Acute suppurative periostitis of the mandible: treatment
Acute purulent periostitis of the lower jaw — a disease infectious nature, characterized by the accumulation of purulent exudate under the periosteum. When this detachment occurs and purulent fusion of the latter, developing General toxic symptoms purulent process may go to Tbilisi organs and tissues. Purulent form of periostitis is a natural consequence of incorrect or missing treatment of serous varieties of the disease. Found in 59% of patients seeking help regarding the flux on the lower jaw. Requires surgical intervention followed by massive antibiotic therapy.
The inflammatory process progresses rapidly and spreads. At the transition of the swelling of the airway may occur immediate threat to the life of the patient associated with mechanical asphyxia. A similar situation occurs during the formation of an abscess of the soft tissues of the head. The disease affects the patient’s quality of life, leads to complete or partial disability, requires a long to diseases of dental profile of the recovery period. The pathological process may be accompanied by severe pain syndrome.
What is caused suppurative periostitis
As mentioned above, the abscess is purulent character develops in the absence of necessary treatment of the serous form. Primary purulent process may occur when it enters the zone of the periosteum of bacteria that have a strong pyogenic action. The disease occurs in the presence of the entrance gate of infection, which may include:
- Caries of the teeth 3-4 degrees of severity;
- Periodontitis, periodontitis and other inflammatory diseases of the gums;
- Recent tooth extraction with subsequent infection of the socket;
- Dry hole;
- Nearby foci of infection;
- Open fractures of facial bones;
- Odontoma (tumors structures of the tooth);
- Infected radicular cysts;
- Proizvoditsa teeth.
It is worth noting that the closed fractures of the jaw rarely lead to the development of purulent periostitis, although patients almost always develops in the inflammatory process and flux. The fact that at the closed traumas in their place do not exist the so-called entrance gates of infection that ensures the sterility of the damage zone.
The likelihood of suppurative periostitis is increased in conditions of a weakened immune system, at constant stress and high mental stress, in the presence of acute stage of any infectious disease. The disease occurs when there is an input gate in conjunction with the aggravating factors.
Microbiological basis of purulent process
Conducted microbiological studies show that in the outbreak of suppurative periostitis is most frequently found mixed microflora, including various strains of staphylococci and streptococci, putrefactive anaerobic bacteria, whose proportion can reach 75% of aerobic bacteria, which number in the lesion usually does not exceed 25%.
Other types of pathogenic microorganisms can also cause Shin splints. However, their presence in purulent masses detected much less frequently. Odontogenic origin of the abscess in the hearth can be detected conditionally pathogenic microflora, typical for the oral cavity of the person (vitamin C performande, spirochetes).
Microbiological study of the pus may be carried out in the absence of visible clinical effect of conducted antibiotic therapy. This study allows to determine the degree of sensitivity of microorganisms to a particular drug. In a further drug to which the bacteria is sensitive to the greatest degree, is administered to the patient. A drawback of the study is that for the cultivation of biological material requires about 7 days. This is unacceptable long term.
Clinical picture and diagnosis of suppurative periostitis
The overall picture of the disease can be divided into 3 large areas: pathologic characteristics, clinical signs, common symptoms.
Pathological anatomy of suppurative periostitis
Depending on the degree of disease post-mortem picture may vary. Thus, in the period of transition to the serous form of the disease festering in the form of significant changes in the structure of the bones is not marked. Elements of pus can be detected in the haversian canals.
At the stage of active flow of the abscess is accumulation of pus under the periosteum, detachment and purulent fusion. In this case the periosteum is swollen, loose, show signs of ischemia, disorders of microcirculation.
In the later stages of the pathological process is offset on the deeper structures of the bone. While gaversovyh channels merge with the bone marrow spaces, bone is resorbed and becomes thinner, and disappears of its cortical layer. Inflammation goes to the area close to the bone marrow.
During the propagation of the infectious process can develop submucosal abscess, purulent cavities. There is swelling of the tissues of the face on the affected side. In severe cases, swelling may be local, but common. Thus affected half of the face, the neck, the airway of the patient.
Subjectively patients with acute purulent periostitis in the form have the following complaints:
- Diffuse nagging pain on the affected side;
- Irradiation of pain in the ear, nape, neck;
- Discomfort when swallowing, pronunciation of sounds, the chewing of food;
- There may be numbness of the lower lip when purulent process in the region of the front teeth.
Objective examination allows to reveal such signs of illness as:
- Hyperemia in the region of the tooth, which has become a source of infection;
- The destruction of the tooth crown;
- Swelling of the gum tissue;
- Abnormal mobility of the affected teeth and Baring their necks;
- Visible swelling of the face (cheek, cheekbone, the area of the orbit, parotid-chewing area).
General symptoms of suppurative periostitis is a manifestation of systemic reaction of the organism to inflammation. Usually, patients identify the following symptoms:
- Hyperthermia (up to 38C);
- Muscle pain;
- Pains in the bones;
- Chills, or fever;
- Decreased tone muscle tissue;
- Increase closest to the source of inflammation of the lymphatic vessels.
