Abscess on the tongue - what is dangerous about an abscess in the mouth and how to remove it

Abscess on the tongue - what is dangerous about an abscess in the mouth and how to remove it without consequences

Tongue abscess is a serious pathological condition, which is characterized by the appearance of a purulent neoplasm against the background of rapid spread of inflammation. In this case, the patient begins to experience severe malaise, the body temperature may rise sharply, and the organ itself will become swollen, which will result in problems with diction, eating, and even breathing. As part of the diagnosis, the doctor may suggest performing a puncture to find out more about the contents of the abscess. Today we’ll talk about the reasons why a purulent process can begin to develop, what accompanying symptoms are characteristic of this condition, and what methods of treating an abscess are used today.

Features of a purulent abscess

An abscess on the oral mucosa is a kind of abscess, which is characterized by severe inflammation and the formation of purulent masses. Gradually, it leads to the death of living tissue, and in an advanced stage it is accompanied by a general deterioration in the patient’s condition and the appearance of severe pain during talking, chewing food and even breathing. Obviously, this pathology can provoke very serious consequences for the body as a whole, so under no circumstances should an abscess in the oral cavity be ignored.

The photo shows a tongue abscess

An abscess of the root of the tongue, as, in fact, of any other part of this organ, is quite readily treatable, but requires an integrated approach to solving the problem. It is important to understand here that the sooner inflammation is detected, the easier and faster it can be eliminated. The pathology in question has a serious impact on the overall health and immunity, so do not hesitate with treatment.

Oral abscess - symptoms and treatment

Symptoms of oral abscesses are variable and depend directly on the type and location of the abscess. In acute purulent periostitis, patients complain of pain in the area of the causative tooth or jaw segment, swelling of the soft tissues. The face of such a patient is asymmetrical.

When the causative tooth is localized in the frontal part of the upper jaw, the swelling is located in the upper lip and infraorbital region, the nasolabial fold is smoothed. If the diseased tooth is located in the frontal region of the lower jaw, swelling of the soft tissues is noted in the area of the lower lip and chin. When the causative tooth is located in the lateral part of the dentition, perifocal edema (near the infectious focus) is located in the buccal region.

Acute purulent periostitis is usually not accompanied by restrictions in mouth opening. Palpation of regional lymph nodes often reveals signs of acute lymphadenitis (enlarged lymph nodes). When examining the oral cavity, the causative tooth is identified, which usually reacts sharply to tapping (percussion). This is explained by the presence of a pathological process behind the root apex. When examining the vestibule of the oral cavity, a painful inflammatory infiltrate is determined, over which there is an edematous and hyperemic (red) mucous membrane. According to the literature, periostitis is most often located on the side of the cheek or lips, less often on the palatal and lingual side [5][8].

Often abscesses of the maxillo-lingual groove, buccal region, and pterygomaxillary space are considered as a complication of acute purulent periostitis. However, in some cases these diseases develop independently, so there is no reason not to consider them in this review.

Abscess of the maxillo-lingual groove is characterized by a more serious course. The patient complains of pain when swallowing, moving the tongue to the sides, and limited mouth opening. A visual examination reveals swelling of the submandibular area and acute lymphadenitis. Examination of the oral cavity is often difficult and is only possible after blocking the motor branches of the mandibular nerve. When examining the oral cavity, acute or aggravated periodontitis of the chewing tooth of the lower jaw or difficult eruption of the lower wisdom tooth is determined. When examining the maxillo-lingual groove, its bulging is determined; upon palpation, an inflammatory, sharply painful infiltrate can be detected.

With an abscess of the pterygomaxillary space, the patient notes an increase in body temperature, pain in the pharynx, difficulty swallowing, mouth opening is limited, in some cases almost impossible. Visually, perifocal edema is often absent. An examination of the oral cavity can be carried out only after blocking the motor branches of the mandibular nerve. In the oral cavity, difficult eruption of the lower wisdom tooth is usually detected, as well as a hyperemic and edematous pterygomandibular fold.

