abscess is preceded by toothache, as in periodontitis. Biting on the affected area increases the pain. Next comes dense swelling with the formation of a painful compaction. An abscess developing under the mucous membrane is characterized by bright hyperemia and protrusion of the affected area. Facial asymmetry is sometimes noted.
In the absence of therapy, the patient’s general condition worsens: body temperature rises, refusal of food is observed. After spontaneous opening of the abscess, the pain subsides, the contours of the face take on normal shape, and general health stabilizes. But due to favorable conditions for microorganisms in the oral cavity, the process becomes chronic, so its spontaneous opening does not indicate a cure. With short-term weakening of the immune system, perimaxillary abscesses worsen. Chronic suppuration from the fistulous tracts is possible; it is accompanied by an unpleasant odor from the mouth and ingestion of purulent masses. The body becomes sensitized by decay products, and allergic diseases worsen.
Abscesses of the floor of the mouth are characterized by hyperemia in the sublingual zone with rapid formation of infiltrate. Conversation and eating become sharply painful, and hypersalivation is noted. The mobility of the tongue decreases, it rises slightly upward so as not to come into contact with the forming abscess. As the swelling increases, the general condition worsens. Upon spontaneous opening, the pus spreads to the peripharyngeal region and neck, which leads to the appearance of secondary purulent foci.
Palate abscess most often occurs as a complication of periodontitis of the upper second incisor, canine and second premolar. During the formation of an abscess, hyperemia and soreness of the hard palate are observed; after the bulging, the pain becomes more intense, eating becomes difficult. Upon spontaneous opening, the purulent contents spread to the entire area of the hard palate with the development of osteomyelitis of the palatine plate.
If a cheek abscess occurs, then depending on the location and depth, swelling and redness may be more pronounced on the outside or on the oral mucosa. The soreness of the lesion is moderate; when the facial muscles work, the pain intensifies. The general condition is practically not affected, but an abscess of the cheek is dangerous if it spreads to neighboring parts of the face even before opening the abscess.
A tongue abscess begins with pain in the thickness of the tongue, the tongue increases in volume and becomes inactive. Speech, chewing and swallowing food are severely difficult and painful. Sometimes with an abscess there may be a feeling of suffocation.
At the site of inflammation, an infiltrate is formed, in the area of which the skin or mucous membrane is hyperemic and tense. A fluctuation is determined in the center of the infiltrate. The boundaries of the changed tissues are clearly defined. Often the skin or mucous membrane in the area of the abscess bulges above the surface.
For a correct prognosis and timely follow-up therapy, it is necessary to differentiate an abscess from a boil, abscessing lymphadenitis and suppurating atheroma or congenital cyst.
Treatment. Superficial abscesses on the face in children of older age groups can be opened under local anesthesia. It must be remembered that infiltration of inflamed tissues with anesthetic causes severe pain. Abscesses located deep in the tissues and abscesses in children of younger age groups should be opened under general anesthesia. It is necessary to carefully evaluate the topography of the abscess in relation to the surrounding tissues, since pronounced reactive edema and the abundance of adipose tissue “mask” the true location of the abscess. To correctly select the location of the incision, this factor must be taken into account. If there is an abscess, the depth of the incision should not exceed the thickness of the skin. Subsequent opening of the abscess is achieved by advancing a closed “Mosquito” type clamp towards the abscess cavity. After the first portion of pus appears, the jaws of the clamp are moved apart, and the cavity is emptied. Drainage is inserted into the latter.