Edema of the temporal region
The temporal space is divided intosurface, middle and deep layers. The superficial layer is located between the skin and the aponeurosis of the temporal muscle, the middle layer between the aponeurosis and the muscle proper and the deep one between the muscle and the skull.
It should be borne in mind that the temporal muscle in the lowerits third is adjacent to the outer surface of the inner surface of the upper part of the masticatory muscle, and the inner surface - to the outer surface of the medial pterygoid muscle. These features create favorable opportunities for the spread of pus from the tanning and pterygo-mandibular spaces to the temporal space and vice versa.
It is necessary to distinguish 4 types of phlegmon of the indicated localization (AI Evdokimov): surface, middle, deep and diffuse. With a superficial phlegmon, the purulent process is localized in the cellulose between the skin and the aponeurosis of the temporal muscle; at the middle - aponeurosis between itself and the temporal muscle or fascial in the closed space above the zygomatic arch; at deep - between the temporal muscle and the skull; when the phlegmon is diffused into the suppuration, all parts of the temporal region are involved, as well as adjacent cell spaces.
For the phlegmon of the indicated localization is characteristicthe appearance of a dense, painful swelling in the temporal region. Instead of an even or slightly sunken, the temporal region becomes a pillow-like one, while the edema extends to the circumorbital, zygomatic and upper part of the parotid region. With a surface phlegmon, fluctuation is well defined, and with a medial and deep phlegmon in most cases, fluctuation is not determined, which forces one to resort to a trial puncture of this region.
For dissection of abscesses and phlegmon of the temporal regiondifferent cuts are used. Thus, radial incisions are carried out with a surface phlegmon. At the middle and deep phlegmon, arcuate incisions are made in the temporal region (along the attachment line of the temporal muscle) and a horizontal incision along the upper edge of the zygomatic arch. If necessary, a tunnel is made between these two cuts.
With diffuse phlegmon, in addition to the indicated sections,sometimes it is necessary to make a cut in the angle of the lower jaw, cut off the medial pterygoid muscle at the place of its attachment and bluntly penetrate into the dorsal fossa along the inner surface of the jaw branch.
maxillofacial surgery », N.M. Alexandrov
The borders of the inframammary fossa are in front -tuberosus of the upper jaw, posteriorly the styloid process of the temporal bone with the muscles leaving from it, from the outside - the upper part of the mandibular branch, from the inside - the pterygoid main process.
Oclo-pharyngeal space is deeply embeddedbetween m.constrictor pharyngis and m.pterygoideus medialis. The posterior wall of the space forms a styloid process with the efferent and subordinate muscles. Anterior wall of the okolothomatous.
In the same section:
Autopsy of a purulent focus in the maxillofacialregions are produced under infiltration or conductive anesthesia with 0.5 and 2% solutions of novocaine or under anesthesia with appropriate premedication. In excitable patients and children, opening abscesses and phlegmon is preferable to anesthesia. Depending on the localization of the abscess or phlegmon, surgical intervention is performed by intraoral access or from the skin.
Incisions of the skin or mucosa should besufficient length. In this case, the following rule should be observed: the dimensions of the cutaneous wound or mucosal wounds should be approximately equal to or slightly larger than the length of dissection or dilution of the soft tissue (fascia, cellulose, muscle) to be treated. Otherwise, the conditions for the outflow of pus sharply worsen, possibly the formation of suppurative deposits, and the like. When the size of the wound is too small.
With large and deep purulent cavities anda significant amount of purulent discharge, found during the first dressing, a tampon or a rubber strip is advisable to introduce again to the full depth. After the second dressing, the swab is usually placed superficially or not injected at all. During the first 2 to 3 days after the incision, dressings are done daily and only as needed (blotching or slipping of the dressing, sudden ascent.
Operational interventions forthe opening of abscesses and phlegmon of the maxillofacial region, as well as with other suppuration processes, differ in a number of features due to the location of the abscess, the phase or stage of the purulent process, the age of the patient and some other factors. parts, purulent.
Peritonsillar abscesseruption of the lower "wisdom teeth", complicated by pericoronitis and retro-molar periostitis, the purulent exudate can accumulate in space behind the "wisdom teeth", called the "retromolar depression". In this case, pus accumulates between the periosteum and bone, or it can spread up the loose side of the frontal cell surface of the mandibular branch upwards - to the side.