ODONTOGENIC PHLEGMON OF THE MAXILLOFACIAL AREA, COMPLICATIONS AND PROGNOSIS

Abstract

The purpose of the study was analyzed the case of a patient M. admitted to the department of thoracic surgery in connection with a diagnosis confi rmed by MRI: gangrenous mediastinitis, in which the pathway of the purulent contents from the mandibular apparatus was completely and accurately described (1 molar left) with a lesion of the periosteum, further into the posterior- pharyngeal space and through the anatomical intercellular spaces of the neck to the mediastinum for 4 days. According to CT scanner of organs of the chest cavity we can see that CT scan is a sign of acute gangrenous mediastinitis with a primary process in the submandibular region. In the left parts of the lower jaw there is a small defect in the outer compact plate for up to 4.0 mm. In the soft tissues of the neck, along the whole length from the level of the larynx, multiple gas accumulations are determined both in the prevertebral space and on both sides, symmetrically under the nival muscles, where there is especially a lot of gas, and along the vascular bundles. There is a gas in the region of the fl oor of the mouth, the chin-tongue muscle. All tissues are swollen because of what anatomical structures do not diff erentiate. The process goes through the interfascial spaces, as well as along the pharynx, larynx, thyroid gland in the mediastinum, where gas is determined along all main arteries and trachea. Then it spreads along the anterior and posterior mediastinum to the diaphragm along the heart and esophagus. In its course, there is infi ltration of the tissue of the posterior mediastinum, and in the anterior one there is more pronounced accumulation of fl uid, more to the right, especially near the right atrium, where its thickness reaches 25.0 mm and there is a reaction of the adjacent parts of the right lung. Osteo-destructive changes are not detected. Thus we observed the pathway of the spread of the purulent infl ammatory process from teeth of the lower jaw to the mediastinum cavity as a consequence of infraction of asepsis (ules therefore a patient M. who had been operated twice and had clinical death was discharged from the department of the hospital with positive dynamics.