Flux is an inaccurate, folk term, which is called any accumulation of pus in the maxillofacial area, which causes a change in the natural shape of the face. An abscess and phlegmon can be suitable for this definition.
Abscess is a limited, local accumulation of purulent exudate. It is erroneous to consider periostitis as a separate, independent disease, as it is just a kind of abscess with a clearly marked localization - on the surface of the bone in space, covered by the periosteum.
Phlegmon - diffuse accumulation of pus, which does not have clear boundaries. It is the next stage in the development of the abscess and occurs if there is no timely treatment or if it is not effective.
Causes of
flux generation 1) Acute or chronic periodontitis in the acute stage. The accumulation of purulent exudate in the region of the apex of the root creates a hotbed of increased pressure, seeking to find the easiest way out of the enclosed space. If the pus does not get outflow through the root canal or the periodontal gap, it breaks through the spongy structure of the bone under the periosteum. Most often this occurs in the direction of the cheek, but it is also possible the formation of periostitis on the palatine or lingual surface of the jaw.
2) Periodontitis of moderate to severe severity during exacerbation. It can cause the emergence of both microabscesses, located in the surface layers of the gum, and deeper - the subperiosteal.
3) Osteomyelitis in the stage of exacerbation.
4) Injuries( bruises, cracks and fractures) of bones. By itself, the trauma can not cause the appearance of flux, the swelling immediately after tissue damage is formed due to the accumulation of blood( hematoma).However, any violation of the integrity of soft tissues in the oral cavity opens wide access for a variety of microflora and can lead to suppuration.
5) Inflammation of the lymph nodes. At the initial stages of inflammation, the lymph nodes increase in size and become painful on palpation( palpation).But with the progression of the disease that caused this process and a significant decrease in the resistance of the organism, it is possible that they are purulent with the formation of flux.
Symptoms of flux
The severity of complaints, their type and intensity depend on the extent of the flux and its location.
When the first symptoms of a flux occur, the patient first complains of the appearance of a swelling that is painful when pressed. However, since this was preceded by severe pain caused by exacerbation of periodontitis, their sharp stunning is perceived by the patient as a significant relief.
Swelling of the nearest lymph nodes, fever and complaints of general malaise are also possible. If a flux occurs in the area of the chewing muscles, the patient may complain of painful difficulties in opening the mouth.
If the abscess is located in the inner surface of the angle of the lower jaw, pain may occur when swallowing, which should be an important symptom of a significant deterioration in the patient's condition.
Clinical manifestations, examination of the patient
The first thing that the doctor often sees when looking at it is a violation of the appearance of the patient. Skin over the focus of inflammation get rounded outlines. If such a zone is in the area of natural folds, the latter are smoothed out. The skin can retain a natural color, but it can also have a pronounced redness.
With palpation, soft tissues are stressed, in case of neglected cases, the fluid under the fingers fluctuates( fluctuation).This study is often painful, especially with a deep location of the abscess and is often very difficult for the same reason.
When examining a patient, special attention should be paid to possible soreness and difficulty in opening the mouth, speech, movements in the neck. Important symptoms may be a violation of the sensitivity of various areas of the skin or oral mucosa.
In case of difficulty in determining the location and boundaries of purulent foci, an additional study should be carried out immediately. Radiography is often untenable, because it does not reflect the real state of non-radiocontrast tissues. High sensitivity and accuracy can be provided by the use of RKT and MRI.
Diagnosis of the
flux Diagnosis is based on:
1) Data of anamnesis( state of the organs of the maxillofacial region before the onset of the underlying disease, the onset of acute inflammation and its first manifestations, the development of pathology before going to the doctor);
2) The results of an objective inspection;
3) The results of additional research methods, including RVT, MRI and antibiotic sensitivity.
Differentiate abscesses from phlegmon, requiring a larger amount of surgical intervention. It is necessary to distinguish purulent foci from non-inflammatory diseases-cysts( for example, the lateral cysts of the neck), various neoplasms, etc.
Treatment of the flux
The basis of purulent surgery was and remains the prompt and complete opening of the abscess for its complete emptying. All other methods of flux treatment are only auxiliary, unable to replace surgical intervention, but significantly increasing its effectiveness.
In operative treatment of flux, the following objectives should be achieved:
1) Disclosure of the area with purulent exudate throughout its extent with access to healthy tissues, which guarantees the usefulness of the incision;
2) Complete drainage of abscess or phlegmon contents. If necessary, the installation of pipe drainage, which allows to wash the focus with solutions of antiseptics;
3) Abandonment of flat drains that prevent the wound edges from clumping and premature healing until the purulent inflammation is completely stopped.
4) In case of incomplete opening of the focus or the formation of new purulent stings, a second operation should be performed.
The second most important method of treatment is antimicrobial therapy. The use of antiseptics should be constant and in sufficient volume( 3% of hydrogen peroxide, 0.02% of chlorhexidine bigluconate, 1% of dihydroxydin,
. It is advisable to administer antibiotics taking into account the sensitivity of the microflora of a particular patient,the results of laboratory studies should begin treatment with broad-spectrum drugs administered intravenously, such as amikacin, cephalosporins, metronidazole, etc.
When prescribing several drugs simultaneously, one must learnIt is a mistake to prescribe two drugs from one group or those that lead to a decrease in the effectiveness of each other.a particular issue is the prevention of the use of drugs on which the patient may have an allergic reaction
The third component of the treatment is the detoxification of the body.to carry out intravenous introduction of blood substitutes with the simultaneous appointment of diuretics. In the presence of flux shows fortifying therapy( including the appointment of vitamins) and is fullyennoe, balanced diet.
Flux treatment at home
Treatment of purulent diseases should be carried out exclusively in the conditions of specialized medical institutions by qualified personnel. If there is a threat of development of abscesses or phlegmon of the bottom of the oral cavity or the near-pharyngeal space, immediate hospitalization is required.
However, with a limited periostitis and the impossibility of an urgent visit to the doctor, it is possible to provide first aid alone. And so, for the treatment of flux in the home, you can do the following:
1) First of all, to relieve tension in the area of inflammation, soda rinses are helpful. On a glass of water with a temperature of no more than 35C is enough to a teaspoon of soda and salt with the addition of 1-2 drops of iodine. Rinse should be at least every two hours.
2) As antimicrobial therapy, antibiotics may be taken, for example, digitan( 500 mg twice a day).But it should be remembered that even getting a significant improvement in your well-being is not an excuse for not contacting specialists. The fact of self-administration of any medication should immediately inform the attending physician at the time of seeking help.
3) In the event of a flux, it is strictly forbidden to use any heating or methods that contribute to the preservation of heat.
Do not use a different kind of bandage, you should exclude the possibility of sleep with a tight contact of the inflammation zone with a pillow. Warming not only increases edema and pus formation, but also activates proteolytic enzymes, increasing the destruction of healthy tissues with purulent exudate.
Flux prevention and prognosis
To prevent the appearance of flux, it is very important to undergo examinations and treatment at the dentist in a timely manner, preventing the occurrence of complicated caries. Also it is necessary to observe a healthy way of life, which contributes to the increase of resistance of the organism.
If the flux appears and its timely treatment, the prognosis is favorable. Uncomplicated periostitis does not pose a threat to the health and life of the patient. However, without qualified treatment, the development of suppurative complications can be rapid.
In case of penetration of pus in the area of the base of the skull or( through the cell spaces of the neck) into the anterior / posterior mediastinum, the likelihood of a lethal outcome still reaches 50% or more. Therefore, it is so important that the patient understands the importance of urgency of treatment to the doctor and the accuracy of all his appointments.
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