LECTURELECTURE

LymphadenitisLymphadenitis, , furuncle and furuncle and carbuncle of carbuncle of

maxillofacial area.maxillofacial area.

Lymphadenitis is the inflammation Lymphadenitis is the inflammation

of a lymph node.of a lymph node.

Lymph nodes Lymph nodes The glandlike masses of tissue in the The glandlike masses of tissue in the

lymphatic system that contain lymphatic system that contain lymphocytes. The lymph nodes also lymphocytes. The lymph nodes also

filter lymph, which is a clear yellowish filter lymph, which is a clear yellowish tissue fluid that carries lymphocytes tissue fluid that carries lymphocytes

and fats throughout the body. and fats throughout the body.

Lymphoid system of maxillofacial area:1 — 1 — glandula parotis; glandula parotis; 2 — 2 — nodi lymphatici occtpitales; nodi lymphatici occtpitales; 3 — 3 — nodi lymphatici auriculares poster. nodi lymphatici auriculares poster. 4 — 4 — nodi lymphatici cervicales profundi superiores; nodi lymphatici cervicales profundi superiores; 5 — 5 — v. jugutaris dextra; v. jugutaris dextra; 6 — 6 — nodi lymphatici nodi lymphatici : : cales cales

superficiales; superficiales; 7 — 7 — nodi lymphatici cervicales profundi inferiores; nodi lymphatici cervicales profundi inferiores; 8 — 8 — nodi lymphatici auricu nodi lymphatici auricu anteriorea; anteriorea; 9 — 9 — nodi lymphatici submaxillares; nodi lymphatici submaxillares; 10 — 10 — nodulus lymphaticus submentalis; nodulus lymphaticus submentalis; 11 — 11 — a. ca a. ca

communis dextra; communis dextra; 12— 12— truncus lymphaticus jugularis dexter.truncus lymphaticus jugularis dexter.

THE MAINS WAYS OF FLOWING LYMPH FROM THE MAINS WAYS OF FLOWING LYMPH FROM LOWER AND APPER LIPSLOWER AND APPER LIPS

Lymphadenitis Lymphadenitis isis often a complication of often a complication of a bacterial infection of a wound, although a bacterial infection of a wound, although it can also be caused by viruses or other it can also be caused by viruses or other disease agents. Lymphadenitis may be disease agents. Lymphadenitis may be either generalized, involving a number of either generalized, involving a number of lymph nodes; or limited to a few nodes in lymph nodes; or limited to a few nodes in the area of a localized infection. the area of a localized infection. Lymphadenitis is sometimes accompanied Lymphadenitis is sometimes accompanied by lymphangitis, which is the inflammation by lymphangitis, which is the inflammation of the lymphatic vessels that connect the of the lymphatic vessels that connect the lymph nodes.lymph nodes.

CausesCauses Streptococcal and staphylococcal bacteria are the Streptococcal and staphylococcal bacteria are the

most common causes of lymphadenitis, although most common causes of lymphadenitis, although viruses, protozoa, rickettsiae, fungi, and the viruses, protozoa, rickettsiae, fungi, and the tuberculosis bacillus can also infect the lymph nodes. tuberculosis bacillus can also infect the lymph nodes. Diseases or disorders that involve lymph nodes in Diseases or disorders that involve lymph nodes in specific areas of the body include rabbit fever specific areas of the body include rabbit fever (tularemia), cat-scratch disease, lymphogranuloma (tularemia), cat-scratch disease, lymphogranuloma venereum, chancroid, genital herpes, infected acne, venereum, chancroid, genital herpes, infected acne, dental abscesses, and bubonic plague. In children, dental abscesses, and bubonic plague. In children, tonsillitis or bacterial sore throats are the most tonsillitis or bacterial sore throats are the most common causes of lymphadenitis in the neck area. common causes of lymphadenitis in the neck area. Diseases that involve lymph nodes throughout the Diseases that involve lymph nodes throughout the body include mononucleosis, cytomegalovirus body include mononucleosis, cytomegalovirus infection, toxoplasmosis, and brucellosis.infection, toxoplasmosis, and brucellosis.