The above list is not complete. The picture of intoxication can vary depending on the condition of the patient, concomitant diseases, held treatment.
Acute periostitis of the jaw reliably diagnosed only after x-ray examination of the patient. Of course, visual inspection suggests the presence of purulent process. However, it is impossible to determine the depth of destruction of bone tissue, the precise localization of subperiosteal abscess and differential diagnosis.
Suppurative periostitis differentialsa with tumors of the jaw, osteomyelitis, periodontitis. It is important to remember that these diseases are not mutually exclusive and can proceed in parallel.
Treatment of suppurative periostitis
Treatment of purulent forms of abscess is always surgical. After opening the abscess, the patient is assigned the appropriate pharmacological therapy, physiotherapy methods of stimulating recovery.
Surgical treatment of suppurative periostitis is in the opening and rehabilitation of the abscess. The operation is performed under local infiltrative (introduction of the anesthetic into the nerve, Innervate the gums) or infiltration (anesthetic impregnated with diseased tissue) anesthesia. The procedure is usually performed in the operating room maxillofacial profile.
After anesthesia, the abscess is opened. To do this, use a pointed scalpel. Cut the soft tissues, the periosteum is lifted and gently exfoliate to provide a complete out the pus. Abscess cavity was washed with solutions of antibiotics. After rehabilitation purulent cavity it sets the drainage of a sterile rubber glove. It is necessary for the outflow of the newly formed wound exudate and pus. The operative wound after the operation is not sutured tightly. Drain the gum is removed in the mouth.
Control the consistency of the drainage is carried out daily or 1 every 2 days. Good abstraction of pus indicates a decrease in the size of the flux, the gradual subsidence of the clinical manifestations of the disease, the feeling the patient purulent taste in the mouth. In the absence of the above symptoms the wound re-opened, the drainage is clear of clots, pus, or installing a new one.
Blind wound closure is carried out only after subsiding of the clinical manifestations of abscess and stopping the discharge of pus in the drainage. Before suturing the drain gum is removed, the wound is carefully inspected for the presence of pus.
Common postoperative pharmacological therapy
The basis for postoperative treatment is the use of antibacterial drugs. Their choice is made empirically, in accordance with the personal experience of the physician and guidelines of the governing organizations. As a rule, are used in dentistry such antibiotics as:
The change of antibiotics for their ineffectiveness is recommended in accordance with the results of microbiological testing. If one was not conducted, assign abaktal, azithromycin, tetracycline. It is important to remember that tetracycline is teratogenic. Therefore, it should not be administered to pregnant and lactating women, and children who have not grown molars (possible development of the syndrome tetratziklinovykh teeth).
In addition to antibiotics, patients are administered:
- Drugs that improve the microcirculation (trental);
- Antihistamines (zyrtec);
- Anti-inflammatory drugs (ibuprofen);
- Painkillers (analgin).
It is considered that all NSAIDs possess both analgesic and anti-inflammatory action. However, it is not so. Strength anti-inflammatory effect is usually inversely proportional to the strength of the anesthetic. Therefore, the purpose of pain relief after surgery, patients should be assigned analgin, ketorol, baralgin. To reduce the intensity of inflammation it is better to use, ibuprofen or diclofenac (ortofen).
Postoperative local pharmacological therapy
Local postoperative therapy should be aimed at acceleration of tissue regeneration and the prevention of infectious complications. With the aim of disinfecting mouth rinse with a weak solution of potassium permanganate (1:5000) or hydrogen peroxide (0.5%). In addition, you can apply herbal teas from the Arsenal of folk medicine:
- Dry chamomile flowers pour boiling water in the ratio 1:10, insist, cool and use to rinse the mouth.
- 1 tsp.l. pharmacy calendula pour boiling water in the amount of 150-200 grams, cooled and further diluted with water 1:2.
- 2 tsp of flax seed, pour a glass of boiling water, boil 10 minutes, strain. The rinse with warm water.
All the above recipes can achieve a disinfecting action, to reduce the likelihood of postoperative complications, accelerate healing.
A few days after wound closure tightly patient is prescribed regenerative drugs: solkoseril, sea buckthorn oil, means comprising vitamins «A» and «E». With the continuing inflammatory process locally can be prescribed ointments with antibiotics (metronidazole).
As physical therapy patients typically assigned to the UHF method that can be applied even in the acute stage of inflammation. The essence of the action consists in the heating of the nidus by means of electromagnetic fields.
Using UHF is achieved in the following therapeutic effect:
- Improved local blood circulation;
- Reduction of edema;
- Decrease pain;
- Subsidence of the inflammation.
Physical therapy is prescribed to the patients the next day after the surgical opening the abscess.
As a periostitis of the upper jaw and the lower periostitis has a favorable prognosis only in the case if treatment is initiated before the date of distribution of purulent process on collegesa tissue. If the abscess was opened on time, the recovery time can take 2-3 weeks.
When running the periostitis is the time required for tissue regeneration, may be several months. The disease is complicated by osteomyelitis, edema of the respiratory tract, sepsis. The patient’s life is under threat.
Timely and properly cured the abscess does not lead to the development of disability. Forecast favorable for health in the absence of complications.