Abscess and phlegmoof the maxillofacial area. Etiology, pathogenesis, clinical manifestations, ndiagnosis, treatment and prevention.
Inflammatory processes of ntissue maxillofacial area in all cases are infectious iature, ie, their norigin, development and current leading role of microbial flora. Inflammatiois a primary link evolutionarily produced stereotypical reactions that cause nthe body’s ability to resist a variety of damaging environmental factors.
Phlegmon – an acute diffuse ninflammation of subcutaneous , intramuscular and mizhfastsialnoyi fiber.
Abscess – purulent ninflammation with formation of cavities.
Phlegmon characterized by a ntendency to spread rapidly , the process from the very beginning is diffuse inature. Inflammation is growing so rapidly that the demarcation process is ndelayed , and separation of the lesion is impossible.
The condition in the nhospital maxillofacial surgery takes leading place . In recent years, the nnumber of patients with this disease has increased, deepened gravity flow nprocess , frequently observed complications ( mediastinit , sepsis, thrombosis nof the cerebral veins and sinuses of the face ).
The cell infiltrate in the ntissue wounds are rare plasma cells (1), numerous lymphocytes (2), diffuse ndistribution of large quantities of neutrophils (3), LABROTSYTY (4).
Etiology. As the research nfor the ” tying ” of local infectious – inflammatory process need nsome “critical concentration ” of disease , individual for each norganism. In surgery is recognized that opportunistic microbes, which include nrepresentatives of oral microflora , can cause inflammation of the nconcentration of 105-106 or more microbes in
Agents of inflammation are nusually different types of cocci ( staphylococci, streptococci and other ) isymbiosis with intestinal and other sticks. The most common pathogen prevails nas white or Staphylococcus aureus. Occurs anaerobic infection: bacteria ndominate nesporohennыe – bacteroides and clostridia . Emphasized the nassociative participation anaerobes and aerobes .
For etiological basis emit n” osteoflehmonu ” that develops on the background of osteomyelitis of nthe jaws and ” phlegmonous adenitis ” – complicating suppurative nlymphadenitis , which may be associated with diseases of the teeth. Provided n” odontogenic abscess ” in which on the basis of periodontitis and nthere suppurative periostitis process, but changes in bone are reversible . nMost scholars distinguish another form of inflammation of the soft tissues – n” cellulite ” and mean by this name form of inflammation of serous ntissue.
Depending on the source of ninfection of inflammatory processes of the maxillofacial region can be divided ninto:
• odontogenic ( cause of – ngangrenous teeth and their roots );
• yntraossalnыe (as nodontogenic kind , including as a result of traumatic peryostytov , nosteomyelytov , pericoronitis , sinusitis , cysts and other diseases );
• hynhyvalnыe (development nassociated with gingivitis and periodontitis );
• mukostomatohennыe ( due nto the presence stomatitis and hlossytov );
• salyvatornыe (resulting nsyalodohytov and sialadenitiv );
• tonzyllyarno – pharyngeal n;
• rynohennыe ;
• Otogenic .
ROZVOLOKNENNYA edema and nsubcutaneous tissue (1), hyperemic vessels ( 2) and small cell infiltrates (3) nin the tissues of the wound.
A clear separatioinflammatory in origin is important because it allows you to avoid tactical nmistakes in diagnosis and treatment.
Depending on the type and nseverity of inflammation of the soft tissues of the process may be serous, npurulent, hemorrhagic , hnoynыm and putrid .
CLASSIFICATION. We consider nit appropriate to distinguish between cellulitis and abscess following nmaxillofacial region and neck:
Phlegmon and abscesses face nand neck.
I. Abscesses and cellulitis nin the vicinity of the upper jaw :
• • infraorbital region;
• • orbital area (including neyelids );
• • temporal region ;
• • infratemporal and npterygopalatine fossa.
