Adenophlegmon is a focus of acute suppuration in subcutaneous fat with blurred contours, developing against the background of abscessing lymphadenitis. Most often, adenophlegmon occurs in the parotid and submandibular areas in children. It is clinically manifested by a manifest tumor fluctuating under pressure, with hyperemic skin in the central part, quite dense, painful on palpation. The general condition of the patient is characterized by symptoms of intoxication. Diagnosis, taking into account a typical clinic, does not cause difficulties, soft tissue ultrasound, blood tests, punctate backposev are additionally performed. Treatment of adenophlegmon consists in immediate surgical intervention.
Adenophlegmon is an acute purulent inflammation of the subcutaneous adipose tissue of an abscessing nature, closely associated with purulent processes in regional lymph nodes (lymphadenitis). Adenophlegmon accounts for more than 21% of all maxillofacial pathologies, other localization is much less common. The pathological process develops more often in children, has no gender coloring, is non-endemic.
It is worth noting that scientists belonging to the Russian school of dermatology played an important role in the study of adenophlegmon. A. Abrikosov gave a coherent theory of the occurrence of adenophlegmon in 1938, and I. Rufanov supplemented and developed the theory of the pathogenesis of the disease in 1960. The relevance of this issue at the present stage is due to the severity of the purulent process, which affects newborns, preschool children and poses a real threat to their lives due to the development of septic complications. In adult patients, adenophlegmon can cause the development of sepsis, osteomyelitis.
Causes of adenophlegmon
Purulent inflammation of subcutaneous fat, like any other purulent inflammation, has a clear cause. This is an external or internal infection, most often with coccoid flora. As a result of a decrease in the body’s defenses of an exogenous-endogenous nature (focal and perifocal infection, especially in the area of the tonsils, oral cavity, kidneys, past illness, skin injury, more often post-injection, pyococcal lesion of the dermis), the anti-infective barrier of lymph nodes decreases.
Adenophlegmon of the submandibular region is preceded by dental intervention (for example, wisdom tooth extraction), regional lymphadenitis. The adenophlegmon of the neck is formed against the background of a general decrease in immunity, which leads to the activation and multiplication of latent pathogenic microbes existing on the skin of the scalp and in the oral cavity, especially with errors in hygiene. The trigger for the development of the disease is the accumulation of a critical number of bacteria, which translates the latent process into the development of a coccoid infection focus.
The development of adenophlegmon in the groin is a consequence of an inattentive, irresponsible attitude to one’s health. They occur as a result of periodic prolonged hypothermia, causing urethritis, cystitis, inflammation of the pelvic organs. The infection that has arisen is so resistant to the therapy that there is a chronization of inflammation, abscess of the inguinal lymph nodes. The outcome is often infertility.
The localization of adenophlegmon in the axillary fossa is due to the introduction of infection from the foci of inflammation located on the upper limb. An abrasion from shaving can aggravate the process. The accumulation of lymph nodes and large arteries in the armpit is the cause causing the migration of microbes to the armpit area.
Usually, lymph nodes and lymphatic vessels together with the venous system provide a natural outflow of fluid from tissues and organs. In case of inflammation, this plays a crucial role, because in the early stages of the development of the process, lymph flow slows down, vascular permeability increases, conditions are created for the accumulation of microbes in the lymph nodes, where pathogenic flora is absorbed by the cells of the reticular-endothelial system, the splitting of the remnants of microorganisms, their release into the circulatory system, where they die under the influence of antibacterial therapy.
If the inflammation increases, the lymphatic vessels are thrombosed, block the outflow, blocking the spread of the inflammatory process. Against this background, microbes from lymph nodes seep into nearby tissues, causing inflammation in them and forming adenophlegmon.
Adenophlegmons are usually distinguished by the localization of the inflammatory process. The most significant in terms of the severity of the current and possible consequences:
- adenophlegmon of the lower jaw and chin is the most common variant;
- adenophlegmon of the neck is a consequence of violations of personal hygiene of the oral cavity, auricle, scalp;
- adenophlegmon of the inguinal region is the result of hypothermia;
- adenophlegmon of the axillary region is a consequence of infection of microtrauma of the skin;
- parotid adenophlegmon is a septic complication.
Symptoms of adenophlegmon
Clinical manifestations are divided into general, characteristic of all varieties, and local, characterizing exclusively one or another form. Common symptoms include a temperature reaction, a feeling of weakness, weakness, lethargy, increasing signs of intoxication of the body, exacerbation of chronic foci of infection. Against this background, a tumor appears located next to the regional lymph nodes. It is dense to the touch, fluctuating in the center, painful on palpation. With further progression of the process, the tumor is abscessed, opened, or septic dissymination of the process occurs. Often such a tumor forms at the injection site.
The symptoms corresponding to the type of adenophlegmon depend on the localization of the process and have features. During the formation of submandibular adenophlegmon, pain is observed when swallowing, opening the mouth, speech is disturbed. Adenophlegmon of the neck is manifested by a painful tumor in the area of the lateral surface of the neck, difficulty and soreness of turning and tilting the head. Parotid adenophlegmon is most often a consequence of septic complications of neck phlegmon, characterized by pain when swallowing and palpation of the auricle.
Advanced adenophlegmon of the maxillofacial region and neck can cause life-threatening complications, including mediastinitis, cavernous sinus thrombosis, meningitis. With the spread of a highly virulent infection, the development of sepsis is not excluded. Adenophlegmons in children are prone to particularly rapid generalization of the infectious process, therefore their treatment should be carried out only in stationary conditions.
The clinic and anamnesis of the disease are typical. Additionally, soft tissue ultrasound, X-ray diagnostics are used to exclude osteomyelitis, tumors, cysts. Mandatory blood test, urine analysis, blood biochemistry, blood test for sterility. To prescribe etiopathogenetic therapy, crops of a purulent focus punctate on nutrient media are used, followed by determination of sensitivity to an antibiotic. Purulent inflammation is differentiated with phlegmon (choice of surgical intervention), tuberculosis, actinomycosis, osteomyelitis, periadenitis, inflammatory infiltrate, osteophlegmon. Purulent surgeons are engaged in the treatment of pathology.
Treatment of adenophlegmon
The therapy of the disease is complex. The severity of the process dictates the need for urgent surgical intervention in a hospital setting. The phlegmon is opened and drained. The wound is carried out in an open way with washing, administration of antibiotics and enzymes, dressings. It is mandatory to prescribe postoperative antibacterial, anti-inflammatory, detoxification therapy. Connect funds for general strengthening of the body (vitamin therapy) and improving immunity (immunostimulants, immunomodulators). It is necessary to sanitize all foci of chronic infection.
Prognosis and prevention
The prognosis with timely diagnosis and treatment is favorable. In advanced cases, septic complications may develop, including fatal ones. Prevention consists in timely diagnosis and treatment of chronic infections, strengthening immunity. At the first signs of infectious inflammation of the lymph nodes, it is necessary to contact medical specialists for qualified help.