What is nonspecific lymphadenitis. Submandibular lymphadenitis in children. Causes of lymphadenitis in various areas

Complaints of spontaneous pain when touched in the area of ​​the affected lymph node or group of nodes.

Clinic. The general condition is satisfactory, low-grade fever and deterioration of general condition may be noted. Signs of intoxication: weakness, loss of appetite, sweating, headaches, sleep disturbances - are more pronounced in children of the younger age group (1-3 years). The skin over the lymph node is not changed in color and is not fused to it. On palpation, the lymph node is enlarged, painful, and the symptom of fluctuation is not determined. With the development of lymphadenitis, the symptoms increase, the swelling of the surrounding tissues gradually increases, the mobility of lymph nodes decreases, and palpation becomes sharply painful. This increase in symptoms occurs within several days from the onset of the disease. With timely initiation of adequate treatment and elimination of the primary source of infection, the process begins to decline. Untimely or irrational treatment leads to periadenitis and purulent melting of lymph nodes.

Acute purulent lymphadenitis

The cause of occurrence is the transition of acute serous lymphadenitis to purulent lymphadenitis during irrational treatment, unfavorable premorbid background (hypothermia, stress, previous serious illnesses, immunodeficiency states etc.).

Complaints of pain in the area of ​​the affected lymph node.

Clinic. The pain is severe, throbbing. Body temperature 37.5-38°C and above. The general condition is satisfactory, but there may be moderate severity. The child develops lethargy, apathy, sleep and appetite are disturbed. Symptoms of intoxication are more pronounced in children of the younger and middle group. Swelling of the tissues surrounding the lymph nodes is determined, the infiltrate is painful and limited. The skin over the lymph nodes is hyperemic, fused with the surrounding tissues, and the symptom of fluctuation is determined. The last symptoms of the disease are well defined with inflammation of superficially located lymph nodes and are not detected with lymphadenitis of deeply located lymph nodes (submandibular, cervical, parotid region).

Treatment.Acute serous lymphadenitis:

1. Medication.

2. Physiotherapy.

Acute purulent lymphadenitis:

1. Surgical.

2. Medication.

3. Physiotherapy.

Acute lymphadenitis is usually a secondary disease. The infection enters the lymph nodes from foci of purulent inflammation:

· From the pulp of the tooth - pulpitis, periodontitis.

· From the nose and nasopharynx - with acute respiratory infections.

· For sinusitis.

· From ulcers, suppurating abrasions, ulcers on the skin of the face or mucous membrane of the nasal cavity.

this implies prevention - rehabilitation of the above diseases and early treatment at the stage serous inflammation in LU. In many ways, it depends on the correct tactics of the pediatrician and dentist, on the presence of certain knowledge of these diseases among parents, on the state of health education work at school and in the region as a whole.

A special place in prevention is occupied by the sanitation of the oral cavity in a clinic, as well as in schools and preschool institutions.

Abscess

Abscess - limited purulent inflammation fiber with the formation of a cavity.

Etiology. The causative agent is isolated mixed flora with a predominance of staphylococci or streptococci in symbiosis with other types of cocci, Escherichia coli and other types of coli.

Pathogenesis. An abscess of the soft tissues of the face occurs as a result of damage or inflammation of the facial skin, mucous membrane of the oral cavity, lips, nose, and eyelids. Less commonly, the cause of an abscess in children is an odontogenic lesion.

Complaints of pain in the area of ​​affected tissue. If the abscess is localized in the chewing area, there are complaints of limited mouth opening and impaired chewing; when localized in the sublingual, pterygomandibular space, tongue - complaints of pain when swallowing.

Clinic. The general condition of an abscess is slightly disturbed; abscesses located deep in the tissues - in the subtemporal, paratonsillar, and peripharyngeal spaces - are severe. They occur with severe symptoms of intoxication and pose a threat to the health and life of the child. Pallor skin, weakness, malaise, temperature 38°C and above. Abscesses are most severe in children of the younger age group.

In the area of ​​inflammation, the skin or mucous membrane is hyperemic, tense, and bulging is often detected. In the center of the infiltrate there is fluctuation. Palpation is painful. The boundaries of the changed tissues are clearly defined.

Treatment.

1. Surgical.

2. Medication.

3. Physiotherapy.

Phlegmon.

Phlegmon is an acute purulent diffuse inflammation of subcutaneous, intermuscular and interfascial loose fatty tissue.

Etiology. The pathogen is a mixed flora with a predominance of staphylococci or streptococci in symbiosis with other types of cocci, coliform and other types of bacilli. The role has increased anaerobic infection(non-sporogenous bacteria, bacteroides, clostridia), associative participation of aerobic and anaerobic microflora.

Pathogenesis. In childhood, the main cause of the development of phlegmon is a complication of lymphadenitis (adenophlegmon) and osteomyelitis (osteophlegmon).

Adenophlegmon

This is a complication of acute or exacerbation of chronic purulent lymphadenitis. It is observed in children aged 2 months and older. It is more common in children 3–7 years old. The cause of occurrence is the melting of the lymph node capsule and the transition of inflammation to fatty tissue, surrounding him. The most common localization of phlegmons: chin region, submandibular region, supramandibular region, buccal region, parotid-masticatory region.

Complaints of increasing pain in the area of ​​inflammation.

Clinic. The general condition worsens, symptoms of intoxication of the body increase (the child eats poorly, sleeps poorly, lethargy and apathy occur). Body temperature up to 39–40°C. The phenomena of intoxication of the body are most pronounced in young children. A diffuse swelling of one or more anatomical areas is determined. The skin is tense, hyperemic, and becomes dense. Palpation is sharply painful; a symptom of fluctuation is determined in the center.

Treatment.

1. Surgical.

2. Medication.

3. Physiotherapy.

Prevention - treatment of acute lymphadenitis should be timely and in full. The process should not be allowed to enter the chronic stage, which, in turn, due to exacerbation, can cause the development of adenophlegmons.

Osteophlegmon

Evolving in the background acute osteomyelitis bones of the facial skeleton and jaws. It is a severe complication of the inflammatory process in bone tissue, osteophlegmons aggravate the course of the disease and increase intoxication of the body. In childhood, superficial osteophlegmons often occur. Cellulitis of deep cellular spaces develops with long-term untreated osteomyelitis. The most serious complications are caused by phlegmon of the retrobulbar space of the orbital cavity, especially in newborns and infants with hematogenous osteomyelitis.

