Sinusitis

Opening abscesses of ENT organs. Abscess and phlegmon as a complication of ENT diseases: types, danger, how to treat

An abscess of the ENT organs is an accumulation of pus in the tissues of the larynx, pharynx, ear and nose. This kind acute diseases is handled by an otolaryngologist or ENT specialist. As the disease progresses, treatment can be either medication or surgery. Do not be afraid that the doctor will order you to open an abscess - surgery can prevent further accumulation of pus in the tissue and its spread deeper into deeper layers. The method of emergency opening of abscesses also works for our otolaryngologists medical center. The high qualifications of our doctors allow us to quickly determine the nature and duration of an abscess of the ENT organs and prescribe appropriate treatment. Under no circumstances should the festering process be left to chance, because the consequences can be unpredictable.

A common abscess of the ENT organs, affecting every second inhabitant of the planet, is a boil. Inflammation hair follicle may occur in the nose and on auricle. The penetration of infection through a tiny wound can short term cause inflammation and accumulation of pus in large quantities. Therefore, the most used method of treating this abscess of the ENT organs is opening the abscess, draining the contents and removing dead tissue.

Abscess of the ENT organs - peritonsillar abscess near the tonsil - a consequence of a sore throat complication or exacerbation chronic tonsillitis. This abscess is dangerous because the continuous accumulation of pus can lead not to a breakthrough to the surface, but to a deepening into the tissues, as well as to the development of fatal complications. Therefore, opening the abscess and draining the contents will quickly solve the problem of the disease.

Abscess of the ENT organs is retropharyngeal or retropharyngeal. The process of suppuration of the lymph nodes and tissue of the retropharyngeal space. The disease may be a complication of measles, influenza, scarlet fever, or may develop independently from injury to the mucous membrane of the pharynx by solid food or foreign body. In most cases, the otolaryngologist first prescribes opening the abscess, and then antibiotic therapy.

Abscess of ENT organs in the form of acute purulent sinusitis– the disease is widespread and long lasting. Due to the lack of knowledge about the nature of the causative agents of sinusitis, we have to admit the fact that the “addiction” of microorganisms to antibiotics leads to a rapid transition acute form to chronic or protracted. Therefore, there is no single regimen for treating an abscess. Our otolaryngologists prefer to take an individual approach to each case of the disease. This means an increased chance of recovery for the patient.
Any inflammatory process in ENT organs requires a qualified specialist approach. Therefore, our center is always open for your visits!

This is a cavity filled with pus, which is located in the muscles or subcutaneous fat. Cause this pathological condition pathogenic viruses or bacteria. As a result of the accumulation large quantity pus, the affected area begins to increase, and there is a risk of an abscess breaking through with the release of pus into the nearby healthy tissue. This leads to the development of widespread inflammation called cellulitis.

In addition, an advanced abscess provokes neuritis, which contributes to the occurrence of osteomyelitis. Is this pathology treatable? conservatively How does an abscess open? Let's look at this in more detail.

Causes of abscess

A purulent disease occurs as a result of a pathogenic infection entering a weakened or damaged organ, which begins to multiply rapidly. At this time, the body actively fights inflammation and limits the inflamed area. As a result, a purulent capsule appears.

The infection penetrates into soft fabrics as a result of violation skin which occurs due to injuries, cuts, wounds, frostbite, burns, open fractures. The following pathogens contribute to the occurrence of an abscess:

staphylococci;
streptococci;
Mycobacterium tuberculosis;
clostridia;
coli.

An abscess can occur due to the fact that under the skin along with medicine infected contents were introduced or medications were infused that are intended only for intramuscular injections. This leads to the development of fiber and purulent inflammation of soft tissues.

Sometimes an abscess can occur as a result of previous diseases: pharyngitis, sore throat, pneumonia, osteomyelitis, ingrown nail.

Possible outcomes of abscess development

What can happen after this purulent cavity appears? The outcome of such a disease is as follows:

breakthrough outward or inward (into the abdominal or articular cavity);
breakthrough into organs (intestines, stomach, bladder or bronchi).

Once the abscess ruptures, the size of the purulent capsule decreases, after which the ulcer begins to scar. But if the pus is not completely removed, the inflammation often recurs or can become chronic. Therefore, the abscess must be opened to remove the accumulated pus.