II. Abscesses and ncellulitis in the vicinity of the mandible :
• • pidnyzhnoschelepovoyi narea;
• • pozadychelyustnoy area;
• • parotid- masticatory narea;
• • pterygoid – mandibular nspace;
• • navkolohlotkovoho nspace.
III. Abscesses and ncellulitis, located both near the upper and lower jaw :
• • Jaw area;
• • zygomatic area.
IV. Abscesses and ncellulitis floor of the mouth :
• • upper ( sublingual area n);
• • lower division (area npidpidboriddya ).
V. Abscesses and cellulitis ntongue :
• • own tongue ;
• • root of the tongue.
VI. Abscesses and phlegmoof the neck:
• • surface ;
• • deep :
1) neurovascular bundle ;
2) around the trachea and nesophagus;
3) peredhrebetnoho space.
On the severity of illness nof patients conventionally divided into 3 groups:
• patients with cellulitis, nlocalized in the same anatomical region;
• patients with cellulitis, nlocalized in two or more anatomical regions;
• seriously ill with nphlegmon temporal region , infratemporal and pterygopalatine fossa, floor of nthe mouth , tongue and neck.
Granulation tissue nwounds
Fibroblasts (1) nvessels ( 2).
Pathogenesis. Most okolochelyustnыe nabscesses and cellulitis occur in persons aged 20-30 years. This is probably ndue to the highest intensity of caries teeth and difficult prorezыvanyem wisdom nteeth. There is seasonality in the development of abscesses and abscesses , with the largest number of diseases observed ispring- summer and summer- autumn periods.
The development and ncourse of acute purulent inflammation of the maxillofacial area and neck ndepends on the microflora, total local nonspecific and specific protective nfactors reliance various organs and body systems and anatomic and topographic nfeatures of the maxillofacial region . The ninflammatory response may be normerhycheskoho , hypererhycheskoho nand hypoerhycheskoho type.
The clinical picture nconsists of local symptoms and general symptoms of intoxication. The clinical ncourse of abscesses in the head and neck differs significantly varied. nDepending on how many anatomical regions is purulent- necrotic process , what are its tendency to spread and are life- nthreatening complications can occur , this will be the clinical picture .
Complaints of patients nwith pain at the site of affected tissue , significant swelling of a particular nanatomical region , painful swallowing, if the process is localized in the nhyoid region, pterygoid – mandibular , navkolohlotkovomu spaces , limiting nopening your mouth and chewing violation , with phlegmon localized near the nmasticatory ‘ muscles . Typically, the growing signs of intoxication: malaise , fatigue , loss of appetite (patients refuse a meal nand liquid) , poor sleep . Some patients with irritable, more sluggish, retarded , are reluctant to come into contact. Violated nphysiological downward daily urine output ( oliguria n), there are locks. Body temperature varies between 38-39 ° C.
From history can be ndefined as the first manifestation of clinical signs of odontogenic abscesses nand abscesses maxillofacial region fit into the clinical picture of acute or nexacerbated chronic periodontitis. Then growing signs that nindicate the distribution process beyond the jaws of defeat of one or more nadjacent anatomical spaces. The patient should be developed to clarify nthe cause of odontogenic cellulitis, determine whether preceded periodontitis , npericoronitis , abstsedyruyuschaya form of periodontitis , abscess or nosteomyelitis of the jaw or disease preceded neodontohenna lesions nlymphadenitis , carbuncle or furuncle, traumatic osteomyelitis specific nprocesses in the maxillofacial region .
OBJECTIVE: local nmanifestations are characterized by five classic signs of inflammation: nswelling or infiltration (tumor), pain (dolor), redness or flushing (rubor), aincrease in local temperature (calor) and dysfunction (functio lesae). nExpression of each of these signs of inflammation depends on the anatomical nlocation of cellulitis . Since the localization of nabscess in subcutaneous adipose tissue is particularly pronounced swelling , redness and increased local temperature . While nin deep abscess location , such as pterygium , nmandibular , navkolohlotkovomu space , these symptoms are less pronounced . Ithis case, are more pronounced pain and dysfunction often seen chewing, swallowing , speech and respiration . The combination of nthese symptoms creates a peculiar clinical picture characteristic of infectious ninflammation of a location.