The clinical picture of an abscess in the buccal region largely depends on the depth of the abscess. With a superficial abscess, hyperemia (redness) of the skin, a local increase in temperature, the skin is tense and does not fold. With a medium and deep location, there is pronounced swelling of the buccal area, the skin is not externally changed, it is difficult to fold into a fold. Local hyperthermia (increased temperature) is usually not observed. When the abscess is deeply located on the mucous membrane of the cheek, marks from teeth are detected.

The condition of patients with these abscesses is usually assessed as moderate. Treatment is usually carried out in a maxillofacial surgery hospital under supervision in order to prevent the development of severe complications. Patients often exhibit symptoms of general intoxication of the body (fever, headaches and muscle pain).

Reasons for the formation of an abscess on the tongue

Most often, the formation of a purulent focus on the body and the root of the tongue in particular becomes a consequence of mechanical or thermal effects. Damage opens a direct path for the penetration and spread of bacterial infection. As practice shows, the formation of an abscess is often preceded by injury to the mucous membrane with sharp fish bones.

“In my case, the abscess was generally the result of my passion for dried vobla! Once again I accidentally scratched the edges of my tongue, then it turned red, began to hurt, and one fine morning I discovered a small abscess on it. I was scared, of course, and immediately made an appointment with a doctor. Fortunately, everything worked out without surgical intervention. The doctor prescribed rinsing with chlorhexidine.”
Anna Semenova, 43 years old, Omsk, from correspondence on the forum www.32top.ru

Quite often, the oral mucosa is injured by sharp edges of teeth or crowns, as well as worn-out prosthetic structures and incorrectly adjusted orthodontic devices for correcting the bite. Patients suffering from periodontitis, ulcerative stomatitis, and acute tonsillitis are also at risk. In this case, pathogenic bacteria can spread from the source of chronic infection in the oral cavity. Thus, to date, experts in the field of dentistry have identified the following main reasons for the development of pathology:

penetration of infection, staphylococci and streptococci,
trauma to the mucous membrane,
imbalance of oral microflora,
dental diseases,
glossitis,
stomatitis,
tonsillitis.

Trauma to the tongue can cause an abscess.
It should also be noted that quite often an abscess develops after a burn as a result of consuming too hot food or drinks. Infection can also appear through fresh scratches from hard foods or sores caused by eating spicy or salty foods.

What is it and why does it happen

This disease is a local acute inflammatory process in the oral cavity, which is characterized by the accumulation of pus in the tissues of the gums, teeth or palate. Lack of timely and correct treatment can lead to a transition to a chronic form or cause such serious complications as the appearance of phlegmon or sepsis.

The causes of this disease are the presence of problems with the gums (gingivitis), with the roots of the teeth and adjacent tissues (periodontitis), with the enamel and hard surface (caries), as well as various mechanical injuries, infection, and chronic diseases. People suffering from diabetes and immune diseases are at increased risk of becoming acquainted with this unpleasant disease.

If your tooth is cracked, the roots are exposed, deep cavities appear, do not wait for an abscess to develop - be sure to visit the doctor at our dental clinic in Lyublino, because untreated caries is the main reason for the development of the inflammatory process.

In our clinic you can get a free dental consultation!

Characteristic symptoms

The pathology is characterized by a fairly rapid pace of development. Based on where exactly the neoplasm is localized, experts distinguish between deep and superficial forms of abscess. Let's look at each of them in more detail.

Surface view

In this case, an abscess occurs on the back of the organ. The person experiences acute pain during swallowing, which often radiates to the ear. As part of a visual examination, noticeable swelling of the mucous membrane can be detected; when touched, a compaction can be clearly felt. Such an abscess can open without outside help, but in any case professional treatment is necessary.

Deep view

This is a more dangerous form of pathology, in which purulent processes develop in the thickness of the tissues of the organ. Experts include the following conditions as associated symptoms:

general weakness,
poor appetite
restless sleep due to constant painful sensations,
tachycardia,
heat,
enlarged lymph nodes,
increased salivation,
severe swelling of the organ, acute pain,
blue mucous membranes, formation of gray plaque,
the appearance of bad breath.

The main danger is that when an abscess develops, the tongue greatly increases in size. As a result, problems arise not only with speech, but also with breathing.