Technique

The opening of the abscess must be carried out as quickly as possible if it is more than four days old and the head of the capsule has already matured. This process is carried out as follows: first, the area of inflammation is treated antiseptic solution and anesthetize with lidocaine. Using a scalpel, the doctor makes a tissue incision (no more than 2 cm) in the area of the purulent head or in the place of greatest inflammation.

Using a Hartmann syringe, the incision is expanded to 4-5 cm and at the same time the connecting bridges of the abscess are ruptured. They begin to remove the pus with electric suction, after which the cavity is examined with a finger to remove remnants of tissue and bridges. The cavity is washed with an antiseptic and drainage is carried out by inserting a rubber tube into it, which ensures the outflow of purulent exudate.

Treatment of postoperative wound

Treatment after opening the abscess is with antibiotics. Basically, the doctor prescribes medications penicillin series(“Amoxicillin”, “Cephalexin”), which should be taken 4 times a day, 200 or 500 mg. The course of treatment lasts 10 days. If the patient is allergic to penicillin, macrolides (Erythromycin, Clarithromycin) are prescribed.

Antibiotics for external use are ointments "Mafedin", "Levomekol", "Levosin" and others, the advantage of which is that their effect extends only to the affected area and they are not absorbed into the blood.

In addition, the wound after opening the abscess requires treatment. To prevent its edges from sticking together until granulation of the cavity from the depths occurs, a tampon with Vishnevsky ointment or Vaseline oil. It should be changed every 2-3 days when changing dressings. As granulation develops, the tampon is removed from the depths. Excess granulation is cauterized, while being careful not to touch the epithelium growing along the edges of the wound. If the wound heals slowly, suturing is indicated.

Let's look at how an abscess is opened in the pharynx area.

The process of opening a Bartholin gland abscess

This gland is considered the largest of those located in the vestibule of the vagina. It becomes inflamed quite rarely, and if a purulent capsule has formed, it must be opened. How is this procedure carried out?

Opening a Bartholin gland abscess begins with the doctor making careful incisions to open purulent cavity, and releases the accumulated liquid. Then the gland is washed with a solution of hydrogen peroxide (3%). A special tube (drainage) is inserted into the cavity, which is necessary to remove the remaining pus. It is removed after 5 or 6 days. Treatment is carried out with antibiotics and ointment applications.

The process of opening an abscess in the pharynx area

Autopsy is considered the main method of treating purulent diseases in the pharynx. This operation is considered simple and rarely causes complications. It is carried out under local anesthesia(solution of cocaine 5% and dicaine 2%). The incision is made in the area of the greatest protrusion of the pharyngeal wall and its depth should not be more than 1.5 cm, otherwise the nearby bundles of nerves and blood vessels can be damaged. After releasing the pus, the doctor uses a blunt instrument to penetrate the cavity to destroy the partitions inside it.

After the peritonsillar abscess has been opened, the cavity is filled disinfectant solution. After it is sutured, usually no measures are taken to stop the bleeding. Postoperative treatment involves taking antibiotics.

Conclusion

Thus, opening an abscess is mandatory procedure, since if left untreated, it can lead to various complications. It is strictly forbidden to open it yourself, otherwise this may contribute to the spread of infection to organs and tissues located nearby.

Suppurative diseases (abscesses and phlegmons) are serious complications of many inflammatory processes occurring in the body. Such complications are especially dangerous in the area of the face and head, since it is possible for pus to spread from the lesion to the brain and develop life-threatening complications.

Abscesses and phlegmons in diseases of the ENT organs are in second place in frequency after odontogenic suppurative complications.

Abscess- This is a purulent inflammatory process of a limited nature. When a virulent infection penetrates deep into tissues, purulent inflammation with necrosis, the formation of a cavity filled with pus and limited from the surrounding tissues by a capsule. Capsule formation is defensive reaction body to prevent the spread of suppuration.

Phlegmon– this is a more serious complication, which is characterized by diffuse spread of purulent inflammation, unrestricted from surrounding tissues.

