Opening an abscess, phlegmon of the maxillofacial area

What is an abscess and what causes it?

An abscess is a painful pustule surrounded by inflamed tissue. Often it can be easily felt. Such a formation can appear on any part of the body, but most often it affects:

• armpits;
• area around the anus and vagina (Bartholin gland abscess);
• tissue around the tooth;
• skin in the groin area;
• hair follicles.

During their development, abscesses are filled with necrotic masses and can open on their own. However, it is best to consult a doctor in case of such a disease, who will open the purulent focus and clean (drain) it.

Causes of abscesses:

• as an independent disease, abscesses of the skin and soft tissues most often occur, caused by blockage of the openings of the sebaceous and sweat glands, the formation of cysts and the proliferation of pathogenic microorganisms there;
• purulent soft tissue abscess can be a complication of skin damage;
• a post-injection abscess develops when the drug is administered with a non-sterile syringe; in severe cases, a purulent process – phlegmon – may spread;
• such a process often complicates the course of any infectious diseases of a bacterial nature, for example, a peritonsillar abscess develops as a complication of tonsillitis;
• Abdominal abscesses can develop when microbes are transferred through blood vessels;
• in some cases, the cause of the disease is not bacteria, but protozoan microorganisms, for example, amoebic liver abscess;
• pathology may arise primarily due to the penetration of a large number of pathogens with high virulence (damaging ability) into the tissues, and a lung abscess may form.

Signs of an abscess occur more often in people with weakened immune systems. Risk factors for developing pathology:

• long-term treatment with glucocorticoids and chemotherapy drugs;
• diabetes mellitus, malignant tumors;
• diseases of the blood and hematopoiesis – sickle cell anemia, leukemia, HIV infection;
• Crohn's disease, ulcerative colitis;
• severe injuries or burns;
• alcoholism, drug addiction.

Other risk factors are exposure to a polluted environment, contact with dust, hydrocarbons, poor skin hygiene, atherosclerosis of peripheral arteries or severe varicose veins.

Risk factors

Favorable background for the appearance of abscesses are also:

• long-term diseases of the gastrointestinal tract (gastroenteritis, enteritis, colitis);
• peripheral circulatory disorders (atherosclerosis, varicose veins, postthrombophlebitis disease);
• metabolic disorders (obesity, hypothyroidism, vitamin deficiency).

Diabetes mellitus with severe damage to the blood vessels plays a particularly significant role in the development and progression of the purulent process.

Symptoms and diagnosis of abscess

Symptoms of an abscess vary depending on its location. When skin and soft tissues are affected, the following is noted:

• skin redness;
• swelling and soreness;
• palpation of a soft space-occupying formation under the skin.

Abscesses of internal organs are accompanied by corresponding symptoms: cough, sore throat, sore throat, right hypochondrium, lower back, back, headache, dysfunction of the affected organs.
The infection causes signs of intoxication - high fever, headache, weakness, nausea. Sometimes the course of abscesses is not accompanied by pronounced symptoms; they become chronic, and in these cases, diagnosing the disease is difficult. Complications of an abscess are associated with the entry of microorganisms from its cavity into the blood vessels. At the same time, they spread throughout the body, causing sepsis (“blood poisoning”). This condition is life-threatening. Therefore, it is very important to identify and eliminate the purulent focus in time.

Diagnosis of an abscess is carried out by external examination. To detect ulcers in internal organs, ultrasound, CT, MRI, and radiography are used. Blood tests reveal signs of inflammation, but they do not provide information about the location of the pathology.

Diagnostics

During the consultation, our surgeons pay attention to any history of evidence of the appearance of inflammatory symptoms after an injury, wound or injection. General practitioners and other specialists are involved to identify underlying diseases according to indications. The examination plan includes the following diagnostic procedures:

• Objective examination.
• Ultrasound of soft tissues. Ultrasound of soft tissues allows you to determine the presence of a capsule and a cavity filled with purulent contents. In our clinic, this study is carried out by experienced ultrasound doctors.
• Diagnostic puncture.
• Bacteriological research. It is carried out to determine the sensitivity of pyogenic microflora to antibiotics.
• X-ray and PCR diagnostics are carried out if inflammation caused by Mycobacterium tuberculosis is suspected.

