Cervical splegmone represents a rapidly spreading purulent inflammation of the soft tissues of the neck. The condition is life-threatening and requires immediate emergency medical attention. Cervical phlegmon can develop from injuries to the mouth.
What are neck phlegmons?
Neck phlegmone is one of the particularly dangerous forms of phlegmon. The term phlegmon is generally used to describe a bacterial inflammation of soft tissues that does not remain confined. Phlegmon is derived from the word phlegm, which translates as mucus. During the course of the disease, a slimy purulent mass forms from the dying tissue of soft tissues. Phlegmons include erysipelas (a so-called phlegmonous erysipelas of the skin), hand phlegmons or orbital phlegmons (eye socket phlegmons). In cervical phlegmon, the soft tissues of the neck are affected by diffuse inflammation that progresses inexorably. Increasingly larger areas of the soft tissues of the neck are affected. The inflammatory processes can also penetrate to the parotid gland or the mediastinum. However, cervical phlegmon can also originate from inflammation of the parotid gland and spread from there to the soft tissues of the neck. The inflammation spreads along the vascular sheath of the neck and reaches the internal jugular vein, where it can cause thrombotic occlusion. Via this thrombosis, the bacterial pathogens can enter the bloodstream en masse and cause sepsis (blood poisoning), which often leads to death if left untreated. In parallel, life-threatening mediastinitis can develop. Because of this fact, cervical phlegmon is a medical emergency that requires immediate surgical and antibiotic treatment. Neck phlegmon is often referred to as oral floor phlegmon because it often originates at the floor of the mouth.
Causes
A possible cause of cervical phlegmon is infection of the soft tissues of the neck with bacterial pathogens. These are mainly streptococci or staphylococci. The pathogens enter the soft tissues of the neck via injuries in the mouth and throat area, among other things. Such injuries can be caused, for example, by hard bone debris or bones in the throat. Injuries also form during dental, root or jaw treatment, which in rare cases can be the starting point of phlegmonous inflammations. Especially during the removal of a wisdom tooth, complications are possible, which may lead to abscesses or, in rarer cases, to oral phlegmon. If inflammatory processes are still going on at the same time, such as dental root infections, caries, tonsillitis or parotitis, there is an increased risk that these germs will enter the bloodstream. If these affect the lymph nodes, they can cause diffuse purulent inflammation in the soft tissues of the neck. However, inflammation can also develop at the injury sites themselves and continue to spread. Even in isolated tonsillitis or parotitis, there is a risk of spread of inflammation in the form of cervical phlegmon. The fulminant development of the inflammatory purulent processes is rare but quite typical. It occurs when the pathogens reach places where they find particularly favorable conditions for their further spread. This is the case in the soft parts of the neck at the vascular sheath of the neck.
Symptoms, complaints, and signs
Neck phlegmon begins with obvious signs of illness. Affected individuals feel fatigued and tired. In most cases, a high fever develops. A painful feeling of pressure develops in the area of the neck and the floor of the mouth, which becomes more and more intense. The soft parts of the neck often swell enormously. The entire face may be severely swollen. The abscess is not limited, but spreads indefinitely. The neck lymph nodes swell. Severe breathing difficulties occur due to narrowing of the airways. In case of an infected thrombosis of the iugular vein, blood poisoning (sepsis) may develop. In very severe cases, this leads to general organ failure resulting in death. On the other hand, cervical splegmons can also spread to the mediastinum and cause mediastinitis. Mediastinitis is a very serious condition that is often lethal.
Diagnosis
A tentative diagnosis of cervical phlegmon can be made on the basis of the symptoms alone.Palpation or ultrasound and computed tomography examinations cannot detect or visualize circumscribed inflammation. Rather, a loosening of the soft tissues is detected. There is no longer a pictorial demarcation of individual organs such as the esophagus, trachea, thyroid gland, or larynx.
Complications
As a rule, cervical phlegmon is life-threatening and for this reason must also be examined and treated immediately by a physician. Without treatment, the patient may die in the worst case. The patient suffers primarily from fever and a general feeling of illness. He or she feels fatigued and the ability to cope with stress decreases enormously. In the mouth, the throat phlegmon causes severe pain and a feeling of pressure, which can increase in the course of the disease. Furthermore, swelling occurs in the mouth area, which often spreads to the entire face. The swellings can lead to shortness of breath and usually considerably restrict the intake of food and fluids. The affected person may also suffer blood poisoning and die from it. In the worst case, inflammation of the mediastinum can also occur, which is also fatal in most cases. Without treatment of cervical phlegmon, the patient’s life expectancy is extremely reduced. Treatment is usually carried out with the help of medication and leads relatively quickly to a positive course of the disease. With early treatment, further complications do not occur.
