SURGICAL INTERVENTIONS WITH PHLEGMONS OF DEEP CELLULAR SPACES OF THE HEAD AND NECK COMPLICATED BY MEDIASTINITIS

Аннотация

Полный текст

Aim. Improving the effectiveness of surgical treatment of phlegmon deep cell tissue spaces of the head and neck complicated by mediastinitis. Material and Methods. Over the past 20 years, 82 patients with phlegmons of deep cell spaces (CP) of the head and neck were on treatment. Sources of phlegmon: peritonsillar abscess (n=30), epiglottis abscess (n=27), odontogenic (n=14) and traumatic causes (n=14), adenophlegmons (n=5). Results and Discussion. Mediastinitis developed in 52 patients. X-ray of chest organs was performed by all patients with neck phlegmon. In 30 observations she allowed to identify, and in 10 - to suspect the presence of mediastinitis. Computed tomography in all cases allowed diagnosing phlegmon of the neck and revealing mediastinitis. All patients are operated under intravenous anesthesia with artificial ventilation. With a sharp edema of the larynx, intubation was performed under the control of the bronchoscope, which allowed to avoid tracheostomy and development of purulent tracheobronchitis. In the presence of phlegmon of the neck - a cortical mediastinotomy according to V. I. Razumovsky, which allows to widely open and drain all the anatomical spaces of the anterior region of the neck and deep spaces of the head. The wound was not closed for subsequent stage necrectomy. With odontogenic phlegmon, the KP of the bottom of the oral cavity, the intertice gap, and the retromandibular fossa were additionally opened and drained. With total anterior mediastinitis (n=4), the anterior mediastinum was drained by its own technique: resection of the xiphoid process, tunnel behind the sternum, drainages to the anterior mediastinum. In 2 cases, the anterior mediastinum was drained according to Sazonov. With total and total posterior mediastinitis - thoracotomy (n=7). Conclusions. Improving the results of surgical treatment of neck phlegmon complicated by mediastinitis is facilitated by early diagnosis based on clinical signs and radiation methods of the study, full preoperative correction of homeostasis, wide opening and draining of all cell spaces of the neck, adequate drainage of the mediastinum, tracheostomy application only in exceptional cases, open wound management.