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Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy Ministry of Health of Ukraine Ukrainian Medical Stomatolgical Academy Methodical Instructions for independent work of students during the training for the practical studies Academic discipline Surgical stomatology Module № 6 The topic of the stadies Lymphadenitis. Adenophlegmons. Abscesses of №8 face, palate, alveololingual groove, hyoid area. Physical therapy in the treatment of inflammatory diseases of maxillofacial area. Phlegmons of submandibular, submental areas and pterygopalatine-mandibular space. Course V Faculty Foreign Students Training, Stomatological Poltava -2020 1. Relevance of the topic: One of the most urgent issues of dentistry nowadays are acute odontogenic inflammatory processes. Despite the development of new methods of treating purulent infection, the number of patients with inflammatory diseases has an aggressive tendency to increase, leading to difficult complications. They not only cause temporary disability of patients, but also, due to serious complications, can be fatal. Iflammation in the maxillofacial area is predominantly odontogenic, associated with pathological processes in the dentofacial segment, starting from complicated caries, difficult dentition, periodontitis, etc. Inflammatory processes of tonsillogenic, rhinogenic, hematogenous and others are also found in the maxillofacial area. 2. THE SPECIFIC AIMS: 2.1.To analize, to know the statistics, classification , characteristics of etiology and pathogenesis , clinical signs of inflammatory processes of the maxillofacial area . 2.2. To explain the diagnostic methods of surface odontogenic inflammatory processes of the maxillofacial area. 2.3. To suggest inspect a patient with superficial inflammatory odontogenic processes of maxillofacial area. 2.4. To classificate the odontogenic inflammation of the submandibular area. 2.5. To explain the theoretical and clinical research on the problem of odontogenic submandibular phlegmonous adenitis . 2.6. To draw diagrams, graphs 2.7. To analize treatment plan with odontogenic phlegmonous adenitis of submandibular area. 2.8. To create a plan evaluation and treatment of patients with odontogenic phlegmonous adenitis of submandibular area. 3. KNOWLEDGE, ABILITIES, SKILLS, WHICH ARE NECESSARY FOR STUDY THEMES (intradisciplinary integration) Names of previous disciplines Skills 1. Topoghrafic Anatomy and Anatomic and topographic structure of Operative Surgery. maxillo - facial region , anatomy milk teeth and permanent 2. Farmakology Drugs used in the treatment of diseases of the teeth and mouth. 3. Subjects provided Causes , prevention and treatment of oral and communication with the general health of patient. 4. Interdiscipline integration The need of dental health dentists. 4. TASKS FOR INDIVIDUAL WORK DURING PREPARATION TO LESSON. 4.1. List of basic terms, parameters, characteristic, which a student must master at preparation to lesson: Term Definition 1. Phlegmonous This diffuse purulent inflammation which zahvatuye few adenitis anatomical spaces melt lymph node. 2.The fluctuation The fluctuations in fluid inflammation. 3. Trismus This muscle dysfunction in inflamatory process 4.2. Theoretical questions to lesson: 1. To know anatomy of maxillofacial area. 2. To know the anatomy of the submandibular triangle. 3.To know the location of submandibular lymph nodes. 4. To know what is lymphadenitis? 5. To know what is phlegmon? 6. To know what is folliculitis? 7. To know what is boils? 8. To know what is carbuncles? 9. To know the difference between phlegmon and abscess. 4.3. Practical work (task) that is performed in class. 1. To be able to palpate the submandibular and cervical lymph nodes. 2. To be able to palpate the submandibular salivary gland. 3. To be able to conduct bouginage duct submandibular salivary glands. 4. To be able to lead palpation sublingual areas with inflammatory processes. THE CONTENT OF THE TOPIC: Classification of the maxillofacial and cervical lymphadenitis. According to the development and causative agent there are such groups of lymphadenitis: 1. Nonspecific 1. Acute: -serous; -purulent. 2. Chronic -purulent; -hyperplastic; - exacerbated chronic. 2. Specific According to the primary infectious focus we may determine: 1. odontogenic 2. Nonodontogenic lymphadenitis -tonsillogenic; - rhinogenic; -otogenic; -dermatogenic; -traumatic. According to the depth: -deep; - superficial. According to the topographic-anatomic sign: 1. Submental. 2. Submandibular. 3. Perimandibular. 