What types are there

Depending on the location of the source of inflammation in the oral cavity, abscesses can be localized to:

Gums One of the most common types, it forms around the inflamed soft tissues of a certain tooth, without proper treatment it becomes chronic. During an exacerbation, bad breath appears, accompanied by the discharge of pus and general weakness;
Palate Usually occurs with periodontitis located in the teeth of the upper jaw, quickly spreads to other tissues, and can cause the development of osteomyelitis (bone necrosis);
Cheeks A very dangerous type of inflammation, if left untreated there is a risk of inflammation spreading to the skin of the face. It affects the inside, and it is possible that the outside of the cheek can also be affected. A possible reason for the appearance is infection in the smallest wounds when biting the mucous membrane with teeth.
Floor of the mouth Placed under the tongue, characterized by severe pain when eating or talking. An abscess that spontaneously opens can further spread the infection through the throat to other organs of the body;
On the tongue, the surface thickens and swells. There is redness, it hurts to eat, talk and even just breathe. This type of inflammation causes a feeling of suffocation and lack of air, and therefore requires urgent hospitalization.

How is diagnostics carried out?

At the first appointment, the doctor is obliged to ask the patient about all the symptoms that worry him. He also needs to find out the circumstances under which the mucous membrane was injured. Next, the specialist sends the patient for blood tests, since the formation of an abscess usually causes a significant increase in the level of leukocytes and ESR.

For diagnosis, a blood test is required.

In order to identify the pathogen, bacterial culture is performed. The patient may also be referred for an X-ray examination, which will help detect the source of the infection, especially if there are complications. Competent diagnosis makes it possible to distinguish between diseases such as tongue abscess and Ludwig's tonsillitis, lymph node abscess, lymphadenitis.

Cellulitis and abscesses of the maxillofacial zone: insidious complications

Go back I would immediately like to warn the reader against the desire to make a diagnosis “with one’s own hand.” Even if it seems to you that all the symptoms are the same, there is not a single reason to think that you or your loved one have an abscess, but there is not a single argument to put off going to the doctor, because where inflammation is involved , the beloved “maybe it will pass” by all of us acquires unsafe features. But if the patient is in the hands of an experienced doctor, most likely everything will end well. First, a few words about what an abscess and phlegmon of the facial part are and how they differ.

Cellulitis (spread purulent formation) can develop as a result of an acute inflammatory process in any part of the body. According to the location, the maxillofacial and cervical spine are in first place for the formation of purulent foci. In recent years, there has been an unfavorable tendency towards the complication and severity of such inflammatory processes. Mediastinitis, thrombosis of the facial veins, cerebral sinuses, sepsis - these can be the consequences of advanced inflammation.

An abscess is distinguished from phlegmon in the following way: the abscess is separated by a pyogenic membrane - the inner wall of the abscess, it is lined with granulation tissue. The membrane helps to differentiate the purulent process from adjacent tissues and produces exudate. The granulation barrier is a manifestation of the body’s normal protective reaction. In the tissues of the maxillofacial region, the membrane is usually thin and cannot always be clearly seen in the image.

Abscesses and phlegmons of the maxillofacial region are classified according to the source of infection:

Odontogenic – those caused by gangrenous teeth and their roots;
Intraosal – resulting from osteomyelitis, periostitis, sinusitis, cyst formation, complicated problematic eruption of “late” teeth;
Gingival – consequences of periodontitis, gingivitis;
Rhinogenic, otogenic - the organs of the nasopharynx or ear are involved in inflammation.

Clinical manifestations

At the beginning of the disease, you may notice swelling of the inflamed area and slight redness. Pain on palpation increases in proportion to the intensification of the inflammatory process. If the purulent-inflammatory process is located in the deep layers of the facial zone, then inflamed skin may not be observed. Clinical symptoms will be moderate and in the case of low-grade inflammation. This feature is characteristic only of abscesses. Unlike an abscess, phlegmon does not have a membrane. A diffuse purulent formation has the same clinical manifestations, but their severity is much more intense. The inflamed area of the skin is hyperemic, painful, and the patient experiences a general increase in body temperature. This is due to a painful dense diffuse infiltrate. As a rule, there are complications with the function of swallowing and chewing. If the occurrence of an abscess or phlegmon of the oral cavity is preceded by microbial sensitization of the body to staphylococcus, streptococcus, E. coli and other microorganisms, then the development of inflammation occurs at a rapid pace and is characterized by aggressiveness. Differential diagnosis in this case will be complicated. The clinical picture is high levels of ESR, leukocytes, anemia, neutrophil shift to the left.