Physical examinationPhysical examination

The diagnosis of lymphadenitis is usually The diagnosis of lymphadenitis is usually based on a combination of the patient's based on a combination of the patient's history, the external symptoms, and history, the external symptoms, and laboratory cultures. The doctor will press laboratory cultures. The doctor will press (palpate) the affected lymph nodes to see if (palpate) the affected lymph nodes to see if they are sore or tender. Swollen nodes they are sore or tender. Swollen nodes without soreness are often caused by cat-without soreness are often caused by cat-scratch disease. In children, the doctor will scratch disease. In children, the doctor will need to rule out mumps, tumors in the neck need to rule out mumps, tumors in the neck region, and congenital cysts that resemble region, and congenital cysts that resemble swollen lymph nodes.swollen lymph nodes.

PALPATION OF SUBMANDIBLE PALPATION OF SUBMANDIBLE LYMPH NODESLYMPH NODES

PALPATION OF SUBMENTAL PALPATION OF SUBMENTAL LYMPH NODESLYMPH NODES

PALPATION OF RETROMANDIBLE PALPATION OF RETROMANDIBLE LYMPH NODESLYMPH NODES

CLINICAL CLASSIFICATION CLINICAL CLASSIFICATION OF LYMPHADENITISOF LYMPHADENITIS

-Acute: serous, purulent.-Acute: serous, purulent.

-Chronic: hyperplastic, purulent.-Chronic: hyperplastic, purulent.

SSymptomsymptoms

Lymphadenitis is marked by Lymphadenitis is marked by swollen lymph nodes that are swollen lymph nodes that are painful, in most cases, when the painful, in most cases, when the doctor touches them. If the doctor touches them. If the lymphadenitis is related to an lymphadenitis is related to an infected wound, the skin over the infected wound, the skin over the nodes may be red and warm to nodes may be red and warm to the touch. the touch.

Acute lymphadenitisAcute lymphadenitis

Chronic lymhadenitisChronic lymhadenitis

Operation of removed lymph nodes Operation of removed lymph nodes attached chronical inflammationattached chronical inflammation

Operation of removed lymph nodes Operation of removed lymph nodes attached chronical inflammationattached chronical inflammation

Removed lymph nodesRemoved lymph nodes

TreatmentTreatment The medications given for lymphadenitis vary The medications given for lymphadenitis vary

according to the bacterium or virus that is according to the bacterium or virus that is causing it. If the patient also has lymphangitis, he causing it. If the patient also has lymphangitis, he or she will be treated with antibiotics, usually or she will be treated with antibiotics, usually penicillin G (Pfizerpen, Pentids), nafcillin (Nafcil, penicillin G (Pfizerpen, Pentids), nafcillin (Nafcil, Unipen), or cephalosporins. Erythromycin (Eryc, Unipen), or cephalosporins. Erythromycin (Eryc, E-Mycin, Erythrocin) is given to patients who are E-Mycin, Erythrocin) is given to patients who are allergic to penicillin. Supportive care of allergic to penicillin. Supportive care of lymphadenitis includes resting the affected limb lymphadenitis includes resting the affected limb and treating the area with hot moist compresses. and treating the area with hot moist compresses. Cellulitis associated with lymphadenitis should Cellulitis associated with lymphadenitis should be treated surgically because of the risk of be treated surgically because of the risk of spreading the infection. Pus is drained only if spreading the infection. Pus is drained only if there is an abscess and usually after the patient there is an abscess and usually after the patient has been started on antibiotic treatment. In some has been started on antibiotic treatment. In some cases, a biopsy of an inflamed lymph node is cases, a biopsy of an inflamed lymph node is necessary if no diagnosis has been made and no necessary if no diagnosis has been made and no response to treatment has occurred.response to treatment has occurred.

