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Phlegmon of Lateral Pharyngeal and Retropharyngeal Spaces. Clinic

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Phlegmon of Lateral Pharyngeal and Retropharyngeal Spaces. Clinic MINISTRY OF HEALTH OF UKRAINE Ukrainian medical stomatological academy “Approved” On the meeting chair Of Propaedeutics Surgical Stomatology The Head of the Department prof. Novikov V.M. ___________ “ ____ ” _____________ 20 ____ GUIDELINES Individual work of students During preparation for Practical classes Educational discipline Surgical stomatology Module № 2 Inflammatory diseases in maxillofacial region. Odontogenous inflammatory diseases in Content module № 3 maxillofacial region Phlegmon of lateral pharyngeal and retropharyngeal Theme lesson spaces. Clinic, diagnostics, medical treatment. Course 3 Faculty Stomatological Poltava 2018 1. Actuality of the topic. In practice of the doctor - stomatologist there are patients with a phlegmon of peripharyngeal region, or an abscess of this region. Less often - a phlegmon of retropharyngeal space. Timely recognition of these diseases will speed up the help to this patient, and to prevent serious complications which threaten life of the patient. 2. The objectives of the studies. To know about a course of operation of disclosing of abscess, phlegmon of forward peripharyngeal space. To know an etiology, clinical manifestation of abscess and phlegmon of peripharyngeal and retropharyngeal spaces, methods of examination and treatment of patients with the given pathology. To acquire skills of examination of patients with abscesses and phlegmons of peripharyngeal region. To make the diagnosis. To carry out differential diagnostics. To combine a treatment planning of the patient with a phlegmon and an abscess of peripharyngeal region. To fill in a case history of the inpatient. 3. Basic knowledge, skills, skills necessary for study topics (interdisciplinary integration). Name of previous These skills courses Physiopathology. Inflammatory processes. Anatomical pathology. Inflammatory processes. Microbiology. The infestant, microbic flora of an oral cavity. Operative surgery and Features of an anatomical structure of the upper and upperographical lower jaws and fat tissue spaces of the face. anatomy. Histology. Features of intraosteal frame of the upper and lower jaws, mild tissues fat spaces of the face. Propedeutics of a Methods of examination of the stomatologic patient surgical odontology. 4. Tasks for independent work in preparation for the classes. 4.1. A list of key terms, parameters, characteristics that must learn the student in preparation for the lesson: Term Definition Anterolaterally the fascia covering the masticator space boundary Posteriorly boundary the parotid space Medially boundary superior constrictor muscle of the pharynx 2 Posteriorly boundary the prevertebral and visceral layers of the deep cervical fascia 4.2. Theoretical questions to lesson: 1. The causes infection forward peripharyngeal space. 1) What teeth can become the cause infection peripharyngeal space? 2) From what fat spaces can the infection contamination in peripharyngeal space will be distributed? 3. The causes of an abscess of peripharyngeal space. What kinds of traumas of a lateral wall of a pharynx result in a peripharyngeal abscess? 4. The causes of an inflammation of retropharyngeal space. Name oral and other routes of penetration of an infection contamination to retropharyngeal space. 5. Clinical manifestation a phlegmon of peripharyngeal space. 1) Describe complaints of the patient at the given pathology. 2) Name attributes of a phlegmon which are possible for revealing at survey and a palpation of the outward side. 3) Describe manifestation a phlegmon of peripharyngeal space in an oral cavity. 6. Clinical manifestation an abscess of peripharyngeal space. 1) Data of survey, interrogation and a palpation. 2) Signs of an abscess in an oral cavity. 7. Clinic of a retropharyngeal abscess. 1) Complaints and an anamnesis at a retropharyngeal abscess. 2) The data of survey of the patient through a mouth. 3) Name instruments which are expedient for applying to survey of a back wall of a pharynx. 8. Treatment of a phlegmon of peripharyngeal and retropharyngeal spaces. 1) Course of operation of dissecting of a phlegmon of peripharyngeal space. 2) A course of operation of dissecting of an abscess of peripharyngeal space. 3) A course of operation of dissecting of a retropharyngeal abscess. 9. Diffusion of a phlegmon of peripharyngeal space. In what spaces pus from peripharyngeal space can be distributed? 10. Medicamental treatment of the patient. What medicamental agents are expedient for applying the patient with this pathology? 4.3. Practical works (tasks) are performed in class: − To take possession of technique of realization observation of the patients with phlegmon of lateral pharyngeal and retropharyngeal spaces. − To make a treatment planning of phlegmon of lateral pharyngeal and retropharyngeal spaces. 