Disclosure of superficial abscess or phlegmon of the maxillofacial region

What is a superficial abscess and phlegmon of the maxillofacial area?

Abscess - a capsule-bound accumulation of pus that occurs in acute or chronic focal infection. The abscess is caused by a hit in fabrics and bodies of purulent microorganisms.

The cause of any purulent disease is getting into a damaged or weakened organ of a pathogenic microorganism, which in favorable conditions begins to multiply rapidly. At this time, the body fights inflammation and limits the inflamed area. A purulent capsule appears.

Phlegmon is a diffuse purulent inflammation of the soft tissues. Phlegmon of the maxillofacial area can develop in cases of late treatment and improper treatment of purulent formations of the face. Phlegmon of the face and neck are diffuse and tend to spread rapidly and develop complications.

Why do abscesses and phlegmons of the maxillofacial area occur?

Inflammatory diseases of the maxillofacial area, as a rule, have an infectious nature.

Depending on the cause of the abscess or phlegmon are:

• Neodontogenic - infectious-inflammatory processes of the facial part of the head and neck, in which the onset of the disease is due to mechanical trauma, tissue infection, tonsillitis, rhinitis, pyogenic skin lesions, etc.
• Odontogenic - infectious-inflammatory processes of the facial head and neck, in which the entrance gates for pathogens are hard tooth tissue (enamel, dentin), defects of the gingival attachment, and the epithelial lining of the gums over the erupting tooth.

When the microcirculation in the area of inflammation is reduced, there is a decrease in tissue resistance to infection, resulting in the appearance of an abscess or phlegmon.

What is the danger of self-treatment of abscesses and phlegmons of the maxillofacial area?

With improper treatment or self-treatment of abscesses and phlegmon on the face or neck with his injury often develop complications.

Phlegmons of the maxillofacial area and neck tend to progress, which often leads to the development of the following complications:

• mediastinitis (inflammation of the mediastinum of the chest);
• sepsis (blood infection);
• meningitis or meningoencephalitis (inflammation of the brain or its membranes);
• thrombosis of the facial veins and sinuses of the brain, which are life-threatening.

Mortality from common phlegmons of the face and neck is from 30 to 50%.

In what cases it is necessary to operate at a superficial abscess or a phlegmon?

If a patient has at least one of the following symptoms, seek medical attention immediately:

• the disease was preceded by toothache or edema;
• swelling of soft tissues with pronounced redness of the skin;
• local lymph nodes enlarge and become painful;
• the mouth opens with difficulty;
• swallowing problems;
• pronounced, sharp, stabbing pain that is not removed (stopped) with painkillers.

General manifestations of abscess or phlegmon:

• weakness, malaise, headache;
• fever, which can reach 39-40 ° C and is accompanied by chills - these symptoms may be associated with the absorption into the bloodstream of toxic substances formed as a result of tissue breakdown inside the abscess or indicate the spread of purulent process.

What are the contraindications to surgery? - There are no absolute contraindications.

How are patients examined and prepared for surgery?

In order to choose the right treatment tactics, maxillofacial surgeons of the clinic conduct a number of diagnostic procedures and examinations, which include:

• collection of complaints and anamnesis;
• physical examination of the patient;
• general blood test;
• examination of the contents of an abscess or phlegmon for sensitivity to antibiotics;
• radiography of the jaws - detection of bone lesions;
• Ultrasound of the maxillofacial area (foci of inflammation) - the presence of a cavity with a liquid component of inhomogeneous echogenicity (to determine the location and depth of the abscess);
• orthopantomogram - to detect the source of odontogenic infection;
• Computed tomography.

How is the opening of a superficial abscess or phlegmon of the maxillofacial area?

In case of abscesses and phlegmons in the maxillofacial area, inpatient treatment of patients is indicated.

When treating patients with inflammatory diseases of the maxillofacial area, surgery should be performed immediately.

The main components of the treatment of abscesses and phlegmon of the maxillofacial area are:

1. Etiotropic treatment:

• Surgical treatment (removal of the causative tooth, opening, and drainage of the purulent focus);
• Antibacterial therapy (general and local treatment).

1. Pathogenetic treatment (influence on various links in the pathogenesis of inflammation) - general and local treatment;
2. Symptomatic treatment (elimination of disease symptoms).

The choice of anesthesia method is decided together with anesthesiologists and other related specialists (if necessary) after a thorough examination of the patient, taking into account the indications and contraindications for both the method of operation and the type of anesthesia.

Stages of the operation:

1. Treatment of the area of inflammation with an antiseptic solution.
2. Anesthesia. Local infiltration or general anesthesia is used.
3. Operative access is chosen according to the location of the purulent focus. The opening of the purulent focus is carried out by external access from the skin, or - intraoral. Also, a needle can sometimes be used to determine the location of the capsule.
4. The abscess cavity or the space affected by phlegmon is emptied.
5. After removal of pus, a thorough instrumental and finger audit is performed along the wound, with the opening of all pockets and bays, and to remove the remaining jumpers and necrotized tissues.
6. The cavity is washed with antiseptic.
7. For drainage in a cavity of an abscess enter the rubber tube or the tampons impregnated with antiseptics and enzymes. At bad drainage from the main section do a contraperture (through an additional incision deduce drainage).
8. After opening and cleaning a cavity the treatment similar to purulent wounds is carried out.

How is the treatment performed in the postoperative period?

Treatment after the opening of a superficial abscess or phlegmon of the maxillofacial area requires special attention. In the postoperative period, the general treatment is prescribed, which consists of antibacterial, desensitizing, detoxification therapy and tonic treatment, correction of homeostasis, and metabolic processes.

Antiplatelet therapy (acetylsalicylic acid, heparin) is prescribed to prevent the occurrence of serious complications (cavernous sinus thrombosis, angular vein phlebitis).

The first 2-3 days the wound is bandaged daily and, when it is cleared of pus and necrotic tissue, switch to rare ointment dressings.

The patient is hospitalized until the wound is cleansed of purulent discharge and the appearance of granulation tissue. Later, after discharge from the hospital, he continues outpatient treatment. It is necessary to continue bandaging the wound with the use of bactericidal, antiseptic drugs and ointments, hypertonic solutions.

How is the rehabilitation after the operation?

To ensure complete rehabilitation of patients with phlegmons and facial abscesses, a coordinated work of a team of specialists is carried out: maxillofacial surgeon, neurologist, therapist, otorhinolaryngologist, anesthesiologist, dentist, physiotherapist.

In the postoperative period, it is necessary to follow the recommendations given by the doctor.

How can you prevent abscesses and phlegmon in the maxillofacial area?

Prevention of abscesses and phlegmon of the face is the timely and proper treatment of pathological odontogenic foci, oral hygiene, and maintaining a healthy lifestyle. If you detect cases of odontogenic diseases - contact the specialists of our Clinic, for further examination and treatment by a specialist dentist or maxillofacial surgeon.