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Cellulitis - Oral Mucosal Lesion
See also in: Overview,Anogenital,Hair and Scalp
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Cellulitis - Oral Mucosal Lesion

See also in: Overview,Anogenital,Hair and Scalp
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Contributors: Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
Other Resources UpToDate PubMed

Synopsis

Cellulitis of the head and neck region is a condition caused by an infection, often of odontogenic origin, resulting in edema and acute inflammation that spreads through the fascial planes of the soft tissues. In general, bacteria are present in the tissue only in small quantities. Pain and swelling are the main complaints. Systemic symptoms of fever, malaise, and chills are common. When cellulitis involves spread to the submandibular space, the term "Ludwig's angina" is used; Ludwig's angina can be life-threatening due to rapid swelling that blocks the airway and makes it difficult to swallow.

With cellulitis of the head and neck region, patients generally report a history of a toothache that is recurrent or relapsing over weeks and months; there may also be a history of trismus. A painful and tender swelling then develops in the face in the area of the painful tooth over a few days. Cellulitis may also result from a penetrating injury to the soft tissues, with ensuing inflammation and infection. In patients with diabetes mellitus and in immunosuppressed individuals, the infection can spread to cause large abscesses, necrosis, and dissemination into the blood. Patients who are immunocompromised are particularly prone to the development of this condition.

A rising prevalence of methicillin-resistant S. aureus (MRSA) has been identified as a pathogen of skin and soft tissue infections in otherwise healthy individuals lacking the aforementioned risk factors for cellulitis (IV drug use, incarceration, participation in contact sports, etc). It has been shown that the majority of purulent skin and soft tissue infections presenting to emergency rooms across the United States are caused by CA-MRSA. It is not currently known if nonpurulent skin infections like cellulitis are more frequently caused by MRSA today.

Codes

ICD10CM:
L03.90 – Cellulitis, unspecified

SNOMEDCT:
128045006 – Cellulitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Parotitis may appear similar but there would also be typical meal symptoms (pain at the start of a meal), and pus may be milked from Stensen's duct.
  • Cutaneous dental sinus tract – most of these are chronic and not associated with significant pain or swelling.
  • Angioedema – not painful; resolves in 24-72 hours.

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 02/03/2015
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Cellulitis - Oral Mucosal Lesion
See also in: Overview,Anogenital,Hair and Scalp
Print 1 Images
Cellulitis : Chills, Erythema, Lymphadenopathy, Lymphangitis, Skin warm to touch, Unilateral, Blanching patch
Clinical image of Cellulitis
Copyright © 2019 VisualDx®. All rights reserved.