ROZVOLOKNENNYA edema and nsubcutaneous tissue (1), hyperemic vessels ( 2) and nsmall cell infiltrates (3) in the tissues of the wound.
Locally defined tight, npainful and spreads quickly infiltrates . At the nbottom it is flyuktuatsyya palpation .
There are acute and nsubacute stages of the disease .
In the acute stage is ncharacterized by the growth of local manifestations of inflammation with ncharacteristic signs of intoxication: hyperthermia , nweakness, change in function. In blood marked leukocytosis (from 12-15 .109 /
Subacute stage following nthe opening of abscesses and abscesses , provided that nno complications arise . Thus there is subsiding acute inflammatio: local – reduced infiltration of tissues , decreases the number of nwound discharge, granulation tissue grows , there is scarring and wound nepithelization . At the same time decreases the severity of common reactions , improving the health of the patient, recovering nbroken functions of breathing, swallowing, chewing.
DIAGNOSIS .
Provides clarifying the nlocalization and nature of the inflammatory process , nevaluating the virulence of the infectious agent and the type of response nreactions ( normerhycheskaya , hypererhycheskaya , hypoerhycheskaya ) and early ndetection of complications. Topicheskaya diagnosis of odontogenic abscesses nmaxillofacial area based on 4 local attributes:
I. Attribute ‘ causal tooth . ” In the mouth is nperyodontytnыy or parodontytnыy tooth, periodontium which is ” generator n” infection spreads and impressive surrounding soft tissue. He turns othe basis of patient complaints , reviews and nradiography.
II. Symptom severity of ninflammatory infiltrates soft tissues. He pronounced in superficial phlegmoand absent or weakly detected in the deep. In this case the measured visible nsigns of infiltration and as a criterion for its violation , nthe configuration of individual or absence of asymmetry. As an example in cheek nphlegmon ( abscess superficial location ) face nasymmetry is evident , while phlegmon pterygoid – mandibular space ( deep nlocation of the abscess ) find asymmetries in the external review of the npatient’s face is not possible.
III. Signs of motor nfunction of the lower jaw. It is known that any inflammatory process localized nin the area of at least one of masticatory muscles in one way nor another gives motor function of the lower jaw. The functions of the nmasticatory muscles will be opening and closing the mouth , nand lateral movement of the jaw and nominate it forward. Knowing when examining nthe patient’s degree of impairment of the lower jaw can be assumed with nsufficient certainty foci of inflammation.
IV. Sign difficulty nswallowing. There is the localization of inflammatory infiltrates in the muscle nlateral pharyngeal wall , thus resulting icompression or muscle contractures occur pain when swallowing.
In clinical diagnosis of nsuperficial abscesses usually does not cause difficulties. This infraorbital such nas cellulitis , jaw , zygomatic , orbital , npidnyzhnoschelepova , pidpidboriddya and hyoid . However, with a deep locatioin the diagnosis of abscess may be some difficulties. This podmasseteryalnoho cellulitis , winged – mandibular and navkolohlotkovoho nspaces, floor of the mouth , infratemporal and pterygopalatine fossa, temporal nregion .
Virulence early ninfection largely determines the scope and depth of tissue damage and the nlikelihood of complications. Virulence depends on the number and characteristics nof pathogens cellulitis . Assessment of virulence nconducted considering the severity of the local inflammatory response and ngeneral reactions. A patient with an average level of immunological reactivity nthere is a direct proportional relationship between the virulence of infectioand the magnitude of the early response reactions (fever , leukocytosis , nincreased ESR , change proteynohrammы , increasing the total proteolytic nactivity of the blood , and increased levels of IgG). Reduced immune responsiveness ncase with endocrine disorders ( diabetes) , blood ndiseases in old age , the people who continued receiving hormones , cytostatics n. It must be remembered that an increase in body temperature by 1 ° C is naccompanied by increased heart rate by 10 beats per minute. In these patients nthere is a marked tachycardia or subfebrile at normal temperature.