Abscesses and phlegmon can form in almost all inflammatory diseases of the ENT organs, as well as as a result of injury. There is no clear classification of suppurative processes in the ENT organs. The most common forms in practice can be listed:

The development of abscesses and phlegmon occurs most often in the subcutaneous or interstitial tissue, which is rich in blood and lymphatic vessels.

Furuncle

A festering boil is also an abscess. This inflammation starts from the hair follicle and spreads to sebaceous gland and surrounding tissues. In ENT pathologies, boils are found in the nasal cavity and in the external ear canal, where the skin is present hair follicles. The penetration of infections into them is facilitated by microtraumas, as well as a general decrease in protective forces, severe somatic diseases – diabetes mellitus, hypovitaminosis. Hypothermia can also be a provoking factor.

Arises sharp pain, redness, swelling, formation of infiltrate. After 3-4 days, softening and formation of a purulent core appears in the infiltrate. The boil can open on its own, and relief comes with the release of purulent contents. With an unfavorable course and progression of the boil, complications such as sepsis, facial phlegmon, orbital and cerebral complications may develop.

Treatment in the infiltrative stage: antibiotics - aminopenicillins, cephalosporins, macrolides, fluoroquinolones. Semi-alcohol compresses and UHF are used locally. When abscessing a boil occurs against the background of massive antibiotic therapy, surgical opening of the abscess is performed, washing the wound with antiseptics and establishing drainage.

Peritonsillar abscess

Peritonsillar abscess occurs as a result of purulent inflammation in the peritonsillar tissue (it is located between the capsule tonsil and fascia of the pharynx). The infection most often penetrates here directly from the palatine tonsil through the crypts - deep grooves that penetrate the entire thickness of the tonsil. The causative agents are mainly, less commonly, anaerobic flora.

Peritonsillar abscess usually occurs at the end of the course or. Inflammation before abscess formation is called paratonsillitis. Its usual localization (in 90% of cases) is the upper pole of the palatine tonsil.

During paratonsillitis there are three stages: edematous, infiltrative and directly abscessing.

Abscess formation usually begins 3-4 days after the onset of the disease.

Upon examination, a rounded bulge is detected in the upper part of the palatine tonsil and palatine arches. When abscess formation occurs, pus becomes visible. Soft palate shifts to midline. Swelling and soreness of the neck muscles and subcutaneous tissue are noted.

Posterior or inferior localization of the abscess is less common. The bulging in such cases is less pronounced, which can complicate diagnosis.

IN general analysis blood, signs of bacterial inflammation are revealed - an increase in the number of leukocytes with a shift leukocyte formula to young forms, increased ESR.

A peritonsillar abscess can open spontaneously into the pharyngeal cavity on days 4-6 of development, while the condition improves. Less commonly, pus breakthrough occurs into the peripharyngeal tissue with the development of more severe complications - parapharyngitis and mediastinitis.

Treatment of paratonsillitis in edematous and infiltrative stages begins with antibiotics wide range actions. Painkillers and antihistamines are also prescribed, and detoxification therapy is also carried out.

IN abscess formation stages emergency opening of a tonsillitis abscess is necessary, possibly followed by removal of the tonsil (abscessonsillectomy). The operation is performed under local or topical anesthesia. The incision is made at the site of the largest protrusion. The edges of the wound are expanded with a blunt instrument to more completely empty the abscess.

Parapharyngeal abscess

This is a purulent inflammation of the peripharyngeal tissue. Occurs as a result of a complicated course of tonsillitis, chronic tonsillitis, progression of paratonsillitis, purulent (,), odontogenic inflammations.

With phlegmon, purulent inflammation is not limited to the capsule, pus spreads through the tissue, passing through the neurovascular bundles from one fascial pocket to another, the surrounding tissue vessels, muscles, tendons are involved in the process, and purulent melting of the tissue occurs.

The causative agents of phlegmon are usually streptococci and staphylococci, Pseudomonas aeruginosa. In more severe cases, phlegmon is caused by anaerobic flora.

Phlegmons are characterized by:

With deep-lying, sluggish phlegmon of the neck, the symptoms may not be so pronounced, which makes diagnosis difficult.

Phlegmon in ENT pathology can be divided into the following groups:

Facial phlegmon

In ENT pathology, facial phlegmon occurs as a complication of nasal boils, when an infection occurs after surgery on the nasal cavity, as well as with the progression of rhino-orbital complications.