Manifestations of abscess and phlegmon of the facial part caused by anaerobic infections are severe even in the case of sufficient drainage. An unsafe complication of such diseases is septic shock. And here everything depends on the timeliness of the treatment started.

Treatment

In acute inflammatory processes accompanying such a serious disease as an abscess or phlegmon of the maxillofacial area, it is very important to choose the right treatment in time, which will be determined by many factors. This is a complex of serious, irreplaceable procedures of a local and general nature.

Among the main treatment methods:

Surgery and opening of the abscess, removal of the source of infection, drainage and rinsing with antiseptic solutions;
Antibiotic therapy. The antibiotic is selected by the doctor only after studying the nature of the inflammation and testing the sensitivity of the infection to the antibiotic; the possible presence of an allergy to a particular antibiotic is also taken into account;
Immuno-stimulating drugs are especially important in cases where antibiotic therapy is not sufficiently effective, such as for serous formations caused by anaerobic infection;
Detoxification therapy;
Physiotherapy (more often used in the last, postoperative phase of treatment) with the use of medications.

Treatment of such inflammations is long and not always pleasant. Nowadays, the range of high-quality drugs used in purulent surgery is quite wide. Only comprehensive and timely treatment gives maximum effect in cases of complications such as phlegmon and abscess.

For consultations at the KIITOS dental clinic, please contact the administrators.

Possible complications

The pathological condition under consideration, especially if the formation of an abscess occurs at the very root of the organ, is fraught with serious consequences for the entire organism as a whole. If treatment is not started in time, the abscess may well result in serious complications. Thus, in advanced stages it is often accompanied by purulent inflammation of the tissue - the formation of phlegmon, the occurrence of sepsis and severe intoxication of the body, and this, in turn, can lead to death.

Treatment of tongue abscess

Conservative therapy involves taking antibiotics and rinsing with antiseptic agents, such as Furacilin or Chlorhexidine. However, such treatment can be effective only at the earliest stage of pathology development. If the situation is advanced, immediate surgical intervention will most likely be required. The dentist will perform an emergency opening of the abscess, thereby preventing further spread of the infection. If a purulent neoplasm has formed deep at the base of the organ, the doctor may perform an autopsy from the outside under the chin. After removing purulent discharge, the specialist will thoroughly rinse the cavity using antibiotics and proteolytic enzymes1.

In some cases, surgery is performed to remove the pus.

In the most advanced cases, when the patient is already experiencing serious breathing difficulties, a tracheotomy is performed. The patient is prescribed antibiotics, anti-inflammatory drugs and antihistamines. To strengthen the body's defenses, it is recommended to take multivitamin complexes and regularly rinse the mouth with antiseptics, including decoctions of medicinal herbs - chamomile and sage. It is important to understand here that the use of any pharmaceutical drugs and traditional medicine must be agreed upon with the attending physician.

Prognosis and prevention

The success of treatment largely depends on how deeply the infection has spread and how quickly the person receives medical care. If an abscess is diagnosed in a timely manner, the likelihood of a favorable outcome will be at the highest level - the disease can be cured in just a couple of weeks. If the problem is neglected, the situation may result in the development of phlegmon and sepsis. To prevent the appearance of an abscess on the tongue, including relapses, it is enough to follow the recommendations of doctors:

pay close attention to oral hygiene, brush your teeth and tongue twice a day,
minimize the consumption of too spicy and salty foods,
take care of the condition of the oral cavity, try not to injure the mucous membrane with foreign objects,
in case of accidental damage, you should thoroughly rinse your mouth with water and an antiseptic solution, and also, just in case, consult a specialist to eliminate the risk of infection of the wound,
strengthen the immune system - a healthy lifestyle, frequent walks in the fresh air, sports and proper nutrition,
systematically visit the dentist for preventative care.