To implement targeted nimmunosuppressive therapy an evaluation of the response of an organism to naction early infection . Thus, when the reaction is ncarried out hypererhycheskom type hyposensybylyzyruyuschaya therapy ihypoerhycheskom – therapy directed at improving the patient’s immune responsiveness . Slow growth involving inflammation in the ninflammatory process of new tissue structures against the background of nmoderately expressed general reactions typical reactions hypoerhycheskoho type. nThe reaction hypererhycheskoho type fast growing signs of ninflammation, early formed cellulitis and abscesses.
Pathological anatomy. Purulent necrotic nprocess develops mainly in the loose connective tissue – subcutaneous , nintramuscular , mezhfastsyalnoy tissue and muscles. Microbes in penetrating ntissue skoplyuyutsya around and around blood vessels. In the inflammatory ntissue reactions , identify the following stages:
edema ;
infiltration ;
purulent fusion of tissues;
necrosis ;
limit foci formation of granulation shaft;
If an abscess a clear serous , sero -purulent nexudation of tissue and subsequent separation of purulent inflammation in a ncavity whose walls are formed granulation tissue . Necrotic processes in septic nfoci expressed a bit.
When phlegmon stage edema, serous, purulent ninflammation alter in varying degrees of severity of the necrotic process : isome cases the dominant diffuse serous , sero- purulent inflammation , iothers, especially in septic necrotic phlegmon – alteration phenomena with nsignificant hemodynamic violation tissue necrosis of tissue, muscle fascia .
Acute inflammation are on the decline after nspontaneous or surgical discharge purulent or purulent necrotic lesions. nSeparation of necrosis is due to leukocyte infiltration , and granulatiotissue develops on the edge of necrotic tissue. Gradually exposed to rejectioand partial resorption of necrotic tissue. Connective tissue growing, replacing nthe lost land, formed connective tissue scar.
In septic necrotic phlegmon driving in the nmovie inflammation is necrotic changes in the form of drainage areas of nnecrosis tissue, fascia and even muscles. There are multiple foci nkrovoyzlyyanyy . Harsh tissue swelling accompanied by mild cellular ninfiltration.
Formulation of diagnosis . Originally nindicated causes of cellulitis, such as odontogenic osteoflehmona , theanatomical region, eg pidnyzhnoschelepovoyi area on the right. Fully diagnosis nis : odontogenic osteoflehmona pidnyzhnoschelepoviy field matter if the ncharacter is diagnosed fluid , it is possible a diagnosis of purulent necrotic nabscess floor of the mouth . Allowed a diagnosis of phlegmonous adenitis neck nleft.
Anesthesia. The best requirements for nanesthesia during surgery opening abscesses and abscesses of the face and the nneck meets the anesthesia that has made physician- anesthetist . nBut he chooses the method of anesthesia. It uses familiar anestetetyky , used nin anesthesiology . However, the general rule is superficial level of nanesthesia with rapid awakening after surgery. If эndotrahealnoho anesthesia nekstubatsiyu performed only after the cessation of bleeding from the surgical nfield in the mouth and in the restored consciousness of the patient.
When opening abscesses chosen method of nanesthesia should provide :
1) Safety for the patient and ease of nmanipulation for the surgeon ;
2) maintaining the airway ;
3 ) rapid awakening of the patient from the nrecovery pharyngeal , throat and tracheal reflexes immediately after surgery.
Since the surgery performed in an emergency , ndrugs for premedication should be administered intravenously. With ntranquilizers can be successfully used Seduxen (5-10 mg) of neyroleptykov – ntalamonal (0,5-2,0 ml). The dose of atropine intravenously may be reduced to n0.1 – 0.3 mg, and an average of 0,5-0,7 ml. It pyam’yataty that after npremedication the patient should not get out of bed .
