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LECTURE. Lymphadenitis , furuncle and carbuncle of maxillofacial area. Lymphadenitis is the inflammation of a lymph node. Lymph nodes
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LECTURE Lymphadenitis, furuncle and carbuncle of maxillofacial area.
Lymphadenitis is the inflammation of a lymph node. Lymph nodes The glandlike masses of tissue in the lymphatic system that contain lymphocytes. The lymph nodes also filter lymph, which is a clear yellowish tissue fluid that carries lymphocytes and fats throughout the body.
Lymphoid system of maxillofacial area:1 — glandula parotis; 2 — nodi lymphatici occtpitales; 3 — nodi lymphatici auriculares poster. 4 — nodi lymphatici cervicales profundi superiores; 5 — v. jugutaris dextra; 6 — nodi lymphatici : cales superficiales; 7 — nodi lymphatici cervicales profundi inferiores; 8 — nodi lymphatici auricu anteriorea; 9 — nodi lymphatici submaxillares; 10 — nodulus lymphaticus submentalis; 11 — a. ca communis dextra; 12— truncus lymphaticus jugularis dexter.
Lymphadenitis is often a complication of a bacterial infection of a wound, although it can also be caused by viruses or other disease agents. Lymphadenitis may be either generalized, involving a number of lymph nodes; or limited to a few nodes in the area of a localized infection. Lymphadenitis is sometimes accompanied by lymphangitis, which is the inflammation of the lymphatic vessels that connect the lymph nodes.
Causes • Streptococcal and staphylococcal bacteria are the most common causes of lymphadenitis, although viruses, protozoa, rickettsiae, fungi, and the tuberculosis bacillus can also infect the lymph nodes. Diseases or disorders that involve lymph nodes in specific areas of the body include rabbit fever (tularemia), cat-scratch disease, lymphogranuloma venereum, chancroid, genital herpes, infected acne, dental abscesses, and bubonic plague. In children, tonsillitis or bacterial sore throats are the most common causes of lymphadenitis in the neck area. Diseases that involve lymph nodes throughout the body include mononucleosis, cytomegalovirus infection, toxoplasmosis, and brucellosis.
Physical examination • The diagnosis of lymphadenitis is usually based on a combination of the patient's history, the external symptoms, and laboratory cultures. The doctor will press (palpate) the affected lymph nodes to see if they are sore or tender. Swollen nodes without soreness are often caused by cat-scratch disease. In children, the doctor will need to rule out mumps, tumors in the neck region, and congenital cysts that resemble swollen lymph nodes.
CLINICAL CLASSIFICATION OF LYMPHADENITIS • -Acute: serous, purulent. • -Chronic: hyperplastic, purulent.
Symptoms • Lymphadenitis is marked by swollen lymph nodes that are painful, in most cases, when the doctor touches them. If the lymphadenitis is related to an infected wound, the skin over the nodes may be red and warm to the touch.
Operation of removed lymph nodes attached chronical inflammation
Operation of removed lymph nodes attached chronical inflammation
Treatment • The medications given for lymphadenitis vary according to the bacterium or virus that is causing it. If the patient also has lymphangitis, he or she will be treated with antibiotics, usually penicillin G (Pfizerpen, Pentids), nafcillin (Nafcil, Unipen), or cephalosporins. Erythromycin (Eryc, E-Mycin, Erythrocin) is given to patients who are allergic to penicillin. Supportive care of lymphadenitis includes resting the affected limb and treating the area with hot moist compresses. Cellulitis associated with lymphadenitis should be treated surgically because of the risk of spreading the infection. Pus is drained only if there is an abscess and usually after the patient has been started on antibiotic treatment. In some cases, a biopsy of an inflamed lymph node is necessary if no diagnosis has been made and no response to treatment has occurred.
Prognosis • The prognosis for recovery is good if the patient is treated promptly with antibiotics. In most cases, the infection can be brought under control in three or four days. Patients with untreated lymphadenitis may develop blood poisoning (septicemia), which is sometimes fatal.
A furuncle is an infection of a hair follicle. A carbuncle is a skin infection that often involves a group of hair follicles.
Causes Furuncles are very common. They are caused by staphylococcus bacteria, which are normally found on the skin surface. Damage to the hair follicle allows these bacteria to enter deeper into the tissues of the follicle and the subcutaneous tissue. Furuncles may occur in the hair follicles anywhere on the body, but they are most common on the face, neck, armpit, buttocks, and thighs.Furuncles are generally caused by Staphylococcus aureus, but they may be caused by other bacteria or fungi.
Risk factorsAlthough anyone — including otherwise healthy people — can develop boils or carbuncles, the following factors can increase your risk: • Poor general health. Having chronic poor health makes it harder for your immune system to fight infections. • Diabetes. This disease can make it more difficult for your body to fight infection, including bacterial infections of your skin. • Clothing that binds or chafes. The constant irritation from tight clothing can cause breaks in your skin, making it easier for bacteria to enter your body. • Other skin conditions. Because they damage your skin's protective barrier, skin problems, such as acne and dermatitis, make you more susceptible to boils and carbuncles. • Immune-suppressing medications. Long-term use of corticosteroids, such as prednisone or other drugs that suppress your immune system, can increase your risk.
Signs and symptoms • A boil usually appears suddenly as a painful pink or red bump that's generally not more than 1 inch in diameter. The surrounding skin also may be red and swollen. • Within a few days, the bump fills with pus. It grows larger and more painful for about five to seven days, sometimes reaching golf ball size before it develops a yellow-white tip that finally ruptures and drains. Boils generally clear completely in about two weeks. Small boils usually heal without scarring, but a large boil may leave a scar. • A carbuncle is a cluster of boils that often occurs on the back of the neck, shoulders or thighs, especially in older men. Carbuncles cause a deeper and more severe infection than single boils do. In addition, carbuncles develop and heal more slowly and are likely to leave a scar. Carbuncles sometimes occur with a fever. • Boils and carbuncles often resemble the inflamed, painful lumps caused by cystic acne. But compared with acne cysts, boils are usually redder or more inflamed around the border and more painful.
Treatment Doctor may drain a large boil or carbuncle by making a small incision in the tip. This relieves pain, speeds recovery and helps lessen scarring. Deep infections that can't be completely cleared may be covered with sterile gauze so that pus can continue to drain. Sometimes doctor may prescribe antibiotics to help heal severe or recurrent infections.
Self-careThe following measures may help the infection heal more quickly and prevent it from spreading: • Apply a warm washcloth or compress to the affected area. Do this for at least 10 minutes every few hours. If possible, first soak the cloth or compress in warm salt water. This helps the boil rupture and drain more quickly. To make salt water, add 1 teaspoon of salt to 1 quart of boiling water and cool to a comfortable temperature. • Gently wash the boil two to three times a day. After washing, apply an over-the-counter antibiotic and cover with a bandage. • Never squeeze or lance a boil. This can spread the infection. • Wash your hands thoroughly after treating a boil. Also, launder clothing, towels or compresses that have touched the infected area.
PreventionAlthough it's not always possible to prevent boils, especially if you have a compromised immune system, the following measures may help you avoid staph infections: • Thoroughly clean even small cuts and scrapes. Wash well with soap and water and apply an over-the-counter antibiotic ointment. • Avoid constricting clothing. Tight clothes may be stylish, but make sure they don't chafe your skin.