Preventive examinations with a dentist will help you avoid problems.
If you detect any suspicious changes in the condition or appearance of the oral cavity, you should definitely consult a doctor for advice. It is better to waste your time and go to a specialist than to undergo long and grueling treatment.

Home remedies

To speed up the wound healing process after treatment, you can resort to proven home methods. Here it should immediately be noted that their use is justified only if the attending physician has given his consent. Here are some reliable tips:

rinsing with a light saline solution at the rate of 2 teaspoons per glass of water at room temperature,
treating wounds with a solution of hydrogen peroxide or Chlorhexidine,
applying a piece of ice to relieve acute inflammation.

Tongue abscess is a disease that is inevitably accompanied by very unpleasant symptoms. A general deterioration in health, high temperature, pain, problems with speech and breathing are only a small part of what the development of such a serious and dangerous phenomenon in an advanced stage entails. To prevent the situation from worsening, consult a doctor immediately when the first signs of pathology appear.

Vernadsky Yu.I. Fundamentals of maxillofacial surgery and surgical dentistry, 2003.

Ultrasound examination of the maxillofacial area

SonoAce Ultrasound Magazine

Contains current clinical information on ultrasonography and is aimed at ultrasound doctors, published since 1996.
The ultrasound research method has become firmly established in general diagnostic practice; its role can hardly be overestimated. A modern approach to diagnosing diseases in the clinic of internal medicine is unthinkable without ultrasound examination of the abdominal organs (including the retroperitoneum and pelvis), thyroid gland, mammary glands, heart and blood vessels.

Compared to the above-listed areas of application of echography, ultrasound examination of the maxillofacial area is performed much less frequently. This is due, on the one hand, to the clinical isolation of dentistry and maxillofacial surgery, which does not allow general practitioners of ultrasound diagnostics to gain sufficient experience in research in this area, and on the other hand, to some conservatism of dentists and maxillofacial surgeons, who consider the main diagnostic tool for them to be X-ray examination method. Their skepticism regarding ultrasound examination is based on the fact that almost all soft tissue structures of the maxillofacial region are accessible to palpation, and the skin and mucous membranes are accessible to inspection.

However, paying tribute to the history of the development of ultrasound diagnostics, it is necessary to mention that the object of the very first (then still one-dimensional - in A-mode) echographic studies performed by a group of researchers led by D. Howry in 1955 were the parotid glands.

Ultrasound of soft tissues of the face and neck in its modern version does not require the use of any special ultrasound scanners or sensors and can be performed on equipment designed for studying peripheral structures: linear sensors with an oscillation frequency of 5.0-7.5-9 are quite sufficient .0 MHz. Transcutaneous echography is quite informative and generally satisfies the needs of clinicians: almost all parts of the face and neck (including the body and root of the tongue) are accessible to echographic examination using external sensors. Only the upper parts of the peripharyngeal space and the pterygomaxillary space, shielded by the branch of the lower jaw, are inaccessible.

There are no age restrictions or special preparation of the patient for an ultrasound examination.

For an ultrasound diagnostic physician, the maxillofacial area can be of great professional interest, since diseases of all nosological groups are found here (from inflammatory, autoimmune and degenerative-dystrophic to tumor), as well as various malformations (angiodysplasia, lymphangiomas, congenital cysts). Differential diagnostic difficulties increase due to the fact that the maxillofacial area is a zone of massive infection and the existence of primary non-inflammatory diseases is often masked by the addition of an inflammatory process with the entire spectrum (from erased to clinically pronounced) of its signs.

The complexity of the anatomical structure of the maxillofacial region creates additional difficulties for interpreting the results of ultrasound examination. At the same time, anatomical detail is of great importance, since determining the organ affiliation of the pathological process and clarifying the topographic and anatomical features of its distribution are one of the most important diagnostic tasks, along with identifying the nosological form of the disease. This point becomes especially relevant if we take into account that during operations specifically on the maxillofacial area, surgeons are especially faced with the task of finding a compromise between choosing the optimal access to carry out the maximum possible radical intervention and causing the least possible aesthetic damage to the patient’s face.