3 − To acquire technique of carrying out observation of patient with phlegmon of lateral pharyngeal and retropharyngeal spaces. − To make the plan of examine of the patient with phlegmon of lateral pharyngeal and retropharyngeal spaces. − To make the plan of local treatment of patients with phlegmon of lateral pharyngeal and retropharyngeal spaces. 5. Theme contents. 1. Lateral Pharyngeal space (parapharyngeal space) pharyngeomaxillary space, pterygopharyngeal space). The lateral pharyngeal space is a lateral neck space. It has the shape of an inverted cone with its base at the skull and its apex at the hyoid bone. Boundaries Anterolaterally: This space is bounded by the fascia covering the masticator space. Posteriorly: By the parotid space. Medially: By the superior constrictor muscle of the pharynx. Posteriorly: By the prevertebral and visceral layers of the deep cervical fascia. The upper limit of the lateral pharyngeal space is a line on the base of the skull along the sphenoid bone, from the root of the medial pterygoid to the sphenoid spine behind. Inferiorly: The lateral pharyngeal space is bounded by the attachement of the capsule of the submandibular gland to the sheath of the stylohyoid muscle and posterior belly of digastric muscle. Contents: The lateral pharyngeal space contains deep cervical lymph nodes, facial and ascending pharyngeal arteries, carotid sheath (internal carotid artery, internal jugular vein and vagus nerve), glossopharyngeal, accessory and hypoglossal nerves and cervical sympathetic trunk. Pathologic Development: Infection of the lateral pharyngeal space may result from: 1. The pharynx peritonsillar suppuration may erode through the superior pharyngeal constrictor muscle to enter the lateral pharyngeal space. 2. Dental Infections: Abscess, may develop in this space from an acute infection around the mandibular molar or from extension of infection from a mandibular nerve block injection. 3. Infections of the parotid space, or space of the body of the mandible. 4 Signs & Symptoms: 1. Because of the depth of the abscess and thickness of the overlying fascia, external fluctuation is seldom encountered. 2. External swelling: Firm, tender and indurate swelling may be observed beneath the angle of the mandible. 3. Internal swelling: Swelling of the lateral wall of the pharynx and medial displacement of the tonsils, tonsillar pillars and the uvula. 4. The patient complains of difficulty of swallowing (dysphagia). 5. Trismus that occurs sometimes is so severe that the patient is unable to open his mouth. This causes a delay in diagnosis and treatment. 6. Excruciating pain radiating to the ear, face or neck. Probably the greatest danger of infections in this area is their tendency to involve the carotid bundle. This bundle is the core of the soft structures of the neck. When the infection travels in this space many complications may result. These include phlebitis, sepsis, tongue paresis, and arterial erosion. Acute suppuration of the mediastinum is a well recognized complication of descending neck infection. Treatment: The treatment consists of antibiotics, surgical drainage and tracheostomy. Incision and drainage may be carried out extra-or intra-orally. Extraoral Incision: The incision is made along the anterior border of the sternocleidomastoid muscle, extending from the angle of the mandible approximately 2 cm. long. To gain entrance to the lateral pharyngeal space, the fascia behind the submandibular gland is opened by a blunt hemostat. The hemostat is introduced medially behind the mandible. For complete evacuation of pus, the hemostat can be introduced superiorly and posteriorly. A drain is inserted. Intra-oral Incision: Vertical incision is made in the retromolar triangle lateral and parallel to the pterygomandibular fold. The posterior part of the buccal space is opened and the tendon of the temporal muscle is exposed. A curved hemostat is introduced medial to the medial pterygoid muscle to evacuate the pus present in the lateral pharyngeal space. A drain is then inserted. 2. The Retropharyngeal Space The retropharyngeal space occurs between the posterior wall of the pharynx and the prevertebral fascia. The loose areolar connective tissue which exists here not only permits pharyngeal movement but allows infection to travel inferiorly to the posterior mediastinum as far as the diaphragm and superiorly to the base of the skull. Adequate drainage of the retropharyngeal and lateral pharyngeal spaces are together considered as parapharyngeal space. 5 Differential Diagnosis of Facial Swelling: 1. Facial edema associated with acute dental infections. 2. Angioneurotic edema due to allergy, hereditary or psychoneurotic forces, in this condition the facial swelling is due
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