Adenoflegmona – the center of sharp suppuration in hypodermic and fatty cellulose with indistinct contours developing against the background of abstsediruyushchy lymphadenitis. Most often the adenoflegmona occurs in parotid and submaxillary areas at children. It is clinically shown by a manifest tumor, flyuktuiruyushchy when pressing, with hyperemic skin in the central part, rather dense, painful at a palpation. The general condition of the patient is characterized by intoxication symptoms. Diagnostics taking into account typical clinic does not cause difficulties, carry in addition out ultrasonography of soft fabrics, blood tests, a punktata. Treatment of an adenoflegmona consists in immediate surgery.
Adenoflegmona – the acute purulent inflammation of hypodermic and fatty cellulose of abstsediruyushchy character which is closely connected with purulent processes in regionarny lymph nodes (lymphadenitis). More than 21% of all maxillofacial pathologies fall to the share of an adenoflegmona, other localization meets much less often. Pathological process more often at children develops, has no gender coloring, is not endemic. It should be noted that in studying of an adenoflegmona the big role was played by the scientists belonging to domestic school of dermatology. In 1938 A. Abrikosov gave the harmonious theory of emergence of an adenoflegmona, I. Rufanov added and developed the theory of pathogenesis of a disease in 1960. Relevance of the matter at the present stage is caused by sharpness of purulent process which strikes newborns, of children of preschool age and poses real threat for their life because of development of septic complications. At adult patients of an adenoflegmon can be the reason of development of sepsis, osteomyelitis.
The purulent inflammation of hypodermic and fatty cellulose, as well as any other purulent inflammation, has the clear reason. It is external or internal infection, most often kokkovy flora. As a result of decrease in protective forces of an organism of exogenous and endogenous character (the focal and perifokalny infection, especially in the field of almonds, a mouth, kidneys, the postponed disease, traumatizing skin, is more often post-injection, piokokkovy defeat terms) the anti-infectious barrier of lymph nodes decreases.
Usually lymph nodes and lymphatic vessels together with venous system provide natural outflow of liquid from fabrics and bodies. At an inflammation it plays a crucial role as at early stages of development of process the lymph flow is slowed down, permeability of vessels increases, conditions for accumulation of microbes in lymph nodes where there is an absorption of pathogenic flora cages of reticuloendothelial system, splitting of the remains of microorganisms, their emission in blood system where they as a result of antibacterial therapy perish are created. If the inflammation accrues, lymphatic vessels trombirutsya, block outflow, blocking distribution of inflammatory process. On this background microbes from lymph nodes filter into nearby fabrics, causing in them an inflammation and forming an adenoflegmona.
Classification of an adenoflegmona
Adenoflegmona it is accepted to distinguish on localization of inflammatory process. Are most significant on sharpness of a current and possible consequences:
- adenoflegmona of the lower jaw and chin – the most widespread option;
- adenoflegmona of a neck – a consequence of violations of personal hygiene of an oral cavity, auricle, a hairy part of head skin;
- adenoflegmona of inguinal area – result of overcooling;
- adenoflegmona of axillary area – a consequence of infection of microinjuries of skin;
- adenoflegmona of parotid area – a septic complication.
Clinical manifestations of an adenoflegmona divide into the general, peculiar to all versions, and local, characterizing only this or that form. Temperature reaction, feeling of weakness, weakness, block, the accruing symptoms of intoxication of an organism, an aggravation of the chronic centers of an infection belongs to the general symptoms. On this background the tumor close to regionarny lymph nodes develops. It dense to the touch, flyuktuiruyushchy in the center, painful at a palpation. At further progressing of process the tumor abstsedirutsya, opened, or there is a septic dissimination of process. Often such tumor is formed in the place of an injection.
Symptoms, the corresponding kinds of an adenoflegmona, depend on localization of process and have features. Adenoflegmone precedes submaxillary area dental intervention (for example, removal of a wisdom tooth), regionarny lymphadenitis. When forming an adenoflegmona are observed pain when swallowing, opening a mouth, the speech is violated. Adenoflegmona of a neck is formed against the background of the general decrease in immunity that leads to activization and reproduction latentno existing on skin of a hairy part of head skin and in an oral cavity of pathogenic microbes, especially at errors in hygiene. As the trigger of development of a disease serves the accumulation of critical quantity of bacteria transferring latent process to development of the center of a kokkovy infection.
Development in a groin – the investigation of the inattentive, irresponsible attitude towards the health. They result from periodic long overcoolings, defiant uretrit, cystitis, an inflammation of bodies of a small pelvis. The arisen infection so a rezistentna to the carried-out therapy that there occurs synchronization of an inflammation, an abstsedirovaniye of inguinal lymph nodes. Infertility happens an outcome often.
Localization of an adenoflegmona in an axillary pole is caused by entering of an infection from the centers of an inflammation located on the top extremity. The graze from shaving can aggravate process. The congestion of lymph nodes and large arteries in an axillary hollow is the reason causing migration of microbes to the area of an armpit. The tumor easily is distinguished, but at insufficiently serious attitude towards her suppurates, becomes the sepsis reason. Adenoflegmona of parotid area most often is a consequence of a septic complication of phlegmon of a neck, is characterized by pain during the swallowing and a palpation of an auricle.
Diagnostics and treatment of an adenoflegmona
The clinic and the anamnesis of a disease are typical. In addition use ultrasonography of soft fabrics, radiodiagnosis for the purpose of an exception of osteomyelitis, a tumor, a cyst. OAK, OAM, blood biochemistry, blood test on sterility is obligatory. For purpose of etiopatogenetichesky therapy use crops of a punktat of the purulent center on nutrient mediums with the subsequent definition of sensitivity to an antibiotic. Differentiate a purulent inflammation with phlegmon (the surgery choice), tuberculosis, actinomycosis, osteomyelitis, periadenity, inflammatory infiltrate, osteophlegmon. Purulent surgeons are engaged in treatment of pathology.
Therapy of a disease complex. Sharpness of process dictates need of carrying out urgent surgical intervention in the conditions of a hospital. Make opening and drainage of phlegmon. The wound is conducted in the open way with washing, introduction of antibiotics and enzymes, bandagings. Appointment of antibacterial, anti-inflammatory, dezintoksikatsionny therapy as the post-operating room is obligatory. Connect means for the general strengthening of an organism (vitamin therapy) and increases in immunity (immunostimulators, immunomodulators). It is necessary to carry out sanitation of all centers of a chronic infection. Prevention consists in timely diagnosis and treatment of chronic infections, immunity strengthening. The forecast at timely diagnostics and treatment favorable.