Surgical Treatment of Infection

Drainage of Intra-oral Abscess

¨ Make an incision parallel to the gingival margin at the lower end of the abscess cavity

¨ Push the scalpel length-wise and positively

¨ Inject Local anaesthetic lateral to the abscess

¨ Open the abscess cavity with curved artery forceps or sinus forceps

¨ In the palate consider removing an elliptical window of mucosa to prevent the wound resealing

 

Anaesthesia

Local anaesthetic injected close to the abscess or ethyl chloride topic spray

 

Drains

Larger and deeper abscesses may seal off shortly after drainage

A corrugated rubber drain, tubular plastic drain or finger of a sterile glove can be used

Suture in place and leave for over 24 hours

 

Larger Abscesses

Cervicofacial space abscesses commonly require an extra-oral approach to allow adequate drainage

A General Anaesthesia is usually required

 

 

Cases Requiring Inpatient Management

 

Hospital admission is required when there is:

¨ Considerable systemic reaction fever and malaise

¨ Failure to control infection / rapid and extensive spread

¨ Significant dysphagia or any dyspnoea

¨ Signs of dehydration, or patient having difficulty drinking

¨ Suspected reduced resistance to infection

¨ Need for general anaesthesia for drainage

 

On admission it is usually necessary to

¨ Obtain venous access

¨ Give IV fluids

¨ Haematological investigation, and occasionally blood culture

¨ Give IV antibiotics

¨ Obtain drainage as required

¨ Arrange for elimination of the cause.

 

Ludwig's Angina

Spreading cellulitis in the floor of the mouth

Cause is often a mandibular molar

Has the potential to threaten life by obstructing the airway

 

Clinical Signs

¨ Oedema of both sides of the floor

¨ Raised tongue

¨ Involvement of both submandibular spacers

¨ Oedema spreading down the neck

¨ Firmness, redness and tenderness of the neck

¨ Progressive trismus

¨ Marked pain/difficulty in swallowing

¨ Speech and breathing affected

 

REQUIRES URGENT ACTION

 

¨ Admission to the hospital

¨ High dose IV antibiotics, usually Ampicillin and Metronidazole

¨ IV fluid replacement

¨ Consider airway management if there is significant risk of obstruction, this may require endotracheal intubation or Tracheostomy

                                                                                                                    

Early removal of the cause (Extraction of tooth) This may be delayed if the severity or

spread of infection makes local anaesthesia, access for extraction or induction of

general anaesthesia impracticable or dangerous.

Drainage of pus.

Spreading dental infections

Investigation of spreading dental infection