Diagnosis of phlegmon is based on general manifestations inflammatory process in the body and local manifestations. Local manifestations depend on the topography of the cellular space in which the inflammatory process occurs.

Treatment

1. Surgical.

2. Medication.

3. Physiotherapy.

Prevention - osteophlegmon is based on timely diagnosis and full-scale treatment of acute odontogenic osteomyelitis.

Inflammatory diseases of the soft tissues of the maxillofacial area occur with symptoms of intoxication of the body. The severity of intoxication symptoms will be an indication for hospitalization of the child in a hospital.

Indications and organization of hospitalization of a child with inflammatory diseases of the soft tissues of the maxillofacial area - as the basis for the prevention of complications of purulent-inflammatory diseases of the face in children.

Test tasks

1. Difficulty in swallowing occurs with phlegmon:

A. temporal region

B. zygomatic region

C. parotid-masticatory region

D. peripharyngeal space.

2. Severe difficulty opening the mouth appears with phlegmon:

A. zygomatic region

B. submandibular region

C. infraorbital region

D. buccal area

E. pterygomaxillary space

F. parotid-masticatory region.

3. Name a typical clinical sign phlegmon of the submandibular region:

A. skin hyperemia in the upper lip area

B. swelling of the pterygomaxillary fold

C. infiltrate and hyperemia of tissue in the submandibular region

D. swelling and hyperemia of the buccal area.

4. Adenophlegmon develops due to:

A. abscess boil

B. periapical inflammation

C. spread of the inflammatory process beyond the lymph nodes

D. spread of the inflammatory process from other areas

5. Most often lymphadenitis occurs at the age of:

A. 0-6 months

B. 6 months -1 year

C. 1 year - 2 years

D. 2-3 years

E. 3-5 years

6. The complex of treatment of inflammatory diseases of the soft tissues of the maxillofacial area includes:

A. sedative therapy

B. antihypertensive therapy

C. surgical treatment

D. antibacterial therapy

1. Vinogradova T.F. Pediatric dentistry. - M. Medicine, 1987.

2. Vinogradova T.F., Vinnicheko A.V. Inflammatory processes in the maxillofacial region. - M. Medicine, 1987. P. 242–230.

3. Kolesov L.A.. Pediatric dentistry. Textbook for students medical institutes. 4th edition, revised and expanded. - M., 1991. P. 386.

4. Roginsky V.V., Volozhin A.I. and others. Inflammatory diseases in the maxillofacial region. - M. Detstomizdat, 1998. P. 272.

5. Shargorodsky A.G. Inflammatory diseases of the maxillofacial region and neck. - M Medicine, 1985.

EXAMPLES OF TEST TASKS TO CONTROL THE LEVEL OF KNOWLEDGE

Exogenous prevention of dental caries with calcium-containing remineralizing agents.

1. Demineralization of enamel is:

a) release of mineral components from enamel

b) loss of shine by enamel

c) diffusion of fluoride ions into enamel

d) maturation of enamel.

1. Specify the physiological value of the Ca/P coefficient:

a) 1.33

b) 1.45

c) 1.67

d) 2.28.

1. Please indicate the main mineral components hydroxyapatite:

a) magnesium

b) iron

c) fluorine

d) calcium

e) phosphorus.

4. What requirements must remix solutions meet?

a) oversaturation with Ca and P ions

b) Ca/P ratio = 1.67 and higher

c) pH more than 7

d) the presence of fluorine ions

e) absence of fluorine ions

e) pH less than 7.

5. Please indicate the most effective options application of repair products:

a) application of solutions

b) gel applications

c) rinsing with solutions

d) applications with pastes

e) tablets

f) electrophoresis of solutions.

6. Specify optimal timing use of remedial drugs:

a) within 2 years after teething

b) immediately after eruption

c) at any time after eruption

d) after the formation of tooth roots is completed.

7. Specify the average duration of prophylactic application of the repair solution (minutes)

a) 5–7

b) 20–25

c) 10–15

d) 40–45

e) 30–35.

8. At what age can enamel remineralization be carried out?

a) 6 years

b) 10 years

at the age of 15

d) 3 years

d) according to indications.

9. Indicate toothpastes that can be used as an application remedy?

a) Parodontol

b) Forest balm

c) Fluorodent

d) New Pearl Calcium

d) Lesnaya.

10. Which method should be preferred in dental practice?

a) Borovsky-Leus

b) Borovsky-Volkov.

Exogenous prevention of dental caries with fluoride preparations.

1. Specify the mechanisms of anti-caries action of fluorides

a) antiseptic

b) activation of remineralization

c) formation of fluorapatite

d) hyposalivation

e) increased adhesion of microorganisms

f) increasing the permeability of enamel.

2. Which formation is most resistant to acids?

a) fluorapatite

b) hydroxyapatite

c) chlorapatite

d) fluorohydroxyapatite.

3. What value does the fluorogel concentration of 1.0% correspond to?

a) 10,000 ppm

b) 1000 ppm

c) 100,000 ppm

d) 1,000,000 ppm

e) 100 ppm.

4. What is the frequency of use of fluoride-containing rinses?

a) daily

b) twice a day

c) every other day

d) weekly

e) depends on the concentration of fluoride

5. Specify sufficient volume of rinse aid for one procedure

a) 50 ml

b) 20 ml

c) 10 ml

d) 5 ml

e) 15 ml.

6. For deep fluoridation the following are used:

a) highly dispersed suspension of calcium hydroxide

b) 5% calcium glycerophosphate solution

c) 2% sodium fluoride solution

d) solution of magnesium fluoride silicate containing copper

e) a solution of calcium and strontium salts containing phosphate ions and carbonate ions.

7. At what age can fluoride varnish be used?

a) 5 years

b) 10 years

c) 12 years old

d) 2 years

e) 6 years.

8. Which fluoride compound has the maximum cariesstatic effect?

a) sodium fluoride

b) sodium monofluorophosphate

c) tin fluoride

d) amino fluoride.

9. At what concentration of fluoride in drinking water the use of fluoride preparations is indicated

a) less than 0.5 mg/l

b) less than 1.0 mg/l

c) less than 1.5 mg/l

d) less than 2.0 mg/l.