PrognosisPrognosis

The prognosis for recovery is good if The prognosis for recovery is good if the patient is treated promptly with the patient is treated promptly with antibiotics. In most cases, the antibiotics. In most cases, the infection can be brought under infection can be brought under control in three or four days. Patients control in three or four days. Patients with untreated lymphadenitis may with untreated lymphadenitis may develop blood poisoning develop blood poisoning (septicemia), which is sometimes (septicemia), which is sometimes fatal.fatal.

HairHair folliclefollicle anatomyanatomy

A furuncle is an infection of a A furuncle is an infection of a hair follicle.hair follicle.

A carbuncle is a skin A carbuncle is a skin infection that often involves infection that often involves

a group of hair follicles. a group of hair follicles.

CausesCauses

Furuncles are very common. They are Furuncles are very common. They are caused by staphylococcus bacteria, which caused by staphylococcus bacteria, which are normally found on the skin surface. are normally found on the skin surface. Damage to the hair follicle allows these Damage to the hair follicle allows these bacteria to enter deeper into the tissues of bacteria to enter deeper into the tissues of the follicle and the subcutaneous tissue. the follicle and the subcutaneous tissue. Furuncles may occur in the hair follicles Furuncles may occur in the hair follicles anywhere on the body, but they are most anywhere on the body, but they are most common on the face, neck, armpit, common on the face, neck, armpit, buttocks, and thighs.Furuncles are buttocks, and thighs.Furuncles are generally caused by generally caused by Staphylococcus Staphylococcus aureus,aureus, but they may be caused by other but they may be caused by other bacteria or fungi. bacteria or fungi.

Risk factorsRisk factorsAlthough anyone — including otherwise healthy people — Although anyone — including otherwise healthy people — can develop boils or carbuncles, the following factors can can develop boils or carbuncles, the following factors can

increase your risk:increase your risk:

Poor general health.Poor general health. Having chronic poor health makes it Having chronic poor health makes it harder for your immune system to fight infections. harder for your immune system to fight infections.

Diabetes.Diabetes. This disease can make it more difficult for your body to This disease can make it more difficult for your body to fight infection, including bacterial infections of your skin. fight infection, including bacterial infections of your skin.

Clothing that binds or chafes.Clothing that binds or chafes. The constant irritation from tight The constant irritation from tight clothing can cause breaks in your skin, making it easier for clothing can cause breaks in your skin, making it easier for bacteria to enter your body. bacteria to enter your body.

Other skin conditions.Other skin conditions. Because they damage your skin's Because they damage your skin's protective barrier, skin problems, such as acne and dermatitis, protective barrier, skin problems, such as acne and dermatitis, make you more susceptible to boils and carbuncles. make you more susceptible to boils and carbuncles.

Immune-suppressing medications.Immune-suppressing medications. Long-term use of Long-term use of corticosteroids, such as prednisone or other drugs that suppress corticosteroids, such as prednisone or other drugs that suppress your immune system, can increase your risk. your immune system, can increase your risk.

FURUNCLE FURUNCLE ((the first stage of the first stage of developmentdevelopment))

FURUNCLE FURUNCLE ((the second stage of the second stage of developmentdevelopment))

Furuncle of faceFuruncle of face

Furuncle of faceFuruncle of face

Furuncle of faceFuruncle of face

Furuncle of faceFuruncle of face

Carbuncle of faceCarbuncle of face

Carbuncle of the lower lipCarbuncle of the lower lip

Signs and symptomsSigns and symptoms A boil usually appears suddenly as a painful pink or red A boil usually appears suddenly as a painful pink or red

bump that's generally not more than 1 inch in diameter. bump that's generally not more than 1 inch in diameter. The surrounding skin also may be red and swollen.The surrounding skin also may be red and swollen.

