Throat phlegmon is a rapidly spreading purulent inflammation of the soft tissues of the throat. The disease is life-threatening and requires immediate emergency medical attention. Throat phlegmon can develop from injuries in the mouth area.
What are throat phlegmons?
Throat phlegmon is one of the particularly dangerous forms of phlegmon. The term phlegmon is generally used for a bacterial inflammation of soft tissues that does not remain confined. Phlegmone is derived from the word phlegma, which means mucus in translation. As the disease progresses, a mucous purulent mass forms from the dying tissue of the soft tissues.
The phlegmons include erysipelas (a so-called phlegmonous erysipelas of the skin), hand phlegmon or orbital phlegmon (orbital phlegmon). In phlegmon of the throat, the soft tissues of the neck are affected by a diffuse inflammation that progresses inexorably. Larger and 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, phlegmon in the throat can also originate from an inflammation of the parotid gland and spread from there to the soft tissues of the throat. Inflammation spreads along the vascular sheath of the neck and reaches the internal jugular vein, where it can cause thrombotic occlusion.
The bacterial pathogens can enter the bloodstream in large numbers via this thrombosis and trigger sepsis (blood poisoning), which if left untreated often leads to death. At the same time, a life-threatening median inflammation can develop. Because of this fact, phlegmon in the throat represents a medical emergency that requires immediate surgical and antibiotic treatment. Throat phlegmon is often also referred to as mouth floor phlegmon because it often starts at the floor of the mouth.
Causes
The cause of phlegmon in the throat is an infection of the soft tissues of the throat with bacterial pathogens. These are mainly streptococci or staphylococci. The pathogens get into 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 fragments or bones in the throat.
Injuries also occur during tooth, root or jaw treatment, which in rare cases can be the starting point of phlegmonous inflammation. Complications are possible, especially when removing a wisdom tooth, which may lead to abscesses or, in rare cases, to phlegmon on the floor of the mouth. If inflammatory processes are also taking place at the same time, such as tooth root inflammation, tooth decay, tonsillitis or parotid gland inflammation, there is an increased risk that these germs will get into the bloodstream.
If these affect the lymph nodes, they can cause diffuse purulent inflammation in the soft tissues of the neck. But inflammation can also develop at the site of the injury itself and spread further. Even with isolated tonsillitis or ear salivary infections there is a risk of the inflammation spreading in the form of phlegmon in the throat.
The fulminant development of the inflammatory purulent processes is rare but quite typical. It takes place when the pathogens reach places where they find particularly favorable conditions for their further spread. This is the case in the soft tissues of the neck at the vascular sheath of the neck.
Symptoms, Ailments & Signs
Throat phlegmon begins with clear signs of illness. Those affected feel exhausted and tired. A high fever usually develops. A painful feeling of pressure develops in the area of the throat and the floor of the mouth, which increases more and more. The soft parts of the throat often swell enormously. The entire face may be severely swollen.
The abscess is not limited, but spreads indefinitely. The neck lymph nodes swell. Narrowing of the airways leads to severe breathing difficulties. In the case of an infected thrombosis of the jugular vein, blood poisoning (sepsis) can develop. In very severe cases, this leads to general organ failure with fatal consequences. On the other hand, phlegmon in the throat can also spread to the mediastinum and cause inflammation of the mediastinum (mediastinitis). Mestis is a very serious condition that is often fatal.
Diagnosis
The suspected diagnosis of phlegmon in the throat can already be made on the basis of the symptoms. No circumscribed inflammation can be detected or visualized on palpation or on examinations with ultrasound and computed tomography. Rather, a loosening of the soft tissues is determined. A visual demarcation of individual organs such as esophagus, trachea, thyroid or larynx is no longer given.
Complications
As a rule, phlegmon in the throat is life-threatening and must therefore be examined and treated immediately by a doctor. In the worst case, if left untreated, the patient may die. This suffers primarily from fever and a general feeling of illness. He feels defeated and his resilience drops enormously.
Throat phlegmon causes severe pain and a feeling of pressure in the mouth, which can increase as the disease progresses. Swellings in the mouth also occur, which often spread to the entire face. The swelling can lead to shortness of breath and usually significantly restricts the intake of food and liquid.