10. Indicate the optimal concentration of sodium fluoride solution used for the prevention of caries within school curriculum

a) 0.5%

d) 0.2%

e) 0.05%.

TOPIC 3

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- is it non-specific or specific? inflammatory lesion lymph nodes Lymphadenitis is characterized by local soreness and enlargement lymph nodes, headache, malaise, weakness, fever. Diagnosis of lymphadenitis is carried out using anamnesis and physical examination; the etiology is clarified by biopsy of the changed lymph node. Treatment of lymphadenitis is carried out taking into account the isolated pathogen and includes antibiotic therapy and physiotherapy. When an abscess or adenophlegmon forms, they are opened and drained.

ICD-10

L04 Acute lymphadenitis

General information

The inflammatory reaction of the lymph nodes with lymphadenitis is barrier function lymphatic system, which limits the spread of infection throughout the body. Typically, lymphadenitis occurs as a complication of primary inflammation of any localization. Infectious agents(microorganisms and their toxins) penetrate the regional lymph nodes with the flow of lymph, which flows from the primary purulent focus. Sometimes by the time lymphadenitis develops primary focus is already being eliminated and may remain unrecognized. In other cases, lymphadenitis occurs when infection directly enters the lymphatic network through damaged skin or mucous membrane.

Treatment of lymphadenitis is carried out by vascular surgeons, in particular, specialists in the field of phlebology and lymphology. With lymphadenitis, the submandibular, cervical, axillary lymph nodes are most often affected, and less often - the popliteal, elbow, and inguinal lymph nodes. Inflammation of deep lymph nodes (pelvic, iliac) occurs.

Causes of lymphadenitis

The causative agents of nonspecific lymphadenitis are usually pyogenic flora - staphylococci and streptococci, as well as the toxins and tissue breakdown products they secrete, which penetrate the lymph nodes by lymphogenous, hematogenous or by contact. The primary focus of nonspecific lymphadenitis can be purulent wounds, felons, boils, carbuncles, cellulitis, erysipelas, trophic ulcers, thrombophlebitis, caries, osteomyelitis. Local inflammatory processes are often accompanied by regional lymphadenitis.

Lymphadenitis in children is often associated with inflammatory processes of the ENT organs (influenza, otitis, chronic tonsillitis, tonsillitis), childhood infections (scarlet fever, diphtheria, mumps), as well as skin diseases (pyoderma, exudative diathesis, infected eczema, etc.). The cause of specific lymphadenitis is the pathogens of tuberculosis, syphilis, gonorrhea, actinomycosis, plague, anthrax, tularemia and other infections.

Classification

According to the course, lymphadenitis can be acute and chronic. Acute lymphadenitis goes through 3 phases in its development - catarrhal, hyperplastic and purulent.

The initial pathological processes in lymphadenitis are characterized by congestive hyperemia of the skin over the enlarged lymph node, dilation of the sinuses and desquamation of their endothelium. This is followed by the phenomena of exudation and serous saturation of the parenchyma of the node, leukocyte infiltration and proliferation lymphoid tissue. These structural changes correspond to the catarrhal and hyperplastic stages of lymphadenitis with the localization of pathological processes within the capsule of the lymph node. With unfavorable further development, purulent melting of the lymph node occurs with the formation of an encapsulated abscess or the breakthrough of infected contents into the surrounding tissue - the development of paralymphadenitis and adenophlegmon. Ichorous lymphadenitis, which occurs due to putrefactive decay of the lymph nodes, is particularly severe.

Less common are fibrinous lymphadenitis, characterized by abundant exudation and loss of fibrin, and necrotizing lymphadenitis, which develops as a result of rapid and extensive necrosis of the lymph node. Also distinguished special shape lymphadenitis - hemorrhagic, characterized by imbibition (soaking) of the lymph node with blood during anthrax or plague.

When idle and hyperplastic form lymphadenitis can take a chronic course. With lymphadenitis, inflammation may involve a single lymph node or several nearby lymph nodes. Depending on the etiology and pathogen, specific and nonspecific lymphadenitis are distinguished.

Symptoms of lymphadenitis

An acute nonspecific process manifests itself with pain in regional lymph nodes and an increase in their size. With catarrhal and hyperplastic forms, enlarged nodes can be easily palpated, their pain is insignificant, general disorders weakly expressed or absent. Lymphadenitis often occurs with the involvement of lymphatic vessels - lymphangitis.

In case of suppuration, the node becomes dense and painful, develops general intoxication– fever, loss of appetite, weakness, headache. Local phenomena increase - hyperemia and swelling in the area of ​​the affected node, the contours of the lymph node become unclear due to periadenitis. The patient is forced to spare the affected area, since the pain intensifies with movement. Quite soon, purulent melting of the lymph node occurs and fluctuation becomes noticeable in the area of ​​infiltration.

If the formed abscess is not opened in time, pus may leak out or into surrounding tissues. IN the latter case adenophlegmon develops, which is characterized by a diffuse, dense and painful infiltrate with individual areas of softening. In the putrefactive form of lymphadenitis, gas crepitus (crunching) is felt when palpating the node. During destructive processes, general disorders progress - fever, tachycardia, and intoxication increase.

In chronic nonspecific lymphadenitis, the lymph nodes are enlarged, slightly painful, dense, and not fused with the surrounding tissues. The outcome of chronic lymphadenitis is wrinkling of the nodes due to the replacement of lymphoid tissue with connective tissue. Sometimes sprawl connective tissue causes lymph circulation disorders: edema, lymphostasis, elephantiasis.

Specific gonorrheal lymphadenitis is characterized by enlargement and severe tenderness of the inguinal lymph nodes. Tuberculous lymphadenitis occurs with high temperature, severe intoxication, periadenitis, often necrotic changes in nodes. Lymphadenitis in syphilis is characterized by a unilateral moderate enlargement of the chain of lymph nodes, their lack of adhesion to each other and to the skin. With syphilitic lymphadenitis, suppuration of the lymph nodes never occurs.

