Phlegmon Case

emergencias 2007;19:52-53 52 Images Received: 30-10-2006 Accepted: 29-11-2006 A 23-year-old patient arrived for consultation at emergency department presenting with an increase of the soft tissue of the right submaxillary and submandibular regions over the last 48 hours. Pain was reported upon cervical palpation, 38ºC temperature, slight trismus, odynophagia, dysphagia and earache in the right ear. No sign of dyspnoea. Right cervical palpation indicated a considerable increase in soft tissue from the angle of the jaw, submandibular and submentonian areas, right up to the upper limit of the hyoid bone but not exceeding middle line. Palpation was very pain- ful, of a hard consistency with no fluctuations. Exploration of the oral and oropharyngeal cavities was difficult due to trism, but no significant lesion was observed in floor of the mouth, jugal mucosa or palatine tonsils. In terms of medical history of interest, the patient reported tooth infection (right lower molar) one week previously which was treated in outpatient mode with broad spectrum antibiotics. A cervical CT scan was performed (Fig. 1) showing a right submaxillary phlegmon. Phlegmon in submaxillary region was diagnosed and treated with cefriaxone and clyn- damycin, with a positive evolution. A background of dental infection and an increase in the soft tissue of the neck, together with fever and general malai- se may indicate deep cervical infection. After having obtained the medical history and performed a physical examination, the first thing we need to check is the permeability of the airway, followed by checking for an abscess. If an abscess has formed, surgical treatment is recommended (abscess drainage), and if it has not yet formed, we may elect a more conservati- ve therapy (IV antibiotics) and reserve surgical intervention depending on evolution over the following 48-72 hours. In any event, we must not forget that given the slightest suspi- cion of airway collapse, we must consider the possibility of performing a tracheotomy. REFERENCES 1- Harrinson G. Leed, L. Arick Forrest. Deep Neck Infection. Pag. 2515- 2525. Cummings Otolaryngology Head and Neck Surgery. Cummings et al. 4ª Ed. Ed. Elsevier Mosby. 2- Byrne M, Lee KJ. Neck Spaces and Fascial Planes. Pag. 437-455. Essen- tials Otolaryngology Head and Neck Surgery. K.J Lee. 7ª Ed. Appleton & Lange. 3- Herzon FS, Martin AD. Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses. Curr Infect Dis Rep 2006;8:196-202. 4- Brook I. Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg 200462:1545-50. 5- Gidley PW, Ghorayeb BY, Stiernberg CM. Contemporary management of deep neck space infections. Otolaryngol Head Neck Surg 1997;116:16-22. 6- McClay JE, Murray AD, Booth T. Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg 2003;129:1207-12. Phlegmon in the submandibular region secondary to odontogenic infection M. de la Cámara Gómez 1 , F. Vázquez de la Iglesia 2 , M. M. Otero Palleiro 3 , J. de la Cámara Gómez 3 , C. Barbagelata López 4 1 EMERGENCY DEPARTMENT, JUAN CANALEJO HOSPITAL, LA CORUÑA. 2 ENT SPECIALIST, ARQUITECTO MARCIDE HOSPITAL, FERROL, LA CORUÑA. 3 ONCOLOGY SPECIALIST, ARQUITECTO MARCIDE HOSPITAL, FERROL, LA CORUÑA. 4 INTERNAL MEDICINE DEPARTMENT, JUAN CANALEJO HOSPITAL, LA CORUÑA. Correspondence: Dra. María de la Cámara Gómez Servicio de Urgencias. Complejo Hospitalario Juan Canalejo. Xubias de Arriba, 84. 15006 La Coruña E-mail: [email protected]

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Transcript of Phlegmon Case

emergencias 2007;19:52-53

Images

Received: 30-10-2006Accepted: 29-11-2006

A 23-year-old patient arrived for consultation at emer-gency department presenting with an increase of the soft tis-sue of the right submaxillary and submandibular regions overthe last 48 hours. Pain was reported upon cervical palpation,38ºC temperature, slight trismus, odynophagia, dysphagia andearache in the right ear. No sign of dyspnoea.

Right cervical palpation indicated a considerable increasein soft tissue from the angle of the jaw, submandibular andsubmentonian areas, right up to the upper limit of the hyoidbone but not exceeding middle line. Palpation was very pain-ful, of a hard consistency with no fluctuations.

Exploration of the oral and oropharyngeal cavities wasdifficult due to trism, but no significant lesion was observedin floor of the mouth, jugal mucosa or palatine tonsils.

In terms of medical history of interest, the patient repor-ted tooth infection (right lower molar) one week previouslywhich was treated in outpatient mode with broad spectrum an-tibiotics.

A cervical CT scan was performed (Fig. 1) showing aright submaxillary phlegmon. Phlegmon in submaxillary re-gion was diagnosed and treated with cefriaxone and clyn-damycin, with a positive evolution.

A background of dental infection and an increase in thesoft tissue of the neck, together with fever and general malai-se may indicate deep cervical infection. After having obtained

the medical history and performed a physical examination, thefirst thing we need to check is the permeability of the airway,followed by checking for an abscess. If an abscess has for-med, surgical treatment is recommended (abscess drainage),and if it has not yet formed, we may elect a more conservati-ve therapy (IV antibiotics) and reserve surgical interventiondepending on evolution over the following 48-72 hours. Inany event, we must not forget that given the slightest suspi-cion of airway collapse, we must consider the possibility ofperforming a tracheotomy.

REFERENCES

1- Harrinson G. Leed, L. Arick Forrest. Deep Neck Infection. Pag. 2515-2525. Cummings Otolaryngology Head and Neck Surgery. Cummings et al.4ª Ed. Ed. Elsevier Mosby.2- Byrne M, Lee KJ. Neck Spaces and Fascial Planes. Pag. 437-455. Essen-tials Otolaryngology Head and Neck Surgery. K.J Lee. 7ª Ed. Appleton &Lange.3- Herzon FS, Martin AD. Medical and surgical treatment of peritonsillar,retropharyngeal, and parapharyngeal abscesses. Curr Infect Dis Rep2006;8:196-202.4- Brook I. Microbiology and management of peritonsillar, retropharyngeal,and parapharyngeal abscesses. J Oral Maxillofac Surg 200462:1545-50.5- Gidley PW, Ghorayeb BY, Stiernberg CM. Contemporary management ofdeep neck space infections. Otolaryngol Head Neck Surg 1997;116:16-22.6- McClay JE, Murray AD, Booth T. Intravenous antibiotic therapy for deepneck abscesses defined by computed tomography. Arch Otolaryngol HeadNeck Surg 2003;129:1207-12.

Phlegmon in the submandibular region secondaryto odontogenic infection

M. de la Cámara Gómez1, F. Vázquez de la Iglesia2, M. M. Otero Palleiro3, J. de la Cámara Gómez3,C. Barbagelata López4

1EMERGENCY DEPARTMENT, JUAN CANALEJO HOSPITAL, LA CORUÑA. 2ENT SPECIALIST, ARQUITECTO MARCIDE HOSPITAL, FERROL,

LA CORUÑA. 3ONCOLOGY SPECIALIST, ARQUITECTO MARCIDE HOSPITAL, FERROL, LA CORUÑA. 4INTERNAL MEDICINE DEPARTMENT,

JUAN CANALEJO HOSPITAL, LA CORUÑA.

Correspondence: Dra. María de la Cámara GómezServicio de Urgencias. Complejo Hospitalario Juan Canalejo.Xubias de Arriba, 84.15006 La CoruñaE-mail: [email protected]