Particular diagnostic issues

Currently, thanks to the introduction of ultrasound diagnostic technologies into obstetric practice, the maxillofacial area becomes an object of medical interest even before the birth of the child. This makes available the intrauterine detection of clefts and other malformations of the fetal face and neck, a number of syndromes with facial signs (Down syndrome, Turner syndrome, Goldenhar syndrome, etc.), as well as recognition of teratomas, hemangiomas and lymphangiomas of the fetus.

Timely detection of these changes forces in some cases to reconsider the approach to pregnancy management tactics or to provide for the need to carry out certain organizational, tactical and therapeutic measures in the perinatal and neonatal periods. This concerns, in particular, the expansion of the obstetric team with the involvement of maxillofacial surgeons to provide specialized care as early as possible.

Ultrasound examination makes a significant contribution to the diagnosis of diseases of the major salivary glands.

In inflammatory diseases of the parotid glands, echography allows for differential diagnosis of various forms of mumps, identifying sialodochitis - inflammation in the ducts of the salivary glands, recognizing inflammation of the intraglandular lymph nodes (lymphadenitis) and clarifying its stage. All this is essentially a distinction between surgical and non-surgical pathology of the parotid glands (Fig. 1-7).

Rice. 1.

Right-sided acute parotitis.

Rice. 2.

Left-sided chronic parenchymal parotitis.

Rice. 3.

Sialodochitis of the left submandibular gland.

Rice. 4.

Acute serous lymphadenitis in the left parotid gland (in two scanning planes).

Rice. 5.

Acute serous lymphadenitis in the left parotid gland with limited periadenitis.

Rice. 6.

Acute serous lymphadenitis with widespread periadenitis (lymphogenous mumps, Herzenberg's mumps) in the left parotid gland.

Rice. 7.

Purulent lymphadenitis in the parotid gland (parotid abscess).

In salivary stone disease, which is most often found in the submandibular glands, ultrasound allows one to identify stones regardless of their location (in the parenchyma of the gland, intraglandular ducts, excretory duct) and the degree of their mineralization, to clarify the presence of sialadenitis - inflammation of the parenchyma of the gland, which can be independent or accompanying salivary stone disease (Fig. 8-11).

Rice. 8.

Salivary stone disease. Calcified calculus in the area of inflection of the excretory duct (typical location) of the left submandibular gland. Associated sialadenitis.

Rice. 9.

Salivary stone disease. Uncalcified calculus in the ampullary part of the excretory duct of the submandibular gland.

Rice. 10.

Salivary stone disease. Calcified stones in the parenchyma of the left submandibular gland. Perifocal edema of the gland parenchyma.

Rice. eleven.

Sialadenitis of the right submandibular gland.

The use of echography in extraorgan inflammatory processes on the face and neck makes it possible to distinguish purulent (abscess, phlegmon) and non-purulent (infiltrate) lesions of soft tissues, and when a purulent lesion is detected, accurately localize accumulations of pus (Fig. 12-14).

Rice. 12.

Infiltration of the left buccal area.

Rice. 13.

Phlegmon of the submandibular region after opening and drainage (drainage is visible).

Rice. 14.

Abscess of the submandibular region.

Visualization of the outer (vestibular) surface of the jaw bones makes it possible to establish periostitis, which is one of the most common causes of inflammatory changes in the soft tissues of the face (Fig. 15).

Rice. 15.

Serous periostitis of the lower jaw on the right. Infiltration in the soft tissues of the right cheek.

The exceptionally developed lymphatic system of the face and neck brings significant specificity to the spectrum of diseases in this area. This applies to both inflammatory and non-inflammatory lesions of the lymph nodes. An echo-graphic study allows one to visualize altered lymph nodes and, based on a number of reference signs (the number of altered nodes, their size, shape and proportions, the nature of the contours, the presence or absence of inclusions and their distribution in the node, the degree of decrease in echogenicity) to reconstruct with a high degree of reliability what is happening in the lymphatic node processes.