Complications

Complications of purulent lymphadenitis can include thrombophlebitis, lymphatic fistulas, and septicopyemia. The breakthrough of pus from the tracheobronchial lymph nodes into the bronchi or esophagus leads to the formation of bronchopulmonary or esophageal fistulas, mediastinitis. The development of lymphadenitis can be the starting point for common purulent processes - adenophlegmon and sepsis. The outcome of chronic lymphadenitis can be scarring of the lymph node with connective tissue replacement of lymphoid tissue. In some cases, impaired lymphatic drainage and lymphedema may develop.

Diagnostics

Recognition of acute nonspecific lymphadenitis superficial localization easy. In this case, the anamnesis and the totality of clinical manifestations. Complicated forms of lymphadenitis are more difficult to diagnose, occurring with periadenitis and adenophlegmon, involving the mediastinal tissue and retroperitoneal space. In all cases, it is necessary to establish the primary purulent focus. Differential diagnosis of acute lymphadenitis is carried out with osteomyelitis, phlegmon, suppurating atheroma, etc.

In case of chronic lymphadenitis, as a rule, a puncture biopsy of the lymph node or its excision with histological analysis. This is necessary to distinguish between the chronic form of lymphadenitis and systemic diseases (sarcoidosis), lymphogranulomatosis, leukemia, metastatic disease of the lymph nodes with cancerous tumors and etc.

Diagnosis of specific lymphadenitis is based on a complex of clinical and laboratory data. To detect tuberculosis, Mantoux and Pirquet tuberculin tests are performed. At microscopic examination Pirogov-Langhans giant cells are detected in punctate. During

Complaints children with acute serous lymphadenitis for the appearance in a certain anatomical area of ​​a movable “ball”, painful on palpation.

Before an enlarged lymph node with odontogenic lymphadenitis, the child notes that he was bothered by toothache or the tooth was recently treated. Non-odontogenic was preceded by ARVI (influenza, pneumonia, tonsillitis, otitis, rhinitis), pustular lesions of the skin of the face and head (strepto- and staphyloderma).

Clinic. The change in the child's general condition is minimal: the increase in body temperature is slight (low-grade fever), intoxication is not pronounced. At general analysis blood reveals slight leukocytosis up to 15x10 9, increased ESR up to 20 mm/h. In preschool age, leukocyte and ESR levels can reach significant numbers, even higher than with purulent ones. This is explained by the fact that metabolism and vital activity in children of this age occur at a high energy level, against the background of somewhat reduced reserve capabilities.

A local examination reveals a round-shaped formation, painful on palpation, mobile, and soft-elastic consistency. The skin over the formation is not changed in color and is folded. On the opposite side, enlargement of the lymph node is usually not observed; damage to the lymph nodes of several anatomical areas is sometimes observed with non-odontogenic lymphadenitis.

When examining the oral cavity and teeth on the upper and lower jaws on the same side, a temporary or permanent tooth is revealed, discolored, with a carious cavity, its percussion is painful. Or you can see viral stomatitis, hyperemic tonsils.

The serous form of inflammation of the lymph node in children quickly turns purulent, especially in children 5-6 years old.

Treatment: 1) removal of the “causal tooth” for odontogenic lymphadenitis and treatment of the underlying disease (otitis, bronchitis, rhinitis) for non-odontogenic lymphadenitis.

2) complex drug therapy

Locally: compresses with a 5% solution of dimexide, in which anti-inflammatory drugs are dissolved medications. To do this, add 1 ml of hydrocortisone solution, 50% analgin and 1% diphenhydramine to 10 ml of 5% DMSO dissolved in furatsilin. Having cooked ex tempore such a solution, apply a classic compress to the area where the enlarged lymph node is located. When speaking “classic”, we must remember: the essence of the compress is that the liquid on gauze napkin should be insulated from the air with parchment paper or cellophane film.

Physiotherapy includes hydrocortisone phonophoresis, DMSO electrophoresis with an antibiotic and diphenhydramine, and laser therapy.

Acute purulent lymphadenitis.

Acute purulent lymphadenitis is a consequence of untreated or untreated acute serous lymphadenitis. If a child has not consulted a dentist for 5-7 days, serous inflammation usually turns purulent, which is also facilitated by the unmotivated prescription of physical methods and compresses.

Complaints mother or child - to an enlarged lymph node, in which there is an accentuated throbbing pain, a significant increase in body temperature, loss of appetite, a change in the behavior of the child, who becomes capricious and restless.

Clinic. General disorders, which are symptoms of intoxication, often come to the fore. These are chills, increased body temperature, malaise, decreased appetite, and headache. How younger child, the more pronounced the clinical symptoms. The temperature is high, but does not exceed 39 degrees. A general blood test reveals significant leukocytosis above 15x10 9, an increase in ESR above 20 mm/h.

The face is asymmetrical. The skin here is swollen, hyperemic, and does not fold. Upon palpation, a painful, enlarged lymph node is determined, inactive, can be fused with other nodes, forming a package with them, and suppurates. The symptom of fluctuation, which should be present during a purulent process, does not always exist, even with superficial localization, since the membrane of the lymph node is dense and tense.

The mouth opens freely, you can find the “causal” tooth, usually with a damaged and discolored coronal part, its percussion is painful.

Differential diagnosis acute lymphadenitis should be carried out with abscesses, phlegmons, specific lymphadenitis (syphilitic, tuberculous, actinomycotic), migrating granuloma, sialadenitis, salivary stone disease, suppurating atheroma.

Treatment: 1)Basic treatment method purulent forms lymphadenitis - surgical The direction of skin incisions is carried out taking into account the natural folds and lines of “safe” incisions. The concept of sanitation of the source of inflammation includes:

· removal of the parenchyma of the lymph node with a curettage spoon (in cases where the parenchyma is represented not only by pus, but also by disintegrated areas of the lymph node);

· mandatory drainage of the wound with a rubber graduate;

· applying a bandage to the wound with hypertonic solution sodium chloride or 5% DMSO solution.

2) removal of the “causal tooth” for odontogenic lymphadenitis and treatment of the underlying disease (otitis, bronchitis, rhinitis) for non-odontogenic lymphadenitis.

Chronic lymphadenitis.

Chronic nonspecific lymphadenitis develops as a result of the subsidence of an acute process or is caused by weakly virulent microorganisms.

In accordance with the classification, chronic odontogenic lymphadenitis can be hyperplastic, purulent and aggravated chronic. Chronic hyperplastic odontogenic lymphadenitis almost never occurs in children.