Abscess treatment

If you experience pain, swelling of the skin, the formation of a tubercle or a lump with a softened center, you should contact a surgeon.

• Treatment of an abscess is carried out under local anesthesia.
• The skin is disinfected, an anesthetic is injected, and the abscess is opened.
• After emptying the cavity, it is washed with an antiseptic solution and dried.
• A drain is inserted into the wound for 1–2 days and covered with a sterile bandage.

Immediately after such an operation, the patient’s well-being improves significantly. Additionally, the doctor may prescribe antibiotics and anti-inflammatory drugs. After a few days, the drainage is removed.

For abscesses of internal organs, the principle of treatment is the same - opening, cleansing, draining. Access to the desired organ may require extensive surgery or the use of endoscopic techniques.

Surgeons do not recommend treating an abscess at home, as this can lead to a delay in the process and the development of sepsis. However, people often use lotions with aloe juice, onion gruel, and compresses with rye bread. We advise you to immediately contact the clinic by making an appointment by phone.

Do not puncture or squeeze out the contents of the abscess. This can cause the infection to spread through the blood vessels.

Treatment of phlegmon

Treatment of phlegmon is surgical - opening the abscess, excision of necrotic tissue (see photo below).

In the photo, the phlegmon is opened, the Achilles tendon is visible at the bottom of the wound.

After opening the abscess, the wound is cleaned, inflammation subsides, and wound healing processes begin.

In the photo, the wound has cleared and is beginning to heal.

In the complex treatment of phlegmon, antibiotics, immunocorrectors, physiotherapy, etc. are also used.

The photo below shows phlegmon of the left forearm, which developed from a boil.

In the photo below, the same phlegmon is opened, the wound is cleaned.

The photo below shows the same wound, almost healed.

The wound has healed.

The photo below shows advanced phlegmon of the thigh. The duration of the disease is 2 weeks.

The patient refused hospitalization, so treatment of phlegmon had to be carried out in a clinic. In the photo below - the same phlegmon 7 days after the operation - the wound has cleared and is granulating.

After cleaning the wound, secondary sutures were applied (photo below).

Treatment at the Mama Papa Ya clinic

The network of family clinics “Mama Papa Ya” offers medical services for the treatment of abscesses by a qualified surgeon. The clinic's branches are located in Moscow and Moscow Region.

Our advantages:

• quick appointment of a patient without a long wait in line;
• immediate surgical care - opening and draining the abscess in a sterile office;
• comprehensive recommendations for caring for the postoperative wound to prevent complications;
• if necessary, consultation with other specialists (gynecologist, ENT doctor, neurologist and others);
• diagnosis of internal abscesses using multislice computed tomography.

To obtain a doctor’s consultation, you must contact our manager by phone or through the feedback form.

Reviews

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Raisa Vasilievna can clearly and clearly explain what the problem is. If something is wrong, she speaks about everything directly, not in a veiled way, as other doctors sometimes do. I don’t regret that I ended up with her. Anna

I would like to express my gratitude to the staff of the clinic: Mom, Dad, and me. The clinic has a very friendly atmosphere, a very friendly and cheerful team and highly qualified specialists. Thank you very much! I wish your clinic prosperity.

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The Mama Papa Ya clinic in Lyubertsy is very good. The team is friendly and responsive. I recommend this clinic to all my friends. Thanks to all doctors and administrators. I wish the clinic prosperity and many adequate clients.

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Forms of the disease and routes of infection

An abscess can be an independent disease, but in the vast majority of cases it appears as a complication of an underlying disease, for example, purulent tonsillitis causes a peritonsillar abscess. Pathogenic microorganisms have a lot of ways to get inside - through damage to the skin as a result of injuries and cuts, from other organs and tissues that were previously infected, through non-sterile equipment during surgical procedures, and others.

Forms of the disease are classified according to the location of purulent accumulation:

• retropharyngeal abscess;
• peripharyngeal;
• peritonsillar abscess;
• subdiaphragmatic;
• soft tissues;
• periodontal;
• appendicular and others.

Forecast and prevention of the disease

The prognosis of odontogenic abscesses and phlegmons is usually favorable. A positive treatment result is observed with timely indication of full surgical care. In such cases, the patient must be hospitalized in a specialized medical hospital.