Evaluating the effectiveness of premedicatioproduced or counting rate and blood pressure , as the autonomic nervous system nis sensitive to inadequate premedication , tachycardia, hypertension, pallor nand damp skin.
While difficult, opening his mouth and nswallowing – when abscess localized in the parotid- masticatory area pterygoid n- mandibular , navkolohlotkovomu spaces with phlegmon floor of the mouth and ntongue , and phlegmon temporal region , the use of barbiturates in intravenous nanesthesia is undesirable because of possible respiratory depression . In the npresence of respiratory failure caused by inflammation of the larynx , the nadditional inhibition of barbiturates can create a very dangerous situation . nEndotracheal anesthesia is also dangerous because of great difficulties during ntracheal intubation . If intubation is successful , then эndotrahealnaya tube ncontributes to edema of the larynx and can lead to tracheitis in the npostoperative period . In such cases, appropriate personal approach with a ncombination of local anesthesia combined with intravenous drugs or anesthesia nbecause of traheostomu .
Schematic representation of a horizontal nfascia neck cut (by VI Shevkunenko )
Acceptable use of local anesthesia. As aanesthetic used novocaine, lidocaine , trimekaina (0.25 %, 0.5 %, 1 %). Pairelief is as follows : first performed anesthesia with 2% solution of a local nanestetikov of up to 5,0 ml., Then 0.25% or 0.5 % solution of anesthetic nanestezuyut layers future line cut ( skin, fat , muscle ). Start infiltratioof the skin with necessary peripheral infiltrates in the unlit tissue. Care nshould be taken that the solution did not get in the abscess cavity . nInfiltration of tissues by the intended line of cut made ithe form of creeping infiltrates , clinically manifested pobelenyem skin, thethe same is done by infiltration of the deeper layers. It is advisable to carry nout infiltration of 4 injections at the ends of two perpendicular diameters. nAfter waiting for 8 to 10 minutes, checking the needle sensitivity of the patient, nproceed to cut.
Formulation of diagnosis . Originally nindicated reason caused such odontogenic phlegmon osteoflehmona , theanatomical region, eg pidnyzhnoschelepovoyi area on the right. Fully diagnosis nis : odontogenic osteoflehmona pidnyzhnoschelepoviy field matter if the ncharacter is diagnosed fluid is a possible diagnosis of purulent necrotic nabscess floor of the mouth . Permissible a diagnosis of phlegmonous adenitis nneck left.
Treatment.
The goal of treatment of patients with nabscesses and phlegmon of maxillofacial localization – as soon as possible the nelimination of infection early with full restoration of disturbed functions. nThis goal is achieved by carrying out a comprehensive therapy. When choosing a nmedical doctor measures into account the localization of the lesion , the nvirulence of infection early , stage of disease , the nature of the ninflammatory process , the type of the response body, comorbidities and age of nthe patient.
Construction of pathogenetic treatment should nreflect :
1) effect on the pathogen ;
2) increasing immunological properties of the norganism ( restorative effect on the body );
3) correction of the functions of organs and nsystems.
Active local treatment of the wound is ncarried out taking into account the phases of inflammation. so
in the I phase ( inflammation) performed nmechanical and physico -chemical antiseptic
in phase II ( proliferation and regeneration) n- Chemical and biological and biochemical reorganization of wounds
in phase III (reorganization and formation of nscar) therapeutic measures aimed at stimulating reparative regeneration in the nwound .