Complaints the child or his parents - for the presence of a long-lasting “ball” that does not cause any inconvenience. From the anamnesis, you can find out that several weeks or months ago this “ball” appeared for the first time and its appearance coincided with the onset of pain in the tooth on the affected side. The tooth was not treated or its treatment was not completed. Subsequently, the pain in the tooth disappeared, but the painless or slightly painful, slightly enlarged lymph node remained. Or the node appeared after suffering from a sore throat, otitis media or acute respiratory viral infection.

The child’s parents indicate several exacerbations of the disease, manifested by a slight increase in body temperature, enlargement of the node and its pain against the background of an exacerbation of the process in the tooth.

Clinic. The child's general condition does not suffer. Examination reveals slight asymmetry of the face due to a neoplasm in the affected area with unchanged skin above it.

Palpation of purulent chronic lymphadenitis reveals a dense, mildly painful, limitedly mobile, round or oval shape, a fluctuation can be detected in its center.

In chronic hyperplastic lymphadenitis, one or more formations of soft or dense elastic consistency are determined in the corresponding anatomical area, with clear boundaries, slightly limited mobility, practically painless, not fused to the skin; the latter may have a bluish tint

Mouth opening is free. If there is an odontogenic cause, a “causative” tooth with a discolored crown part (destroyed or filled) is determined. Sometimes, at the time of treatment, this tooth has already been removed.

With an exacerbation of chronic inflammation, the lymph node enlarges, becomes painful, the skin over it changes in color - it becomes hyperemic. With further development of inflammation, the lymph node softens and its parenchyma can completely melt, only the capsule of the lymph node remains preserved - a “bag” of pus is formed, which leads to perforation of the skin and the formation of a fistula, which eventually closes and scars. Then a fistula appears nearby. It is practically important to first establish whether lymphadenitis is common or specific.

Chronic lymphadenitis is differentiated with lymphogranulomatosis, lymphocytic leukemia, atheroma, dermoid, epidermoid, lipoma, neck cysts, malignant tumors and their metastases.

Treatment: 1) In case of chronic lymphadenitis, both odontogenic and non-odontogenic, the node is removed followed by pathohistological examination.

2) removal of the “causal tooth” for odontogenic lymphadenitis and treatment of the underlying disease ( chronic otitis, bronchitis, rhinitis) – with non-odontogenic.

3) complex drug therapy

Lymphogranulomatosis.

Lymphogranulomatosis (limphagranylomatosis) is a systemic disease manifested by damage to the reticular skeleton of the lymph nodes - tissue that is the main biological filter of the body.

For the first time, a description of a disease similar to lymphogranulomatosis is found in the works of Malpighi “De visceniM structura” (1666), but the systematic study of diseases associated with damage to the lymph nodes began much later. In 1890 S.Ya. Berezovsky published the work “On the question of the structure and clinical course Lymphadenoma malignae", where he cited 6 cases of the disease, characteristic feature which was an enlargement of lymph nodes with a peculiar histological structure.

Lymphogranulomatosis can be observed in adulthood, in infants, and in old people. But most often it affects people of mature age: men from 45 to 49 years old, women from 30 to 40 years old.

There is no single name for this disease. Lymphogranulomatosis can be found under the names “glandular relapsing fever” (O.O. Kisel, 1895), “lymphoadenoma”, “malignant lymphoma”, “malignant granuloma”, “lymphogranuloma”, “Hodgkin’s disease” and “lymphogranulomatosis”. Most authors use terms "Hodgkin's disease" (American and French literature) and "lymphogranulomatosis".

The development of lymphogranulomatosis can be caused by:

1) infectious diseases and changes in the body as a result of them;

2) tumors.

For pediatric maxillofacial surgeons, this disease is of interest only from the point of view that its first pathognomonic symptom is damage to the lymph nodes, including the maxillofacial area. In addition, children have different age groups A common inflammatory disease is chronic hyperplastic lymphadenitis, which requires differential diagnosis with lymphogranulomatosis.

Complaints parents or children - for the presence of enlarged, painless lymph nodes in the submandibular region or neck. With a prolonged course of the disease, observed general weakness, increased body temperature, decreased appetite, sleep disturbance.

Clinical sign Lymphogranulomatosis is an enlargement of the lymph nodes, which is more common (in 50-75 % cases) begins with the nodes of the neck located along the jugular vein.

The affected lymph nodes are usually painless, elastic in consistency, not fused to each other or to the underlying tissues.

Most researchers distinguish three histological stages of development of the lymphogranulomatous process in the lymph nodes:

Stage I - diffuse hyperplasia of the lymph nodes. The pattern of the node is erased and accumulates in the marginal and intermediate sinuses a large number of cells, both normal and pathological.

Stage II - the stage of formation of polymorphic cell granuloma. Starts
focal or diffuse proliferation of reticular endothelial cells in the blood
nasal and lymphatic vessels, connective tissue cells.

At this stage, the lymph node tissue is replaced by reticular cells, plasma cells and eosinophils. Reticular cells have different sizes and shapes. Observed large cells with several nuclei, which are pathognomonic for lymphogranulomatosis. They are named after the authors who described them, Berezovsky-Sternberg cells.

Stage III - stage of fibrosis. The knot shrinks and becomes dense.
Lymphogranulomatosis is characterized by a temperature reaction, which is

a consequence of intoxication of the body, however, the lymph nodes are painless, while with banal inflammation of the lymph nodes they are painful on palpation against the background of an increase in temperature. With lymphogranulomatosis, changes occur in the blood formula, namely an increase in ESR and the development of anemia. Most researchers explain the development of hypochromic anemia by the pathological influence of an enlarged spleen or by the involvement of retroperitoneal lymph nodes in the pathological process. If the disease progresses, a decrease in leukocytes is observed, up to the development of leukopenia and eosinophilia. The cardiovascular system is affected secondarily due to dystrophic changes in the myocardium, caused by anemia, intoxication and general exhaustion.

Lymphogranulomatosis also affects alimentary canal. Involvement of the liver in the pathological process significantly affects the course and further development of lymphogranulomatosis. In terms of frequency of damage, the spleen is in second place after the lymph nodes.

