Odontogenic infections generally pass through three stages before they resolve, the characteristics of which are listed

in Table 15-4.
During the first 1 to 3 days the swelling is soft, mildly tender, and doughyin consistency. Between days 2 and 5 the swelling becomes
hard, red, and exquisitely tender. Its borders are diffuse and spreading. Between the fifth and seventh days the center of the cellulitis
begins to soften and the underlying abscess undermines the skin or mucosa, making it compressible and shiny. The yellow color of the
underlyingpus may be seen through the thin epithelial layers. At this stage the term fluctuance is appropriately applied. Fluctuance
implies the palpation of a fluid wave by one hand as the abscess is compressed by the other hand. The final stage of odontogenic
infection is resolution, which generally occurs after spontaneous or surgical drainage of an abscess cavity. The swelling then begins to
decrease in size, redness, and tenderness. The resolving swelling may stay firm for some time, however, as the inflammatory process
is involved in removing necrotic tissue and bacterial debris.\

Clinical Presentation. It is characterized by swelling of the cheek, which extends from the zygomatic arch
as far as the inferior border of the mandible, and from the anterior border of the ramus to the corner of the
mouth. The skin appears taut and red, with or without fluctuation of the abscess (Fig. 9.44 b), which, if neglected,
may result in spontaneous drainage.

Anatomic Location. This condition is an acute, diffuse inflammatory infiltration of the loose connective tissue found underneath the
skin (Figs. 9.69 a, 9.71 a). It is believed today that cellulitis and phlegmon are interchangeable
terms. The term cellulitis has prevailed and so the term phlegmon has just about been abandoned.

This disease is characterized by edema, headache, and reddish skin. The edema, whose margins are diffuse and not defined, may
present in various areas of the face and its localization depends on the infected tooth responsible. For example,if the mandibular
posterior teeth are involved, the edema presents as submandibular, and, inmore severe
cases, spreads towards the cheek or the opposite side, leading to grave disfigurement of the face (Figs. 9.69 b,
9.71b).When the infection originates in the maxillary anterior teeth, the edema involves the upper lip, which
presentswith a characteristic protrusion (Fig. 9.74). In the initial stage, cellulitis feels soft or doughy
during palpation, without pus present, while in more advanced stages, a board-like induration appears, whichmay lead to suppuration.
At this stage, the pus is localized in small focal sites in the deep tissue.