In the acute stage of the disease the maiproblem is to limit the spread of infection zone and restore the balance nbetween cell chronic odontogenic infection and the patient’s body . The nature nof the inflammatory process ( serous, purulent or purulent- necrotic ) largely ndetermines the therapeutic approach. In serous tissue inflammation ( cellulitis n) possible regression of the process in a timely opening and drainage of ninfective foci in the jaw (tooth extraction ) and carrying out the relevant ncausal and pathogenetic therapy. When purulent and necrotic suppurative ninflammation than described interventions jaw requiring urgent surgical nintervention okolochelyustnыh soft tissues. Reduced virulence provides drainage nof purulent foci through dissection of the soft tissues over the place of naccumulation of pus and drainage of the primary focus of infection in the jaw n(tooth extraction ). This , together with manure removed part of nmicroorganisms, their toxins and products of tissue disintegration that is ndamaged by endogenous factors , mediators of inflammation. the earlier nevacuation of pus made better prognosis , the nlower the likelihood of complications ( thrombosis of the sinuses of the dura nmater , meningoencephalitis, medyastenyt , sepsis ).
In carrying out surgery on abscesses and nabscesses of the face and neck choice of anesthesia depends on the localizatioof infection beginning of training anesthesiologist and the appropriate nequipment.
When surgery is necessary to carefully treat ntissue , avoiding their excessive compression, hyperextension , undesirable nextensive delamination periosteum. Length of cuts on the skin and in the mouth nis determined length infiltrates . Io case moves to create a funnel with a nsignificant cut surface tissues and a small entrance in the purulent cavity. nSkin , mucosa , muscle and subcutaneous fascia towards infectious focus should nbe cut and hlybokolezhachi tissue along kletchatochnыh spaces stupid flake . Ipatients with septic -necrotic phlegmon showecrectomy ( excision areas of nnecrosis ). This is done to reduce toxicity, necrotic tissue serve as a good nbreeding ground for microorganisms and a source of endogenous intoxication.
Draining wounds made:
I. All sorts of drains ( rubber strips, ntubes, polyethylene alumni , cotton strips , etc.) introduced into the wound. nUse gauze graduates inappropriate because they 6 hours become purulent plug , nwhich makes content flow from the wound. For a better outflow of fluid from the nwound above superimposed aseptic cotton – gauze bandage impregnated with nhypertonic solution ( 10% solution of NaCL, 25 % solution MgSO4). Change ndressings made daily to reduce the appearance nof exudation and wound granulation. With the advent of granulation impose nmazevыe dressing.
II.Dializ wounds ( wound lavage to remove nmicrobes and their toxins and products of tissue destruction ). How ndyalyzyruyuschyh solutions solutions used antibiotics, antiseptics ( dimeksid , nэtonyy , эkterytsyd , furatsilin ), surfactants ( slfanol , katamyn AB, nhlrheksydyn biglyukonata , rokkal ), proteolytic enzymes ( trypsin, hemopsyetc.), brine 4-8 % solution of soda, acids , etc. Dialysis is:
continuous (during entry solutions in wound nthrough the blood by gravity or by creating a vacuum in the wound by jet or nelektrovidsmoktuvannya . Dyalyzat However , that vidsysayetsya , when the nbandage is removed iapivzamkneniy system or after passing through the filters nagain enters the wound with circular dialysis in a closed system ).
fractional dialysis (through puncture ncatheter and tissue installed every 4 hours dyalyzyruyuschye solution is ninjected into the wound with a syringe ).
III.Pereryvyste or continuous suction of nfluid through the catheter , introduced into the infectious focus through the nsurgical wound or an optional cut – puncture. In this way, by vacuum drainage. nIts duration depends on the phase of exudation.
As a general treatment is targeted antibiotic ntherapy. Antibiotics are used considering planting flora of suppurative focus nand sensitivity to them. The choice of dose and route of administration are ncarried out by the general principles of antibiotic therapy. During the nintroduction of the patient to obtain antibiotikogrammy prescribe a broad nspectrum antibiotic or combination thereof including synergy effects. It is nusually combined with antibiotic therapy appointment sulfanylamydnыh drugs, nanalgesics.