Changes in the bones with lymphogranulomatosis in most cases are secondary, due to the transfer of the process from the lymph nodes per con-tinuitatem or hematogenously during generalization of the process. Such a variety of clinical manifestations creates certain difficulties for the doctor when making a diagnosis in children. Therefore, it is necessary to highlight the most characteristic pathognomonic symptoms of this disease, which are: enlarged lymph nodes and the presence of Berezovsky-Sternberg cells (large reticular cells with several nuclei), fluctuations in body temperature; weakness; damage to the spleen and other organs and systems.

Differential diagnosis must be carried out with:

1. Odontogenic and non-odontogenic lymphadenitis.

2. Tuberculosis of the lymph nodes.

3. Reticulosis.

4. Lymphosarcoma.

5. Brill-Simmers tumor.

Differential diagnosis banal lymphadenitis is based on the following pathognomonic signs:

1) the appearance of a painful round-shaped neoplasm in the areas of the most common localization of lymph nodes;

2) anamnestic connection with the causative disease (dental, rhinitis, tonsillitis, bronchitis, etc.);

3) general signs inflammatory process;

4) response of the lymph node to anti-inflammatory therapy;

5) laboratory confirmation of the inflammatory process (data from a detailed blood test, local manifestations of lymphadenitis, thermography, ultrasound, etc.).

For tuberculosis Lymph nodes are characterized by the formation of so-called packets (enlarged nodes welded together and the skin). In addition, tuberculous lymphadenitis is accompanied by perifocal infiltration, the formation of fistulas and scars, and more often this occurs in children of early and preschool age. In the miliary form of tuberculosis, giant Pirogov-Langhans cells appear in the lymph nodes.

Reticulosis have much in common with lymphogranulomatosis (the latter also belongs to this category of diseases). The clinical picture of reticulosis resembles acute leukemia. Weakness, headache, hemorrhages in the skin and mucous membrane come to the fore. Lymph nodes are small, densely elastic, painless. The diagnosis is made based on characteristic changes in the blood and bone marrow (reticular cells predominate).

Lymphosarcoma- a malignant tumor often diagnosed in children of different ages. With lymphosarcoma, the lymph nodes of a certain area are affected and only in in rare cases the process is generalized. Only at the beginning of the process can the lymph nodes have a soft consistency; later they become denser, welded together into a single conglomerate, which can reach significant sizes. The skin stretches, becomes bluish, and ulcers appear. Lymphosarcoma is characterized by rapid enlargement of lymph nodes and a severe course.

Brill-Simmers tumor known as “giantofollicular lymphadenopathy”, is characterized by the presence of giant hyperplastic lymphoid follicles in the lymph nodes. Painting peripheral blood normal, body temperature does not increase, there is a tendency to exudative reactions and swelling.

Treatment Lymphogranulomatosis is complex, carried out in specialized hospitals and includes x-ray therapy, chemotherapy and hormonal therapy. Surgical treatment consists of removing enlarged lymph nodes.

Nonspecific lymphadenitis is a disease that is manifested by enlargement and inflammation of the lymph glands (nodes). Often, this pathological process develops as a result of a primary underlying disease state in the human body and, quite rarely, progresses autonomously. Nonspecific lymphadenitis, which occurs with signs of serous inflammation, usually goes away on its own after the main provoking factor is eliminated.

Accordingly, it is extremely important for any discomfort in the area of ​​the lymph glands to immediately seek qualified medical help.

Brief characteristics of lymphadenitis

Lymphadenitis is a disease that is manifested by inflammation of the lymph nodes. Depending on the factors causing this pathological process, it is classified as:

• Nonspecific lymphadenitis. Most often, its occurrence is provoked by the introduction of various pathogenic microorganisms(streptococcus, coli, staphylococcus). In rare cases, it may occur as independent disease, when exposed to infectious agents contact method, directly into the lymph node itself. For example, injuries, cuts.
• Specific lymphadenitis. Progresses due to such specific diseases as: HIV, toxoplasmosis, tuberculosis, mononucleosis, syphilis, etc. Lymphadenitis always accompanies tumor processes associated with lymphatic system. These are both benign (lymphangioma, localized lymphoma) and malignant (lymphogranulomatosis, Hodgkin's disease).

With nonspecific lymphadenitis, pathogenic agents penetrate into the capsule of the lymph nodes through the blood and lymphatic vessels due to the inflammatory process in the body. As a result, a primary focus of infection is formed, which tends to spread to nearby lymph glands.

For example, with lacunar, follicular tonsillitis (purulent inflammation of the tonsils). With pharyngitis (damage to the mucous and lymphoid tissue of the pharynx), as a rule, the cervical and submandibular lymph nodes are affected. For adnexitis (inflammation of the ovaries), prostatitis (inflammation of the prostate) - inguinal.

Classification of nonspecific lymphadenitis

Nonspecific lymphadenitis is divided according to the degree of pathogenicity of infectious agents into the following types:

• Serous - initial stage lymphadenitis. It occurs as a reaction of the body to inflammation in various parts of the body. As a rule, lymph nodes located near the source of infection, that is, regional ones, react. Accompanied moderate symptoms inflammation.
• Hyperplastic. It is characterized by an unstable wave-like flow and an inconspicuous acute phase. This pathology can be considered a complication chronic process in the lymph node itself, due to which the lymphoid tissue begins to be replaced by granulation tissue (formed as a result of wound healing). Often the disease is accompanied by the release of a small amount of pus in the lymph nodes themselves. A sluggish chronic purulent process is formed. However, if untreated, inflammation can extend beyond the membrane of the lymph node and provoke the development of adenophlegmon - fistula.
• Purulent - acute purulent inflammation of the lymph glands. Accompanied by severe pain and a sharp deterioration in the patient’s well-being. In some cases, there is formation purulent cavity above the lymph node. If this disease is not treated, pus from high probability will destroy the membrane of the node and penetrate other tissues located nearby. Complications such as sepsis, thrombophlebitis, and bleeding may develop (pus can melt the walls of nearby blood vessels).

Important! Purulent lymphadenitis is dangerous because it can occur in a blurred form. Then its symptoms will resemble those of serous inflammation. To avoid the development of complications, you should consult a doctor if you experience any discomfort in the lymph glands.