In the structure of inflammatory diseases of the soft tissues of the maxillofacial region, inflammatory lesions of the lymph nodes occupy one of the first places. An echographic examination allows one to reliably distinguish reactive (inflammatory) hyperplasia of the lymph nodes from their true inflammation - lymphadenitis (Fig. 16-18).

Rice. 16.

Acute reactive (inflammatory) hyperplasia of the lymph node of the neck.

Rice. 17.

Chronic reactive (inflammatory) hyperplasia of the lymph node of the neck.

Rice. 18.

Acute serous lymphadenitis of the neck.

The key point in choosing a treatment method for lymphadenitis is to determine the nature (stage of development) of the inflammatory process: serous or purulent lesion of the lymph node. Ultrasound examination, even in B-mode, makes it possible to resolve this issue with a high degree of reliability, and the use of blood flow visualization techniques (color Doppler mapping, power Doppler mapping) makes it possible to identify the process of purulent melting at its earliest stage (Fig. 18-21).

Rice. 19.

Purulent lymphadenitis of the neck with periadenitis.

Rice. 20.

Purulent lymphadenitis of the submandibular region.

Rice. 21.

Dopplerographic dynamics of the process of purulent melting of the lymph node (over 3 days).

All this makes it possible to rationally approach the combination of methods of conservative therapy and surgical treatment, to choose adequate treatment tactics, avoiding the use of unjustified treatment methods. In everyday practice, metastatic lesions of the lymph nodes of the neck are often encountered, as well as their involvement in the pathological process in lymphoproliferative diseases. An echographic examination makes it possible to distinguish these groups of diseases with a high degree of reliability and differentiate these types of lesions from inflammatory changes in the lymph nodes.

In case of injury from glass, wooden and plastic objects, as well as after gunshot wounds and road traffic accidents, foreign bodies often remain in the soft tissues of the face and neck, the timely detection of which allows for the most effective primary surgical treatment of the wound and reduces the risk of inflammation.

After gunshot wounds, multiple and, as a rule, metallic foreign bodies usually remain in the soft tissues, the high radiopacity of which allows traditional X-ray examination to see even the smallest of them and determine their skeletotopy. In these cases, echography, of course, is inferior to x-ray examination in determining the number and size of foreign bodies, but ultrasound examination is certainly necessary to clarify their organotopy in relation to soft tissue structures - vascular bundle, muscles and fascia.

In cases where there are glass, plastic or wooden foreign bodies in the soft tissues, echography is essentially the only method that allows you to study the infiltration zone, obtain an image of foreign bodies, determine their number, size, location and organotopy (Fig. 22- 26).

Rice. 22.

Foreign body in the soft tissues of the left parotid-masticatory region (metal ball - air gun bullet).

Rice. 23.

A foreign body in the subcutaneous tissue of the left cheek is a glass fragment.

Rice. 24.

A foreign body in the left cheek area is a splinter.

Rice. 25.

Foreign bodies in the keloid scar of the lower lip are small stones and asphalt crumbs (after a traffic accident).

Rice. 26.

A foreign body in the submandibular region is a fragment of a plastic catheter.

A significant proportion of diseases of the maxillofacial area are congenital cysts of the neck and oral cavity. An echographic examination makes it possible to visualize them, clarify their structure and organotopic characteristics, on the basis of which differential diagnosis is based.

Among congenital cysts of the neck and oral cavity, there are: thyroglossal (middle) and branchial (lateral) cysts and fistulas, retention cysts of the sublingual gland, as well as dermoid cysts.

The urgent need for distinctive recognition of the group affiliation of congenital cysts and fistulas is dictated by the necessity of their radical excision in order to avoid relapse. And if dermoid cysts and retention cysts of the sublingual gland are characterized by a clear demarcation and absence of fistulous tracts, then thyroglossal cysts usually have a connection with the hyoid bone and the root of the tongue, and branchial cysts are often connected by a fistulous tract with the lateral wall of the pharynx (Fig. 27-30).

Rice. 27.

Thyroglossal (median) cyst of the neck. There is a connection with the hyoid bone and the root of the tongue.

Rice. 28.

Branchial (lateral) cyst of the neck. Relationship with the vascular bundle of the neck (compression of the internal jugular vein and displacement of the common carotid artery).