Facial phlegmons are most often located in the area of the nose, in the area of the lower jaw.

Orbital phlegmon

This type of phlegmon is mainly a complication of purulent sinusitis (most often inflammation of the cells of the ethmoid labyrinth, less often - other paranasal sinuses nose).

With the transition to retrobulbar fiber.
Without transition to retrobulbar fiber.

Cellulitis of the neck

1) Localized:

Submental;
Submandibular;
Anterior neck area;
Lateral neck area.

2) Common:

With transition to peri-esophageal fiber.
Complicated by mediastenitis.
With the transition to the cellular spaces of the back.

Treatment of phlegmons of the face and neck is carried out in a specialized department purulent surgery. An emergency operation is required, the purpose of which is:

Opening a purulent cavity,
Maximum and gentle removal of necrotic tissue,
Washing the wound with solutions of antiseptics and antibiotics,
Establishing drainage for the outflow of inflammatory exudate.
IN postoperative period massive antibiotic therapy and detoxification measures are prescribed.

Orbital complications

The orbit borders directly with the paranasal sinuses: bottom wall-c maxillary, the inner wall - with the ethmoid and sphenoid, the upper - with the frontal. The veins of the nasal cavity connect to the orbital veins. That's why purulent processes in the paranasal sinuses can lead to suppurative complications in the orbit. Rhino-orbital complications in sinusitis include: subperiosteal abscess, retrobulbar abscess, orbital phlegmon.

The clinical picture of all orbital complications is similar. Noted:

Swelling of the eyelids and tissues surrounding the eyes,
Protrusion of the eyeball
Hyperemia of the conjunctiva,
Pain when moving your gaze,
purulent discharge,
Rapidly progressive decrease in vision up to blindness.
With paresis of the nerves and muscles of the eye, the eye becomes motionless, the eyelid does not close, and double vision is noted.
Expressed and general symptoms: headache, weakness, vomiting, fever.

The diagnosis is confirmed by performing a CT scan of the orbit. Treatment purulent complications the orbit lies in emergency surgery on the affected sinus - radical wide access to the affected sinus, its sanitation with removal of necrotic tissue. In addition, decompression and drainage of the orbit is carried out through external incisions or the endonasal endoscopic method.

Sometimes, when an infection spreads from the nasal cavity or paranasal sinuses through the nasolacrimal canal, suppuration of the lacrimal sac and surrounding tissue occurs. In this case they talk about phlegmon of the lacrimal sac. Most often it is a complication of ethmoiditis or sinusitis.

In the area of the inner corner of the lower eyelid, redness, swelling, pain, and lacrimation occur. The swelling quickly spreads to both eyelids, cheek, and nose. The temperature rises. After a few days, softening appears in the center of the compaction, and purulent contents become visible.

The abscess can open outwards, sometimes as a consequence of this a fistula can form. The breakthrough of pus through the nasolacrimal duct into the nasal cavity can be complicated by an internal fistula. The most severe complication is orbital phlegmon.

Treatment is antibiotic therapy, surgical opening of the lesion, drainage.

Prevention

Unfortunately, quite often patients are admitted to hospitals with already formed advanced forms of suppurative complications. This indicates a late visit to the doctor for treatment of the underlying disease. Need to remember:

A peritonsillar abscess is the formation and accumulation of purulent masses in the tissues located around the palatine tonsils in the so-called peritonsillar tissue. Usually this condition is a complication of tonsillitis, when the inflammatory process from the tonsils spreads to nearby tissues. In addition to sore throat, factors leading to the appearance of a purulent pocket in the pharynx are purulent pharyngitis, dental diseases, damage to gums, palate, weak immunity, smoking. The causative agents of the disease are most often staphylococci, streptococci, in more cases in rare cases – coli, Pseudomonas aeruginosa and fungi.

Depending on the location of the purulent pocket, several forms of peritonsillar abscesses are distinguished: posterior, anterior, inferior and external. The anterior form of the disease is more common, when a purulent accumulation is located between top part tonsils and anterior palatine arch.