Based on localization, nonspecific lymphadenitis is classified as follows:

• Isolated. This is inflammation of a separate group of lymph glands, or one lymph node under the influence of pathogenic infectious agents.
• Regional. Inflammation of the lymph nodes located adjacent to the source of infection. For example, in women, hyperplasia of the inner layer of the uterus can cause hardening and enlargement of the inguinal lymph nodes.
• Generalized. Inflammation of all groups of lymph glands. May be present, for example, in sepsis, septicemia.

According to the type of pathogen that provokes nonspecific lymphadenitis, it is divided into the following types:

• Fungal.
• Viral.
• Bacterial.

According to the pathological process, nonspecific lymphadenitis can be acute or chronic.

Causes of inflammation of the lymph nodes

Nonspecific lymphadenitis is provoked by diseases such as:

• Furunculosis.
• Carbuncles.
• Pyoderma ( purulent lesion skin).
• Various purulent wounds.
• Caries teeth, gingivitis.
• Osteomyelitis.
• Erysipelas.
• Otitis, sinusitis.
• Sore throat, pharyngitis.
• Injuries.
• Hidradenitis (inflammation sweat glands armpits).
• Herpetic skin lesions.
• Parotitis, measles, rubella.
• Staphylococcal, streptococcal infections.
• Pathologies of the thyroid gland.

The etiology of lymphadenitis in children under 6 years of age is due to an immature immune system. Lymph nodes during this period are very vulnerable and susceptible to inflammation.

The following diseases that contribute to inflammation of the lymph glands in children are quite common:

• Stomatitis, caries.
• Sore throat, otitis media, adenoiditis.
• Diathesis, eczema.
• Frequent acute respiratory infections viral diseases(ARVI).
• During teething.

Clinical picture

The symptoms of nonspecific lymphadenitis can be found in the table below:

For lymphadenitis of any severity, systematic medical supervision is necessary.

The fact is that the regeneration of the lymphatic glands is determined by the process of proliferation of connective tissue fibers.

But sometimes there may be too pronounced, intense proliferation, which becomes the cause of impaired lymph movement and, as a consequence, the development of lymphostasis, elephantiasis, and edema.

In addition, with chronic inflammation of the lymph nodes, proliferation of lymphoid tissue (hyperplasia) can be observed, which is also a deviation from the norm and requires observation.

Which doctors should you contact if you have swollen lymph nodes?

Each group of lymphatic glands cleanses the lymph that flows to the corresponding anatomical structures in the human body.

Lymphadenitis in the area of ​​a certain organ and part of the body indicates pathological process in this area.

In case of inflammation of the lymph nodes, first of all, you need to consult a general practitioner, who, after examination, will refer you to further treatment to the right specialist. For example, to something like:

• Mammologist.
• Phthisiatrician
• Urologist.
• Gynecologist.
• Proctologist.
• Dermatologist.
• Infectious disease specialist.
• Surgeon.
• Dentist.
• Endocrinologist.

Examinations that need to be completed for lymphadenitis

For nonspecific lymphadenitis, the doctor may prescribe the following tests:

• General analysis of urine and blood.
• Donating blood for viral hepatitis (B, C), syphilis, HIV.
• Bacteriological examination of urine and blood.
• Tumor markers.
• Blood for hormonal levels.
• Biochemistry of blood.
• Skin scraping.
• Bacteriological, cytological analysis of discharge from the urethra and vagina.
• If unspecified lymphadenitis occurs, the doctor will prescribe a puncture of the lymph node followed by a cytological examination.
• Bacteriological blood test for sensitivity to antibiotics.

In addition, in case of pathological lymph glands, you may have to undergo such methods instrumental research, How:

• Various x-ray examinations (urography, fluorography, mammography).
• Computed tomography(CT).
• Ultrasonography(ultrasound).
• Magnetic resonance imaging (MRI).

Treatment

Nonspecific catarrhal and hyperplastic lymphadenitis responds well to conservative therapy.

After examination and diagnosis, the doctor may prescribe the following treatment to the patient:

• Observe bed rest in a week.
• Keep the affected area of ​​the body at rest.
• Taking antibiotics vitamin preparations, probiotics and prebiotics.
• Drink plenty of fluids(up to 2 liters of liquid per day).
• Attendance at physiotherapeutic procedures (UHF, Ural Federal District).
• Treatment of primary pathology.

In acute purulent form, it is usually carried out surgical intervention.

The festering node, abscess, phlegmon is opened, sanitized and drainage is installed for subsequent administration of antibacterial, antiseptic drugs (antibiotics, antiseptics - Chlorhexidine, Miramistin), rinsing. Also, the patient is prescribed medications such as:

• Solutions for intradrop infusion - 5% glucose, 0.9% sodium chloride.
• Antibiotics.
• Hepatoprotectors (Essentiale, Karsil).
• Prebiotics, probiotics.
• Vitamins.
• Painkillers.

Prevention

In order to prevent inflammation of the lymph nodes, the following recommendations must be followed:

• Monitor the health of your teeth and gums.
• Promptly engage in antiseptic treatment of wounds, abrasions, and abrasions. A fresh wound cavity must be washed with a solution of chlorhexidine, the edges of the wound should be dried with a sterile cloth, and treated with a 5% iodine solution.
• If the edges of the wound are more than 6 mm apart from each other, and the length of the cut itself is more than 1.5 cm, you must contact a trauma center for suturing.
• Women should visit a mammologist and gynecologist once a year without any complaints. After forty years, once every six months.
• Men should visit a urologist every year.
• For any manifestations of lymphadenitis, consult a doctor immediately.

It is important to know that inflamed lymph glands cannot be treated on your own. In case of lymphadenitis of any severity, you must consult a doctor, as incorrect actions can cause serious complications.

Acute lymphadenitis is acute process inflammation of the lymph node tissue. As a rule, this disease progresses against the background of an infection already present in the human body, for example, purulent wound.

The most common causative agent of the disease is staphylococcus, which penetrates the nodes along with the lymph. If the source of infection is in the lower part of the body, for example, on the leg, then they are most susceptible to inflammation inguinal nodes, less often popliteal. If the source arose in upper limbs, the lymph node in the armpit becomes inflamed.

Classification of acute lymphodentitis

Types of acute lymphadenitis 1. According to the nature of inflammation:

• purulent;
• serous.

• specific;
• nonspecific.

• acute lymphadenitis of the neck and face;
• cervical;
• inguinal;
• mesenteric;
• submandibular;
• odontogenic.

