Diagnosis and Treatment of Odontogenic Phlegmons of the Oral Floor and Neck

Abstract

The treatment of odontogenic phlegmons of the maxillofacial area is still remaining an urgent problem of oral and maxillo-facial surgery due to the steady increase in their frequency, tendency to generalization of the process and adverse consequences. In this regard, there is a constant search for ways to elevate the effectiveness of managing patients with odontogenic phlegmons of the maxillofacial area, to elaborate new technologies for diagnosis, surgical and medical treatment approaches and to put them into practice.
 The purpose of this study is to analyze the methods of diagnosis and treatment outcomes among patients with phlegmon of the oral floor and neck based on the records of the maxillofacial department.
 Materials and methods. We analyzed 71 case histories of phlegmon of the oral floor and neck in patients who received treatment at the maxillofacial department from 2017 to 2022 year.
 The analysis reveals that the primary cause behind the occurrence of deep phlegmons in the oral floor and neck was odontogenic inflammatory processes, accounting for 37 cases; tonsillogenic lesions accounted for 9 cases, foreign bodies of the esophagus accounted for 12 cases, and adenophlegmons accounted for 13 cases. 12 patients out of 71 underwent tracheotomy followed by the intubation through a tracheostomy. All patients experienced urgent surgical intervention, including dissection and drainage of the tissue spaces in the oral floor and neck. Due to the unique structure of the fibrous spaces in the neck and the high hydrophilicity of mediastinal tissues, wide incisions were made on one or both sides of the neck to ensure adequate drainage and treatment with antiseptic solutions. Following wound cleansing, secondary delayed sutures were applied for a period of 11-18 days. Adequate medical therapy was provided to patients from the time of admission to the hospital until clinical recovery.
 Microbiological examination of the exudate from the wound in 54 patients revealed various pathogens, while no growth of microflora was observed in 17 patients. The isolated microflora included hemolytic streptococcus in 20 patients, various types of staphylococci in 12 patients, mixed flora in 14 patients, and anaerobes in 8 patients, all of which were identified as causative agents of purulent-septic processes.
 Nevertheless, a high frequency of purulent-necrotic lesions in the cellular spaces of the oral floor and neck persists, and can result in fatal consequences in some cases. The use of modern, highly effective diagnostic tools, such as computed tomography and magnetic resonance imaging, can aid in early diagnosis and determine the indications and volume of surgical intervention required for phlegmon formation.