Phlegmon parotid

- purulent spilled inflammation of the subcutaneous, submucosal and interfacial tissue of the maxillofacial region. 

Etiology: streptococci, staphylococci, dental spirochetes, anaerobes. Pathogenesis is associated with the state of lymphatic outflow and venous flow of tissues, infection in the deep layers of soft tissues, and the state of allergic and non-specific reactivity of the body. The development of phlegmon is often preceded by osteomyelitis of the jaw, acute peritoneal diseases of the teeth, lymphadenitis, etc.

Symptoms. Sharp pain when chewing, impaired mobility of the jaw (trizm), breathing, speech, difficulty swallowing, salivation, facial asymmetry. Spilled, dense, painful on palpation swelling of the face on the side of the lesion, the skin is glossy, does not gather in a fold. Symptoms of intoxication are expressed — weakness, sweating, chills, rapid pulse and breathing. In the blood, a shift to the left, neutrophilic leukocytosis, ESR is sharply increased. The body temperature of 39-40°C. 

The course may be complicated by asphyxia, facial vein thrombosis, meningitis, mediastinitis, sepsis, etc. 

Surgical treatment: wide incisions and opening of a deep focus by blunt means. General anaesthesia or injection, novocaine in combination with the introduction of 1 ml of 1% solution of morphine, omnopone or promedol. The purulent focus is drained with rubber or gauze strips. Enter large doses of broad-spectrum antibiotics, sulfonamides, hemodesis, glucose solution in/in, anti-streptococcal serum, gamma globulin, polyglucin, ringer's solution. 

In the putrefactive process-anti-gangrenous polyvalent serum (administered Occasionally); with phlegmon of the neck, bottom of the mouth, near-pharyngeal — sometimes tracheotomy. 

Conservative treatment (antibiotics, dry heat, UHF therapy) is prescribed in the initial stages of the process with a relatively satisfactory overall condition.

The prognosis for radical opening of the abscess and intensive antibiotic therapy is usually favorable, for putrid phlegmons and delayed treatment - doubtful.

Prevention is the same as for parotid abscess.