The affected person can also develop blood poisoning and die from it. In the worst case, the mediastinum can become inflamed, which in most cases is also fatal. Without treatment of phlegmon in the throat, the patient’s life expectancy is extremely reduced. The treatment is usually carried out with the help of medication and leads relatively quickly to a positive course of the disease. If treated early, there are no further complications.
When should you go to the doctor?
In the case of throat phlegmon, a doctor should be consulted immediately. The inflammation usually spreads very quickly and can also 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 mouth area in addition to fever. Swollen lymph nodes or breathing difficulties can also indicate the disease and should be examined.
In the worst case, the person affected suffers organ failure from the throat phlegmon and ultimately dies from it. The visit to the doctor should take place if there is a painful feeling of pressure in the mouth. Severe swelling of the face can also indicate the disease. As a rule, a general practitioner can be consulted for this disease. The symptoms can be treated well with antibiotics. 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 & Therapy
A doctor or dentist must be consulted immediately at the first sign of such symptoms as a feeling of pressure in the throat, fatigue and fever. The disease can take a dramatic course very quickly, so that immediate measures must be taken as quickly as possible, which can only be carried out on an inpatient basis. First of all, the throat phlegmon must be treated surgically.
This involves removing the dead tissue and abscess. The initial focus of the disease must also be treated thoroughly with medication. The patient receives high doses of antibiotics within the next ten days. These are usually given intravenously via a drip. Penicillin is used as an antibiotic.
Patients who are allergic to penicillin are treated with other antibiotics. Among other things, active ingredients from the family of macrolides are used here. During treatment, patients eat liquid food. In addition, an antiseptic oral care must be carried out. Painkillers can also be given if the pain is severe.
Outlook & Forecast
Phlegmon in the throat or floor of the mouth is a very serious disease that can be fatal within a few days if left untreated. After the diagnosis, action must be taken quickly. The therapy consists of administration of antibiotics, cooling and an operation. As a result, constant rinsing of the throat with disinfectant solutions is necessary. The therapy lasts about 10 days. With these measures, the throat phlegmon can usually be treated very well and also completely healed. Consequential diseases or organ damage do not occur.
In immunocompromised people, however, the disease can be fatal despite intensive treatment. Serious complications are also possible if treatment is started 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 throat phlegmon to flare up again. A phlegmon in the neck area is particularly dangerous because from here the bacteria along the vascular sheath of the neck can quickly get into the bloodstream and trigger a life-threatening sepsis.
Furthermore, the mediastinum is quickly attacked. A so-called mediastinitis develops, which is a particularly life-threatening complication. If the mediastinum is already affected, a drainage must also be created there in order to constantly drain the infectious fluid. But even in this advanced stage of the disease, a complete cure is still possible.
Prevention
Daily oral hygiene is recommended to prevent phlegmon in the throat. This includes brushing your teeth intensively at least in the morning after breakfast and in the evening before going to bed. Dental floss or an interdental toothbrush can be used to remove any leftover food as much as possible. Oral hygiene should also include regular antiseptic rinsing with mouthwash.
You can do that yourself
Throat phlegmon is an acute and serious illness, so self-help measures must always be coordinated with the treating specialist. After the surgical intervention, the patient usually remains under inpatient supervision, with extensive rest periods being important. Such rest periods should also be maintained after the patient returns home after surgery to aid healing and prevent complications from overwork and stress.
As a result of the surgical intervention on the neck, patients with phlegmon in the throat initially suffer from considerable pain, and it is necessary to find a comfortable resting position for the individual. It may help the patient to support their head on a high armrest to relieve the neck muscles.
During the entire recovery phase, physical and psychological stress must be minimized in order not to impair the healing process. Adequate care of the wound and hygienic measures to avoid wound infections and further inflammation are also of great importance. Numerous patients struggle with swallowing difficulties after the operation, with soft to liquid food providing relief. Oral and dental hygiene should also be given special consideration, since any inflammation of the teeth or tooth roots can, in the worst case, spread to the area of the throat phlegmon.