4. Buccal 5. Parotid 6 Extramandibular 3. Clinical picture, diagnostics and development of lymphadenitis in children. Lymphadenitis is the medical term for inflamed and enlarged lymph nodes. It is usually due to an infection. Lymph nodes are filled with white blood cells that help your body fight infections. When lymph nodes become infected, it's usually because an infection started somewhere else in your body. Rarely, lymph nodes can enlarge due to cancer. You have about 600 lymph nodes in your body. But normal lymph nodes may be felt only below your jaw, under your arms, and in your groin area. A normal lymph node is small and soft. When lymph nodes become infected, they usually increase in size, become tender, and may be felt in other areas of your body during a physical exam. Infections that spread to lymph nodes are usually caused by bacteria, a virus, or a fungus. It is important to learn how the infection spread into your lymph nodes so that the right treatment can be started. Lymphadenitis can be one of 2 types: Localized lymphadenitis. This is the most common type. Localized lymphadenitis involves one or just a few nodes that are close to the area where the infection started. For example, nodes enlarged because of a tonsil infection may be felt in the neck area. Generalized lymphadenitis. This type of lymph node infection occurs in two or more lymph node groups. It may be caused by an infection that spreads through the bloodstream or another illness that affects the whole body. What causes lymphadenitis? Lymphadenitis occurs when one or more lymph nodes are infected by a bacteria, a virus, or a fungus. When lymph nodes become infected, it's often because an infection started somewhere else in your body. Symptoms. Lymphadenitis mainly causes enlarged, tender lymph nodes. A lymph node is considered enlarged if it is about 1/2-inch wide. Symptoms caused by an infected lymph node or group of nodes may include: Nodes that increase in size Nodes that are painful to touch Nodes that are soft or matted together Redness or red streaking of the skin over nodes Nodes that are filled with pus (an abscess) Fluid that drains from the nodes to the skin These symptoms may look like other health problems. Always see your healthcare provider for a diagnosis. Acute lymphadenitis. Slight traumas of the gingival tissues and puffy mucosa are the conditions for infection to penetrate the lymphatic system at no apparent causes present. The initial stage of acute lymphadenitis is characterized by dilation of the vessels, swelling and cellular infiltration of the lymph nodes tissues, because of what it may quickly increase in size. The serous inflammation quickly develops into the purulent one, which is characterized by the necrosis of the lymphoid-reticular tissue, which further will be enzymatically fused with a cavity to be formed. The periadenitis signs appear. The fusion of the lymph node capsule provides for spread of the infectious inflammatory process over its borders. Imperfect tissue barrier leads to the quick development of one nosologic form of the disease into another one: serous lymphadenitis – purulent lymphadenitisperiadenitis- adenophlegmon. The general reaction in children may go ahead the local inflammatory signs. Acute serous lymphadenitis. A child complains about the appearance of a painful “ball” under the skin in one of the anatomic areas. A trauma, various inflammatory processes or operative interventions may frequently precede it. The general condition of a child is satisfactory. Body temperature is normal or subfebrile. The haematological and biochemical data are normal. The affected lymph node is contoured as a small round swelling. The skin under it is without changes, producing a fold. Palpation helps to determine the mobile, slightly painful oval malformation of elastic consistency, 2-3 cm in diameter. If the submandibular lymph nodes are affected, a patient may complain of painful swallowing, parotid nodes – pain if the patient opens his mouth widely. It is possible to detect the odontogenic infection focus in the oral cavity (periodontitis, alveolitis, periostitis, etc.). The infection may be located on the skin, mucosa, and tonsillar pillars at nonodontogenic lymphadenitis. The acute serous lymphadenitis in children (especially small children) may quickly develop into the purulent form (in 2-3 days). If the serous inflammation doesn’t develop into the purulent process, the nodes will decrease in size and become less painful at palpation. In 2-3 weeks they will obtain their usual shape and consistency. Acute purulent lymphadenitis. There appears throbbing pain in the affected lymph node area, explained for the formation of an abscess in a relatively closed area. As the capsule limits the infectious-inflammatory process spread, it decreases absorption of the microorganisms and tissue metabolism products. Such patients are characterized by an expressed intoxication. The general condition is satisfactory. The body temperature usually doesn’t exceed 38 degrees by Celsius, moderate neutrophillic
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