Lethal outcomes from purulent lesions of the soft tissues of the maxillofacial area are associated with late presentation of the patient and systemic suppression of his immunity.

Prevention of the disease is achieved in the following ways:

sanitation of the oral cavity, during which the dentist treats all carious, pulpitic and periodontitis teeth; strict adherence by patients to the rules of personal hygiene and regular brushing of teeth; undergoing regular preventive examinations at the dentist, at least twice a year; timely consultation with a doctor if symptoms of dental diseases are detected. Every person should remember that the cost of prevention is much lower than the cost of treatment. And in some cases, sanitation of the oral cavity can prevent the development of severe complications, which are accompanied by high mortality in patients.

Prevention

To prevent abscess, patients are recommended to:

• promptly disinfect and treat abrasions, wounds, injuries;
• observe the technique of performing therapeutic and diagnostic procedures;
• observe the rules of sanitation and hygiene;
• promptly treat inflammatory diseases, primary purulent processes, local foci of infection (caries, periodontitis).

This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.

Clinical picture of the disease

In the initial stages, abscesses and phlegmons adjacent to the lower jaw are manifested by compaction and progressive swelling of the soft tissues of the face. The skin over the purulent focus is often hyperemic. The key symptom of suppuration is fluctuation - the feeling of fluid in a confined space.

The course of phlegmon is accompanied by general intoxication, in which the patient presents the following complaints:

malaise and feeling of chronic fatigue; increase in body temperature; fatigue and joint pain.

Abscesses, as a rule, do not cause such symptoms due to the limited nature of the pathological process.

Abscess, phlegmon of the maxillofacial area in children is characterized by an acute and severe course of the disease. Diffuse purulent lesions of soft tissues are formed as a result of the imperfection of the children's immune system.

Complications of abscesses and phlegmon

Purulent lesions of the maxillofacial area can be complicated by the following pathologies:

Sepsis is a serious condition of the body that is caused by the penetration of a bacterial infection into the circulatory system. Treatment of such a complication is difficult due to the development of body resistance to antibiotic therapy. Sepsis is often the cause of death. Mediastenitis in the form of purulent inflammation of the tissue of the mediastinum, where the heart, lungs and bronchi are located. Meningitis . Inflammatory damage to the meninges develops as a result of the spread of purulent infection through the lymphatic and blood vessels of the head.

Complications

In the absence of timely and adequate treatment, complications of abscesses are very dangerous for the life and health of the patient:

• phlegmon;
• neuritis;
• osteomelitis;
• internal bleeding of the walls of blood vessels;
• peritonitis,
• sepsis as a result of purulent abscess of the appendicular region;
• purulent meningitis and others.

Contacting the clinic

A purulent accumulation is fraught with dangerous consequences, therefore, if the slightest sign of the presence of an accumulation of pus in tissues or organs appears, you should immediately consult a doctor. The ideal solution would be to call an ambulance.

At (academician Roitberg’s clinic) you will receive the necessary assistance in treatment. In addition, JSC “Medicine” (academician Roitberg’s clinic) has the ability to accommodate patients in a 24-hour hospital and has the function of calling a doctor at home around the clock.

Diagnosis of the disease

Establishing a diagnosis for acute odontogenic infections includes the following measures:

Collection of medical history. The doctor finds out the patient’s complaints and the general condition of the patient. External examination of the maxillofacial area and palpation of regional lymph nodes. Most inflammatory and purulent processes cause enlargement and pain of the lymph nodes. Instrumental examination of the oral cavity, during which the doctor detects chronic foci of odontogenic infection. X-ray in frontal and lateral projection. Laboratory blood test, in which there is an increase in SOE, leukocytes and a decrease in the concentration of red blood cells and hemoglobin.

Abscess symptoms

Symptoms characteristic of an abscess are as follows:

• a sharp increase in temperature (up to 40 degrees);
• general weakness;
• dizziness;
• decreased appetite;
• the formation of subcutaneous capsules with pus, accompanied by redness, swelling and pain (with a superficial abscess), ending with its rupture and release of pus.

If you experience similar symptoms, consult your doctor

. It is easier to prevent a disease than to deal with the consequences.