When should you go to the doctor?
In the case of cervical phlegmon, a doctor should be consulted immediately. The inflammation usually spreads very quickly and may affect other parts of the body. To avoid further complications and discomfort, a visit to the doctor is necessary. The doctor should be consulted if there is severe pain in the area of the mouth in addition to fever. Swollen lymph nodes or breathing difficulties may also indicate the disease and should be examined. In the worst case, the affected person suffers organ failure due to cervical phlegmon and eventually dies from it. The visit to the doctor should take place when there is a painful feeling of pressure in the mouth. Severe swelling of the face may also indicate the disease. As a rule, a general practitioner can be consulted for this disease. With the help of antibiotics, the symptoms can be treated well. Particular complications do not occur and there is a positive course of the disease. If the symptoms are very severe, the hospital can also be visited.
Treatment and therapy
Already at the first signs of such symptoms as feelings of pressure in the throat, fatigue and fever, a doctor or dentist must be consulted immediately. The disease can very quickly take a dramatic course, so that immediate measures must be initiated as soon as possible, which can only be carried out as an inpatient. First, the neck phlegmon must be treated surgically. The dead tissue and the abscess are removed. Furthermore, the initial focus of the disease must be thoroughly treated with medication. The patient receives high doses of antibiotics within the next ten days. These are usually administered intravenously via a drip. The antibiotic used is penicillin. Patients who are allergic to penicillin are treated with other antibiotics. Among others, active substances from the macrolide family are used here. During treatment, patients subsist on liquid food. In addition, antiseptic oral care must be given. Painkillers may also be administered if the pain is severe.
Outlook and prognosis
Cervical phlegmon or oral phlegmon is a very serious condition that can be lethal within a few days without treatment. Therefore, action must be taken quickly after diagnosis. Therapy involves administration of antibiotics, cooling and surgical intervention. Subsequently, constant rinsing of the throat with disinfecting solutions is necessary. The therapy lasts about 10 days. Through these measures, the neck phlegmon can usually be treated very well and also healed completely. Consequential diseases or organ damage do not occur. In immunocompromised persons, however, the disease can lead to death despite intensive treatment. Serious complications are also possible if treatment is initiated too late.The same applies if the treatment is stopped too early. Then bacteria that have not yet been killed can multiply again and cause the neck phlegmon to flare up again. A phlegmon in the neck area is particularly dangerous because from here the bacteria can quickly enter the bloodstream along the vascular sheath of the neck and cause life-threatening sepsis. Furthermore, the mediastinum is quickly attacked. A so-called mediastinitis develops, which is a particularly life-threatening complication. If the mediastinal cavity is already affected, a drain must also be placed there in order to constantly drain off the infectious fluid. However, even at this advanced stage of the disease, a complete cure is still possible.
Prevention
To prevent cervical phlegmon, daily oral hygiene is recommended. This includes intensive tooth brushing at least in the morning after breakfast and in the evening before bedtime. Flossing or interdental toothbrushing can remove all food debris as well as possible. Oral hygiene should also include regular antiseptic rinsing with mouthwash.
What you can do yourself
Cervical phlegmon is an acute and serious condition, so self-help measures should always be coordinated with the specialist providing treatment. After the surgical intervention, the patient usually remains under inpatient supervision for the time being, and extensive rest periods are important. Such rest periods should also be maintained when the patient returns home after the operation in order to support healing and prevent complications due to overwork and stress. As a result of the surgical procedure on the neck, patients with cervical splegmons suffer considerable pain for the time being, and the most comfortable rest position possible should be found for the individual. It may help the patient to rest the head on a high side rest to relieve the neck muscles. During the entire recovery phase, physical and mental stress should be minimized so as not to impair the healing process. Adequate care of the wound and hygienic measures are also of great importance to prevent wound infections and further inflammation. Numerous patients have difficulty swallowing after surgery, and soft to liquid food can provide relief. Special consideration should also be given to oral and dental hygiene, as any inflammation of the teeth or tooth roots may spread to the neck phlegmon area in the worst case.
