Incision and drainage of a submandibular abscess
This is the management of an extensive right submandibular abscess under general anesthesia.
Submandibular abscess develops beneath the tissues in the floor of the mouth. Pus collects under the tongue, pushing it upwards and toward the back of the throat, which can cause breathing and swallowing problems.
An abscess formation usually happens secondary to dental or odontogenic infection.
Inflammation caused by dental caries leads to edema and hypoxia of the dental pulp resulting in pulp necrosis. This environment allows for easy bacterial invasion of the bone tissue.
Spread of infection within the bone occurs in all directions until a cortical plate is encountered. If infection perforates the bone above the mylohyoid, fascial space involvement occurs. Spread of infection through fascial planes into deep neck spaces, such as the submandibular space, can result in local abscess formation. Extension of odontogenic infection into the deep neck spaces and massive abscess formation is an unusual, but potentially life threatening.
Examination findings included moderate to severe trismus and marked right submandibular swelling.
Treatment involves maintenance of airway patency, surgical incision and drainage of the abscess, and antibiotics to cover both oral anaerobes and aerobes (eg, clindamycin, ampicillin/sulbactam, high-dose penicillin).