Rice. 29.

Dermoid cyst of the floor of the mouth.

Rice. thirty.

Retention cyst of the right sublingual gland.

Clinicians are well aware of the difficulties in distinguishing between festering cysts and abscessing lymphadenitis. The specificity of the echographic picture makes it possible not only to solve emerging differential diagnostic difficulties, but also to determine the severity of scar changes around the cyst.

Congenital cysts of the neck and oral cavity often have to be differentiated from the cystic form of lymphangioma, which is essentially a malformation of the lymphatic vessels. Cystic lymphangioma is more characterized by multiple chambered cavities or multiple cyst-like formations, as well as significant prevalence. All these signs are clearly identified echographically. In cases of single-chamber and limited prevalence of lymphangioma, differential diagnosis is significantly difficult (Fig. 31).

Rice. 31.

Lymphangioma of the left parotid gland.

In the face and neck area, pathological formations from blood vessels are often found - so-called “hemangiomas”, which in most cases (up to 95-97%) are vascular hyperplasias and vascular malformations (angiodysplasias). True vascular tumors occur only in 3-5% of cases.

In this case, either only the vascular periphery - capillaries, or only larger vessels with the formation of arteriovenous communications (stomachs, fistulas) can be involved in the pathological process; a combination of these options is possible. Dysplastic changes can be localized only in the venous part of the vascular bed; this type of lesion is referred to as “venous dysplasia” (Fig. 32).

Rice. 32.

Venous dysplasia of the right parotid gland.

Vascular formations can have a diffuse distribution in soft tissues or be clearly demarcated, and also have their own hemodynamic characteristics (Fig. 33).

Rice. 33.

Vascular hyperplasia of the right buccal region.

All these factors entail the need for an individual approach to the choice of treatment method and tactics. Ultrasound examination, allowing to determine the main morphological and hemodynamic parameters of vascular formations of the face and neck, is an effective method for their diagnosis.

A very significant role belongs to echography in recognizing tumors of the salivary glands. The possibility of a detailed assessment of the contours of the neoplasm and its internal structure (echostructure) makes it possible to distinguish benign tumors of the salivary glands from malignant tumors with high reliability (Fig. 34-36).

Rice. 34.

Polymorphic adenoma of the left parotid gland.

Rice. 35.

Lipoma of the left parotid gland.

Rice. 36.

Malignant tumor of the right parotid gland (histologically: undifferentiated carcinoma).

Of great importance in clarifying the nature and extent of the tumor process is also the assessment of the condition of the regional lymph nodes, in which echographic examination is a recognized leader (Fig. 37).

Rice. 37.

Malignant tumor of the left parotid gland (histologically: adenoid cystic carcinoma). Metastatic lesions of regional lymph nodes.

The abundance of lymphoid tissue in the parotid glands determines the high frequency of their damage by benign and malignant lymphoproliferative diseases, which also have their own characteristic echographic signs (Fig. 38-39).

Rice. 38.

Damage to the left parotid gland due to lymphoproliferative disease (histologically: lymphogranulomatosis).

Rice. 39.

Damage to the lymph nodes of the neck due to lymphoproliferative disease (histologically: lymphosarcoma).

Without in any way contrasting ultrasound of the maxillofacial area with the traditional clinical examination of the patient, there is every reason to assert that the use of echography is certainly indicated not only in diagnostically unclear cases, but even with an already established diagnosis, when the method allows us to identify individual characteristics of the course of the disease , which can be significant when planning a patient’s treatment.

The non-invasiveness and harmlessness of ultrasound examination makes it possible to carry it out many times to monitor the dynamics of the pathological process and evaluate the effectiveness of treatment measures.

The high information content of an echographic examination (reaching 95-98% in general) makes it possible to limit the use of radiological techniques (traditional radiography, sialography, angiography), significantly less often use invasive diagnostic interventions (soft tissue biopsy) and more rationally approach the use of such expensive studies as computer and magnetic resonance imaging.

SonoAce Ultrasound Magazine

Contains current clinical information on ultrasonography and is aimed at ultrasound doctors, published since 1996.