Phlegmonous adenitis: Simptomi i liječenje
Phlegmon is an acute purulent diffuse process in the subcutaneous fat layer.Adenophlegmon is localized near the lymph nodes, the abscessing inflammation of which is the direct cause of the pathology.
Note: most often with adenophlegmons is experienced by dental surgeons, since in most cases the parotid, submandibular and chin areas are affected.
Treatment is carried out only in a hospital.Contents: Possible causes of acute process Symptoms of adenophlegmonia
Possible causes of acute
A of a denofefmona develops against the background of a weakening of the body's defenses .Normally, the lymphatic system is a barrier to the spread of infection.In the lymph nodes the process of capture and destruction of cells, identified as alien, proceeds.With inflammation of the nodes, the outflow of lymph is significantly reduced, and the permeability of the vessels.The focus of purulent inflammation( abscess) is formed, from where the pathogenic microflora penetrates into nearby tissues.As a result, the acute process acquires a spilled character.
The most common causes of adenophlegmonia:
- dental diseases( with chronic foci of infection);
- traumatic injuries of soft tissues;
- inflammation of the tonsils;
- infectious diseases;
- some dermatitis;
- diseases of the urogenital system;
- infection during medical manipulations( in violation of asepsis and antiseptic rules);
- cystic neoplasm of the jaw;
- malignant tumors.
Microorganisms that provoke the development of adenophlegmons include staphylococci( including golden), diplococci and streptococci.
Symptoms of adenophlegmonia
With the development of the pathological process in the area of the lymph nodes, a painful, slight swelling is formed, which quickly grows .The patient has symptoms of intoxication of the body - weakness, headache and general malaise.The body temperature rises( in some cases - up to 39-40 ° C).
Important: if inflammation begins in a child, it becomes inhibited, contactless and sluggish, complains of pain and refuses to eat.
The examination reveals pronounced hyperemia( redness of the skin) in the center of the swelling. Education has a tight-elastic consistency.During palpation, a fluctuation is detected, which indicates the presence of fluid in the formed pathological cavities.On the skin or surface of the mucous membranes( in the area of the vestibule of the mouth), multiple spot hemorrhages can be seen.At a late stage, the abscess can break out to form a fistulous course.
Progression of pathology threatens with complications such as mediastinitis( mediastinum inflammation), sepsis( infection of the blood) and infectious meningitis. If emergency measures are not taken with adenophlegmon, life-threatening conditions of the patient develop - cardiac, respiratory and( or) renal failure.
The most common adenoflegmon is found in the submaxillary region.Patients complain of worsening general condition, fever and the presence of swelling .During the course of the history, it usually becomes clear that a painful compaction occurred near the lymph node earlier.On examination, puffiness, hyperemia, tissue infiltration and severe soreness are detected.If purulent inflammation is localized in the lower submandibular triangle, swallowing and speech are difficult. Because of the pain reaction, patients can hardly even open their mouths.
When analyzing blood, leukocytosis, neutrophilia and a significant( up to 500 mm / h) increase in ESR are detected.
Note: , the cause of adenoplegmons of the submaxillary zone can be a retinued( uncut) or a half-retina third molar( wisdom tooth).It remains in the thickness of the periosteum and is partially hidden under the mucous membrane.The presence or absence of such a focus of a chronic infection is easily established by means of X-ray examination.
In the anterior and lateral areas, there are anatomical spaces in which a significant amount of pus can accumulate.
Pathology develops against the background of an infectious disease and a significant decrease in immunity.Infection can spread from the submandibular lymphouse to the deep cervical .Adenophlegmon of this localization often results from insufficient hygiene of the oral cavity and the scalp;The impetus to the beginning of the process is the accumulation of a critical amount of coccal microflora.
Adenoflegmon axillary region
Primary phlegmon of this localization in most cases becomes a consequence of infected upper limb injuries .Pathogenic microflora penetrates into the axillary lymph nodes of the hematogenous.Lymph nodes increase in size( lymphadenitis develops), merging into "packages" of dense consistency.Then the swelling loses its clear outlines and there is a fluctuation, which clearly indicates the development of phlegmon.
Note: to adenoflegmone can lead to a banal abrasion when shaving the armpit.
Adenophlegmon of the inguinal zone
An impetus to the development of pathology may be prolonged hypothermia, against which the defenses of the body weaken, and the bladder or urethra become inflamed.
Important : often even prolonged antibiotic therapy of cystitis or urethritis does not lead to complete cure, but translates the acute process into a chronic sluggish state with recurrent relapses.
Infection from the pelvic organs is spreading by the hematogenous route( with blood flow). Adenophlegmon inguinal lymph nodes have the property of rapidly progressing .
Diagnosis of pathology
In most cases, the detection of adenophlegmonia is not particularly difficult.The doctor makes the diagnosis, based on the patient's complaints, as well as data of anamnesis, examination and laboratory tests.The dynamics of the process is necessarily taken into account.
If necessary, ultrasound scanning of the affected area is additionally assigned.In some cases, radiography is required to exclude cystic lesions and osteomyelitis.
To establish the type of pathogenic microflora and the degree of its sensitivity to various antibiotics, the biomaterial( punctate from the source) is sown to nutrient media.
Differential diagnosis is performed with "classical" phlegmon, inflammatory infiltrates, actinomycosis, osteomyelitis, periadenitis and tuberculosis.
Note: In acute purulent process, there is a significant deterioration in the general condition, and, for example, in tuberculosis it is quite satisfactory.
Treatment of adenophlegmons
When the diagnosis is confirmed, the patient is hospitalized in the profile department of the hospital, where complex treatment is performed.
In the first stage, surgical intervention is performed under general or local anesthesia( children - only under anesthesia). If the source of the infection is a sick tooth, then it is removed.The purulent focus is opened by cutting the skin and the subcutaneous fat layer with the extension of the wound edges by the surgical jaws.Emptying the hearth is easy;The pus comes out under pressure.There is no need for an additional audit of the cavity, if osteophlegmon was excluded.The next step is antiseptic treatment( washing with a solution from a syringe) and setting the drainage( the wound is not sutured).Then a sterile bandage is applied, which changes at least once a day.
The patient must be prescribed antibiotics of a wide spectrum of action, anti-inflammatory and restorative drugs( immunostimulants, immunomodulators and vitamins). If necessary, resort to detoxification therapy.The incision site is washed daily with an antiseptic solution during dressing;If necessary, change the drainage.
Important: prophylaxis of adenophlegmons involves timely sanation of chronic foci of infection, treatment of infectious diseases until complete recovery and strengthening of immunity.
With timely diagnosis and adequate treatment, the prognosis with adenophlegmone is quite favorable .Complex therapy allows you to achieve full recovery in a fairly short time.A real threat to life is a neglected process, accompanied by the development of a septic state.
Vladimir Plisov, medical reviewer