In patients with septic -necrotic phlegmoadvisable to appoint a mixture of sera against the main types of anaerobic nbacteria , as well as to hyperbaric oxygenation ( space in barokameu , 5-10 nsessions) or administered through a catheter into the wound ynsufflyatsyy noxygen. Patients with anaerobic microflora prescribe metronidazole ( trihopol ) nat a dose of 0.25-0.5 2 times a day.
It is advisable to carry out activities to nimprove the rheological properties of blood hypercoagulability and correction .
For excretion of degradation products and toxic nsubstances monitoring the adequate intake of fluids. At night the patient nshould get about 3-
The severity of inflammation of the intensity nhyposensybylyzyruyuschey therapy and the choice of drugs. Of course prescribed ncalcium supplements derived salicylic acid and pyrazolona , protyvohystamynnыe nproduct. When hypererhycheskom inflammation when rapid development of the local nmanifestations of the disease combined with severe general reaction of the norganism using drugs adrenal and their synthetic analogues: hydrocortisone , nprednisone , dexamethasone .
To enhance nonspecific and specific nimmunoreactivity body , especially when purulent necrotic phlegmon use nadaptogens ( 0,005 dibazol 2 times a day for 5-10 days). In patients with nhypererhycheskoy reaction to it provides hyposensybylyzyruyuschyy pronounced neffect in patients with hypoerhycheskoy reaction – activates immunological nprocesses .
To clean the wound from the remnants of nnecrosis topically applied proteolytic enzymes. When the granulation tissue and nits stimulation by an electric field UHF. Microwave, radiation of helium- neolaser , UV oblucheniyem .
In the subacute stage of the disease the maiobjective in the shortest possible time to ensure healing of the wound with the nelimination of the infectious focus and full restoration of disturbed functions n. This is achieved by the use of drugs stimulating tissue metabolism, fyzyo and ndiet therapy .
After the cessation of suppuration , cleaning nthe wound of necrotic tissue may be imposed secondary seams:
• prevychno – delayed ( 2-3 days after nsurgery, the appearance of the wound granulation tissue );
• Secondary (for granulating wound ).
Contraindications to the imposition of nsecondary joints:
common causes : the presence of fever and nseverity of acute inflammation , chronic comorbidities (diabetes , rheumatism , ninfectious arthritis, nephritis, malignancy, cardiovascular failure iviolation of the peripheral circulation , chronic radiation sickness );
local causes: signs of osteomyelitis n(mobility of teeth with suppuration from the gums, positive symptom Vincent , nthe X-ray – bone resorption , etc.) is stored infiltration of the wound edges , nwhich does not tend to decrease in dynamics.
It should refrain from imposing secondary nsutures in children and the elderly. Near these patients after treatment of nwound necrosis produced seamless convergence of its edges by strips of sticky nplaster. Draining wounds this period the strips of rubber gloves.
Surgical technique .
Skin around the wound treated with a solutioof iodine , alcohol , and then conduct a local infiltration anesthesia . Thethe wound copiously washed with antiseptic solution ( furatsilinom , 3 % nhydrogen peroxide solution ). Since the depth of the wound at a distance of n0.5-
With the stabilization of inflammation around ninfectious foci formed soedynytelnotkannaya capsule. It is on the one hand nhelps limit the spread of infection , and on the other – delays penetratiointo infectious focus antibiotics, cellular and humoral factors of immunity , nprevents complete destruction of microorganisms. Therefore, at this stage of nthe disease to delay the excessive development soedynytelnotkannoy capsule and nincrease its permeability through the use of ultrasound, elektroforez potassium niodide lydazы . Displaying purpose exercise that helps restore facial functioand masticatory muscles.
Patients should receive full power. While ndifficult, opening his mouth and swallowing painful jaw assigned diet. Food is nground to kashepodibnoho condition diluted broth or milk and introduced into nthe stomach naturally or through poyilnyka or probe. Power supply such patients nshould be high to have enough vitamins and be balanced in proteins, fats and ncarbohydrates .
Forecast. Generally favorable with timely and nproper treatment of abscesses and phlegmon of maxillofacial area and nneck.
