Inflammation around the jaw

Inflammations around the jaw are inflammations in the area of the alveolar ridges. It spreads to the defined areas around the upper and lower jaws.

Jaw spaces

Jaw spaces are created by inflammation, so they are "artificial" spaces. They are not sharply demarcated and are slit shaped. They can be delimited by the jaws, muscles, muscle fascia, skin, subcutaneous tissue and ligaments. There are slits between the individual muscles, which allow the individual spaces to communicate and, thanks to this, the rapid spread of inflammation. We divide them into surface and deep spaces.

Causes

Up to 70% of the cause is of odontogenic origin:

• Tooth decay around the tooth root (necrosis, gangrene);
• radicular cyst;
• follicular cyst;
• periodontal defects.

Causes that are not of odontogenic origin:

• Untreated jaw fracture;
• tonsil infection;
• salivary gland infections;
• administration of anesthesia through an inflammatory lesion.

Inflammation in the mandible

Sublingual abscess

• Source of infection – lower premolars and molars.
• Clinical manifestations – sublingual lashes are swollen and painful. The tongue partially loses its mobility.
• Therapy – incision and drainage (the procedure is performed after the application of seductive anesthesia). The drainage is guided by the largest arch of the abscess on the lingual side, it runs parallel to the alveolar ridge.

Submandibular abscess

• It is one of the most common perennial inflammations.
• Source of infection – lower molars and premolars, from whose apexes the inflammation spreads to the lower edge of the mandible.
• Clinical manifestations – submandibular swelling and limited mouth opening due to contracture. Other clinical manifestations include febrile illness, reddening of the skin, pain and overflow of the liquid contents during palpation.
• Therapy – extraoral incision below the margin of the mandible, penetration of the pean into the abscess, pus release and drainage. We perform the whole procedure under general anesthesia. We treat the procedure with antibiotics.
• Differential diagnostics – submandibular lymphadenitis, inflammation of the submandibular salivary glands and metastatic node.
• Inflammation can spread from the submandibular space to the perimandibular space, the submental space (medially), to the regio coli lateralis (caudally), or to the parapharyngeal space (dorsally, through the pterygomandibular cleft).

Perimandibular abscess

• Source of infection – lower molars.
• Clinical manifestations – the swelling is located laterally from the body of the mandible.
• Therapy – extraoral incision - this is the case as for submandibular abscess. We treat the procedure with antibiotics.

Submental abscess

• Source of infection – lower incisors; however, the infection here may spread from the submandibular landscape.
• Clinical manifestations – submental swelling.
• Therapy – extraoral incision with drain; the patient has a tilted head and the incision is made vertically in the midline. We treat the procedure with antibiotics.

Abscess in the base of the tongue

• Source of infection – lower canines and premolars; exceptionally, the source of infection may be an infectious dermoid or epidermoid cyst.
• Clinical manifestations - reduced mobility and swelling of the tongue, which may be accompanied by pain.
• Therapy - penetration by pean through the submental space and through the raphe mylohyoid into the muscles of the tongue. We perform the whole procedure under general anesthesia.

Pterygomandibular abscess

• Source of infection – third molars, from which the infection spreads between the attachment of the pterygoid medialis and the inner surface of the mandible branch.
• Clinical manifestations – contracture and swelling on the inside of the mandible angle. Intraorally, the arch of the mucosa at the attachment of the pterygoid medialis is visible.
• Therapy – we make the incision either intraorally - by cutting lingually from the third molar - or extraorally. Then we make a skin incision at the angle of the jaw. Intraoral incision is performed after submucosal anesthesia, extraoral incision is performed under general anesthesia. We drain the incision and treat with the ATB. Rehabilitation is necessary after the acute inflammation has subsided.

Submasseteric abscess

• Source of infection – third molars, from which the inflammation spreads to the soft tissues laterally from the angle and branch of the mandible.
• Clinical manifestations – swelling outside the angle of the mandible, maxillary contracture. These manifestations often have a chronic course.
• Therapy – extraoral incision at the angle of the mandible, penetration through the attachment m.masseter. Then we drain the incision. The procedure is treated with ATB. The contracture must be rehabilitated.

Inflammation in the parapharyngeal space

• Inflammation in the parapharyngeal space is caused primarily by spread from the surrounding, most often submandibular spaces, and from the tonsils. The odontogenic origin of this inflammation is mostly secondary.
• Clinical manifestations – contracture, difficulty swallowing, arching of the pharyngeal wall.
• Therapy – extraoral incision through the pterygomandibular or submandibular space.

Symptoms

• Celsus signs of inflammation;
• leukocytosis;
• increased sedimentation;
• high CRP (15 and more).

Complication

• Thrombophlebitis sinus cavernosus;
• purulent leptomeningitis;
• mediastinitis;
• cardiac tamponade.

Links

References

• PAZDERA, Jindřich. Základy ústní a čelistní chirurgie. 1. vydání. Olomouc : Universita Palackého v Olomouci, 2007. ISBN 978-80-244-1670-0.

• HRUBÝ, Zdeněk. Kolemčelistní záněty [přednáška k předmětu Orální chirurgie, obor Zubní lékařství, 1. lékařská fakulta Univerzita Karlova]. Praha. 2010-12-14.