Overview General symptoms of inflammation Clinical manifestations of inflammation Differential diagnosis Causes Spectrum of bacterial therapy Prevalence of different abscesses Classification of abscesses
Overview General symptoms of inflammation Clinical manifestations of inflammation Differential diagnosis Causes Spectrum of bacterial therapy Prevalence of different abscesses Classification of abscesses
Inflammation is a defence reaction of the organism to local injuries of any type, to infection. Infection is a pathological state resulting from the invasion of the body by pathogenic microorganisms and their proliferation within the organism.
Inflammation is a defence reaction of the organism to local injuries of any type, to infection. Infection is a pathological state resulting from the invasion of the body by pathogenic microorganisms and their proliferation within the organism.
Loss of function (trismus, difficult to swollow speech)
Additional: leucocytosis and CRP increasis
CRP (C-reactive protein) is synthesised in the liver. It is one of the chemical mediators of inflammation and its serum level increases faster and to higher levels than that of any other parameters in acute infectious and non-infectious inflammation.
CRP (C-reactive protein) is synthesised in the liver. It is one of the chemical mediators of inflammation and its serum level increases faster and to higher levels than that of any other parameters in acute infectious and non-infectious inflammation.
Therefore, CRP belongs to the group of acute-phase proteins. These are blood lipids the concentration of which increases in the course of inflammatory diseases.
CRP binds to invading foreign substances and activates important steps of the immune system with macrophages and the complement system. Due to its relatively short half-life of 24 hours, changes in CRP concentration indicate changes in the inflammatory process.
submucous abscess, smooth vestibule Localized collection of pus an a cavity caused by necrosis of tissue due to bacterial infection
submucous abscess, smooth vestibule Localized collection of pus an a cavity caused by necrosis of tissue due to bacterial infection
Demarcation by abscess mambrane (granulation tissue)
Firm elastic consestence
Fluctuation can be palpated only in superficial abscesses
Oedematous swelling of the ocular region in abscess of the canine fossa concomitant oedema of the upper lip in submucous abscess in region 11 accumulation of fluid in tissue
Oedematous swelling of the ocular region in abscess of the canine fossa concomitant oedema of the upper lip in submucous abscess in region 11 accumulation of fluid in tissue
classic sign of any acute inflammation (tumour) soft and elastic on palpation. Due to the anatomical situation in the maxillofacial region, the typical fluctuation of an abscess is absent in the majority of cases or only rarely identifiable
swelling caused by neoplasms (sarcomas, malignant lymphomas, carcinomas)
swelling caused by neoplasms (sarcomas, malignant lymphomas, carcinomas)
salivary gland diseases
diffusely spreading inflammation between superficial tissue levels (without being limited to them)
diffusely spreading inflammation between superficial tissue levels (without being limited to them)
No demarcation
infection by highly virulent bacteria (release of lytic enzymes)
impaired defence mechanisms of the organism serous-purulent and necrotising inflammation
In 92-94% of the cases, infections in the oro-maxillofacial region are of odontogenic origin
Periapical periodontitis
Infection after teeth extraction
difficult dentition (pericoronitis)
Marginal priodontitis
infected retained root fragments
Odontogenic infections are always caused by a mixed flora of aerobic and anaerobic bacteria.
Odontogenic infections are always caused by a mixed flora of aerobic and anaerobic bacteria.
The count of anaerobic bacteria always outnumbers that of aerobic bacteria (at least by 102).
Pure anaerobic mixed infections also occur. Anaerobic bacteria play a predominant role in the generation and spreading of odontogenic soft tissue infections. Infection by clostridia as well as mixed infections by yeasts and bacteria may occur
The following statement that Galen made almost 2,000 years ago - "ubi pus, ibi evacua" (if there is pus, remove it) which is still valid in the era of antibiotics could be considered the clinical conclusion from the abscess pathophysiology explained above. Therefore, incision and drainage are the primary therapy of an phlegmonas
The following statement that Galen made almost 2,000 years ago - "ubi pus, ibi evacua" (if there is pus, remove it) which is still valid in the era of antibiotics could be considered the clinical conclusion from the abscess pathophysiology explained above. Therefore, incision and drainage are the primary therapy of an phlegmonas
Incision of an abscess is advisable, possibly by a sufficiently wide incision at the maximum point of the swelling.
Incision of an abscess is advisable, possibly by a sufficiently wide incision at the maximum point of the swelling.
Obtain sufficient discharge of pus with the incision. Prepare for drainage of the purulent exudate
In smaller abscesses, it is usually sufficient to insert a Iodoform gauze packing strip for 2-3 days; extensive abscess cavities are drained through a tube that is fixed in place with sutures
Antibiotics for parenteral therapy Infections are classified as mild, moderate or severe infections. Differential surgical and antibiotic treatment is indicated according to the extension tendency and severity grade of infection as well as the general condition of the patient.