Serous acute lymphadenitis

With this type of lymphadenitis, general health does not suffer. It is characterized by:

• no temperature or slight increase in temperature;
• painful sensations in the area of ​​lymph nodes and their enlargement;
• slight compaction of lymph nodes and mobility.

If you take appropriate measures in time and start treatment, then in a couple of days the lymph nodes will return to normal, the painful sensations will disappear, and your health will completely return to normal.

Purulent acute lymphadenitis

With this type of lymphadenitis the following is observed:

• pronounced pain in the lymph nodes;
• temperature rise to 38°C;
• constant headache;
• severe weakness and fatigue.

After some time, an abscess may form at the site of the lymph node, which can only be removed surgical methods.

Causes of development of acute lymphadenitis

The main causes of the disease include:

1. A sharp weakening of the human immune system. This may be due to the course of severe concomitant diseases, which every day deplete the body, sucking vitamins and immune cells from it.
2. Excessive amounts of bacteria trapped in the lymph nodes. In this case, the tissues of the lymph nodes simply will not be able to cope with the threat that has arisen. This picture is observed in the presence of complex purulent processes in the body.
3. The number of bacteria is small, but they are very aggressive. Then even a small part of them can cause a severe inflammatory process.
4. A simultaneous combination of several of the above factors. For example, the development of a complex infectious disease against a background of weakened immunity.

Common symptoms of acute lymphadenitis

Acute lymphadenitis can manifest itself in the form of general and local symptoms.

General symptoms of inflammation:

• temperature rise to high performance(up to 40°C);
• manifestation of chills;
• severe migraine;
• overall strong severe weakness;
• painful sensations in muscle fibers;
• bad dream.

Local manifestations of acute lymphadenitis:

• enlarged lymph nodes;
• the appearance of red swelling over the lymph nodes;
• the appearance of a noticeable tumor of the skin in the area of ​​the lymph nodes;
• painful sensations, both when palpating the lymph nodes and at rest;
• increase in local skin temperature;
• violation motor function the area where the lymph nodes are located.

Possible complications of acute lymphadenitis

If you don't start timely treatment and start the disease, the following types of complications of acute lymphadenitis are possible:

• development of general infection of the body;
• periadenitis;
• adenophlegmon;
• the occurrence of thrombophlebitis of closely located veins;
• bleeding;
• chronic esophageal fistulas;
• caseous melting of lymph nodes.

Diagnosis of acute lymphadenitis

Diagnosing acute lymphadenitis is not difficult. For this, a consultation with a specialist and the patient’s medical history will be quite sufficient.

The main methods for diagnosing the disease are:

• tuberculin tests Mantoux and Pirquet, if there is a suspicion of tuberculosis;
• x-ray chest;
• detailed examination of sputum;
• consultation with medical specialists;
• Ultrasound diagnostics;
• tomography of the affected limbs;
• lymphoscintigraphy.

Treatment of acute lymphadenitis

Treatment is carried out in accordance with the type of inflammatory process.

Therapy of serous lymphadenitis.

• treatment of the source of the disease, which caused the infection to enter the lymph nodes (caries, treatment of open wounds);
• antipyretic drugs for a significant increase in temperature;
• drugs to relieve inflammation and pain in the lymph nodes;
• taking multivitamin complexes as strengthening therapy;
• painkillers;
• antibacterial drugs.

Therapy for purulent lymphadenitis:

• sending the patient to the hospital;
• surgical intervention (opening a purulent focus, removing dead tissue);
• rest in the affected area;
• carrying out antibiotic therapy;
• UHF therapy;
• regular postoperative dressings;
• strict adherence to personal hygiene;
• rational diet;
• physical therapy to reduce inflammation and speedy healing wound

Drug treatment of acute lymphadenitis:

• use of antibiotics wide range(augmentin, sumamed, azithromycin);
• the use of antibiotics in accordance with the identified disease (syphilis - macropen, penicillin; tuberculosis - streptomycin);
• multivitamin preparations as general strengthening agents (vitrum);
• drugs to prevent allergic reactions (erius, cetrin);
• painkillers (ketalong).

Traditional medicine in the fight against acute lymphadenitis

Application traditional methods for the treatment of lymphadenitis it is recommended only for early stages development of the disease and only after a face-to-face consultation with a specialist. A late visit to the doctor can cause very severe consequences.

The use of folk remedies together with antibiotic therapy prescribed by the attending physician will undoubtedly lead to recovery.

The best folk remedy consider echinacea tincture, which must be diluted with warm water, soak a bandage in it and apply a compress overnight.

Side effects

When treating lymphadenitis with medications, the following side effects are possible:

• stomach upsets;
• small rash on the skin;
• all kinds of allergic reactions;
• dizziness;
• feeling of restlessness;
• general weakness.

Prevention of acute lymphadenitis

The best way of prevention is timely and adequate treatment underlying disease, which may subsequently become main reason development of acute lymphadenitis.

Diagnosis and therapy should be carried out in a timely manner:

• foci of disease in the body: treatment of caries, bronchitis, opening of boils;
• syphilis and tuberculosis;
• scratches, cuts and deep wounds in order to prevent infection from entering them.

In any case of enlarged lymph nodes, which is accompanied by high fever and pain, you should immediately consult a doctor.

Rational diet for lymphadenitis

During therapy, you must strictly adhere to the following diet:

• limit fatty, salty and fried foods;
• do not eat fast food;
• enrich your diet with plant, dairy and protein products (fish, lean meat, cottage cheese).

Features of acute lymphadenitis in children

Inflammation of the lymph nodes in children has a number of features. Thus, all infection processes occur much faster and with more severe symptoms. That is why it is necessary to immediately consult a doctor as soon as you notice pain in the lymph node.

To prevent acute lymphadenitis in a child it is necessary:

• treat on time carious processes;
• monitor the occurrence inflammatory processes V oral cavity;
• treat colds in a timely manner;
• treat all abrasions, cuts and injuries.

How to treat acute lymphadenitis for pregnant women

Pregnant women are most often shown:

• antibiotics approved for use during pregnancy;
• dry heat;
• irradiation of lymph nodes with ultraviolet light.

In case of suppuration, it is forbidden to apply warm compresses. In such a situation, an operation is performed to open the lymph node with its subsequent drainage.

Acute lymphadenitis in children