Stages and symptoms of the disease

Peritonsillar abscesses with tonsillitis and other diseases go through several stages. The first stage is edematous (tissue swelling occurs). At this stage, the symptoms of the disease do not manifest themselves in any way. The second stage is infiltration, when the body temperature rises and the patient complains of painful sensations in the throat. At this stage it is already possible to make a correct diagnosis. The final stage is abscess formation. It begins approximately on the fourth or fifth day of illness. It is during this period that an accumulation of pus occurs.

The disease is characterized by the following symptoms:

main symptom – severe pain during swallowing; pain may radiate to the teeth or ear;
it is problematic for the patient, and sometimes completely impossible, to open his mouth wide (trismus chewing muscles);
sensation of a foreign object in the throat;
lymph nodes enlarge and become painful;
arises bad smell from the mouth;
the voice becomes nasal;
general condition The patient deteriorates, body temperature rises to 39.

In rare cases, the opening of the abscess occurs spontaneously. In this case, the patient immediately feels noticeable relief. But, as a rule, an abscess with a sore throat does not open independently: the patient requires professional help from an ENT doctor.

* - discount is provided when complex treatment diseases

Opening a paratonsillar abscess

If on the fourth day of formation of a purulent pocket spontaneous opening does not occur, a decision is made to surgically open the abscesses.

Before surgical intervention the patient is undergoing local anesthesia using Lidocaine, or better yet Ultracaine DS or Ultracaine DS-forte. An incision is then made using a scalpel. The location of the incision is selected individually in each case. This is often the area of greatest swelling. A Hartmann syringe is carefully inserted into the incision site, and the syringe is used to evacuate pus from the cavity. After the procedure, the otorhinolaryngologist prescribes a regimen postoperative treatment, which usually includes taking antibiotics, using water-based antiseptic rinses, taking decongestants and anti-inflammatory drugs.

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104 clinics where the service is provided Opening of a paratonsillar abscess in Moscow
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Service	Price, rub.
Opening a paratonsillar abscess or hematoma of the ENT organs	3000
Opening a peritonsillar abscess	3600
Opening of paratonsillar abscess (revision)	5750
Opening the paratonsillar; parapharyngeal; retropharyngeal abscess	2000
Opening of paratonsillar, parapharyngeal retropharyngeal abscess and laryngeal abscess	4000
Opening a retropharyngeal abscess	4000
Opening a peritonsillar abscess	14365
Opening of a hematoma (abscess, boil, atheroma, cyst) of the ENT organs	3850
Opening abscesses, cysts, ulcers of the nose, pharynx, ear, larynx	4500
Opening a paratonsillar or retropharyngeal abscess	85000

Main indications

Indications for the procedure are:

the presence of an abscess after conservative treatment;
high temperature;
swallowing disorder;
inability to open your mouth wide;
breathing problems;
severe pain;
chewing disorder.

Contraindications include:

unconsciousness of the patient;
thrombosis of cerebral vessels;
cachexia due to severe illness;
purulent meningitis.

How to prepare for the procedure

During initial appointment An otolaryngologist conducts a full examination of the patient, collects an anamnesis of life and illness. The patient must undergo a blood test for viral hepatitis, HIV, Wasserman reaction, undergo electrocardiography and fluorography of organs chest, consultations with a therapist and anesthesiologist. You need to tell your doctor about all medications you are taking and bad habits- this will help to avoid complications in the future. Medical staff must convey to the patient information about the procedure for the operation and possible complications.

Features of the procedure

The procedure is carried out under sterile conditions sterile instruments. The area of the future incision is treated with lidocaine by spraying or smearing. After a few minutes, when the anesthesia begins to take effect, an incision is made with a scalpel at the site of the greatest swelling of the abscess. After this, a forceps is inserted into the abscess cavity to improve the outflow of pus. Then the cavity is washed with distilled water or an antiseptic. No stitches are required as the cavity heals on its own. In some cases, after opening the abscess, it is necessary to remove the tonsils.

After the procedure, antibacterial, antipyretic, decongestant, painkillers, vitamin therapy and physiotherapeutic procedures are prescribed. In the first days after surgery, the patient is advised to remain calm, talk little and eat warm liquid food.

Possible complications:

bleeding;
thrombosis;
allergic reaction to anesthetic;
sepsis;
inflammation of the soft tissues of the neck;
inflammation of the space between pleural cavities(mediastinitis).