Within a few days, the bump fills with pus. It grows larger Within a few days, the bump fills with pus. It grows larger and more painful for about five to seven days, sometimes and more painful for about five to seven days, sometimes reaching golf ball size before it develops a yellow-white tip reaching golf ball size before it develops a yellow-white tip that finally ruptures and drains. Boils generally clear that finally ruptures and drains. Boils generally clear completely in about two weeks. Small boils usually heal completely in about two weeks. Small boils usually heal without scarring, but a large boil may leave a scar.without scarring, but a large boil may leave a scar.

A carbuncle is a cluster of boils that often occurs on the A carbuncle is a cluster of boils that often occurs on the back of the neck, shoulders or thighs, especially in older back of the neck, shoulders or thighs, especially in older men. Carbuncles cause a deeper and more severe infection men. Carbuncles cause a deeper and more severe infection than single boils do. In addition, carbuncles develop and than single boils do. In addition, carbuncles develop and heal more slowly and are likely to leave a scar. Carbuncles heal more slowly and are likely to leave a scar. Carbuncles sometimes occur with a fever.sometimes occur with a fever.

Boils and carbuncles often resemble the inflamed, painful Boils and carbuncles often resemble the inflamed, painful lumps caused by cystic acne. But compared with acne lumps caused by cystic acne. But compared with acne cysts, boils are usually redder or more inflamed around the cysts, boils are usually redder or more inflamed around the border and more painful.border and more painful.

TreatmentTreatment

DDoctor may drain a large boil or carbuncle octor may drain a large boil or carbuncle by making a small incision in the tip. This by making a small incision in the tip. This relieves pain, speeds recovery and helps relieves pain, speeds recovery and helps lessen scarring. Deep infections that can't lessen scarring. Deep infections that can't be completely cleared may be covered be completely cleared may be covered with sterile gauze so that pus can continue with sterile gauze so that pus can continue to drain. Sometimes doctor may prescribe to drain. Sometimes doctor may prescribe antibiotics to help heal severe or recurrent antibiotics to help heal severe or recurrent infections.infections.

Self-careSelf-careThe following measures may help the infection The following measures may help the infection

heal more quickly and prevent it from spreading:heal more quickly and prevent it from spreading: Apply a warm washcloth or compress to the affected Apply a warm washcloth or compress to the affected

area.area. Do this for at least 10 minutes every few hours. If Do this for at least 10 minutes every few hours. If possible, first soak the cloth or compress in warm salt possible, first soak the cloth or compress in warm salt water. This helps the boil rupture and drain more quickly. water. This helps the boil rupture and drain more quickly. To make salt water, add 1 teaspoon of salt to 1 quart of To make salt water, add 1 teaspoon of salt to 1 quart of boiling water and cool to a comfortable temperature. boiling water and cool to a comfortable temperature.

Gently wash the boil two to three times a day.Gently wash the boil two to three times a day. After After washing, apply an over-the-counter antibiotic and cover washing, apply an over-the-counter antibiotic and cover with a bandage. with a bandage.

Never squeeze or lance a boil.Never squeeze or lance a boil. This can spread the This can spread the infection. infection.

Wash your hands thoroughly after treating a boil.Wash your hands thoroughly after treating a boil. Also, launder clothing, towels or compresses that have Also, launder clothing, towels or compresses that have touched the infected area. touched the infected area.

PreventionPreventionAlthough it's not always possible to prevent Although it's not always possible to prevent boils, especially if you have a compromised boils, especially if you have a compromised

immune system, the following measures may immune system, the following measures may help you avoid staph infections:help you avoid staph infections:

Thoroughly clean even small cuts and Thoroughly clean even small cuts and scrapes.scrapes. Wash well with soap and water Wash well with soap and water and apply an over-the-counter antibiotic and apply an over-the-counter antibiotic ointment. ointment.

Avoid constricting clothing.Avoid constricting clothing. Tight Tight clothes may be stylish, but make sure they clothes may be stylish, but make sure they don't chafe your skin. don't chafe your skin.