Subcutaneous granuloma of the face is a disease characterized by indolent focal inflammation of the subcutaneous tissue. Many experts refer to subcutaneous granuloma as granuloma migrans. Recent studies have shown that the process does not change the place of localization, so the use of the term "migratory" not justified.
Depending on the clinical course, granulomas can be multiple and solitary. Depending on the cause, subcutaneous granulomas are classified into odontogenic and non-odontogenic.
Odontogenic granuloma occurs as a complication of chronic periodontitis. Nonodontogenic develops in the presence of foreign bodies in the fiber.
- What provokes the growth of subcutaneous granuloma of the face
- Causes and clinical manifestations of subcutaneous granuloma of the face
- Differential diagnosis and treatment of subcutaneous face granuloma
What provokes the growth of subcutaneous granuloma of the face
Glass and metal foreign bodies DO NOT provoke the development of subcutaneous granuloma.
The granuloma begins to grow when organic foreign bodies enter.
Historical digression. Granulomas have been observed when hit by pine needles. A unique case is described when, when extracting a tooth, the doctor accidentally cut off part of his nail with an elevator and pushed it into the subcutaneous tissue of the patient's chin. The tooth extraction procedure ended successfully, but after a couple of months, a subcutaneous granuloma formed on the patient's chin. During surgery, a nail was found in the granulation tissue. This is definitely casuistry. But what doesn't happen in real life?
Causes of development and clinical manifestations of subcutaneous granuloma of the face
The cause of odontogenic granuloma lies in the microflora that penetrates from the focus of chronic granulating periodontitis into the subcutaneous tissue, where granulation tissue develops with the formation of granulomas.
Granulomas can reach up to 4 cm in size, have clear boundaries. Palpation of the granuloma is not painful. The skin over the granuloma is sharply thinned, forms folds, irregularities and acquires a bluish tint. There is a false symptom of fluctuation, because when the granuloma is opened, there is no pus. False fluctuation is explained by the presence of granulation tissue in the focus.
A characteristic clinical sign of a subcutaneous granuloma of the face is the presence of a causative tooth, a cord that goes from this diseased tooth to the granuloma, and the granuloma itself. Thus, the subcutaneous granuloma is located near the diseased tooth.
Stages of development of odontogenic subcutaneous granuloma:
- Infiltration – the formation of a mobile, dense and non-painful infiltrate in the skin and subcutaneous tissue.
- Abscess formation – the formation of an abscess located superficially. The patient complains of itching, burning and pain in the area of granuloma formation. The general condition is not violated. The opening of the granuloma is accompanied by the release of bloody or bloody-purulent contents, at the bottom of the wound granulations are visible.
Differential diagnosis and treatment of subcutaneous granuloma of the face
Subcutaneous granuloma is very difficult to distinguish from superficial parotid-masticatory lymphadenitis. Signs of superficial lymphadenitis – the area of the affected skin is less than the infiltration of the underlying tissues, while the depth is much greater.
With subcutaneous granuloma, the skin is purple-bluish, and with lymphadenitis, bluish coloration of the skin is observed only in the central parts of the focus.
The course of the granuloma is always chronic and sluggish. Self-healing of the granuloma is not possible.
Treatment consists in the removal of a diseased tooth, which is the cause of the development of the inflammatory process, and in a thorough revision of the tooth socket. Affected skin is excised without fail.
Scraping is carried out to a depth until a granulation shaft is formed. The granulation roller has the appearance of a dense white tissue, from which the granulation tissue is easily separated. Surgical intervention is completed with local plastic surgery. With a large extent of the lesion site, local plasty is not performed, but free skin grafting is performed.
To prevent the formation of subcutaneous granuloma of the face, it is important to treat dental caries in time. In the presence of suspicious infiltrates on the skin, a visit to a specialist should not be postponed.
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