We have reported a case of submandibular abcess

1. MANAGEMENT OF SUBMANDIBULAR ABCESS
A CASE REPORT
Yulia anggraini, H.R. Yusa H

2. INTRODUCTION
The submandibular abscess is one of the forms of
a deep neck space infection
A deep neck abcess is formed in a potential space
between the deep neck fascia as a result of spread
of infection from various sources, such as teeth,
mouth, throat, paranasal sinus, middle ear and
neck

3. INTRODUCTION
Altough the incidence of deep neck infection has decreased
mainly for the avaibility of antibiotics , this infection still
occurs with considerable frequency and can be associated
with high morbidity and mortality
The incidence of submandibular abcess is more
common in men than in woman with a ratio of 3:2
frequency submandibular abcess is 13% - 60%.

4. INTRODUCTION
Predisposition factors are bad orodental hygine,
diabetes mellitus, and immunodeficiency disorders .
Submandibular abcess is the most common site of spreading
infection from tooth, the another cause by salivary gland infection,
upper respiratory tract infection, trauma, corpus alienum, and 20%
cases of unknown focal infection.
The management of abcess involves surgical drainage
associated with use of intravenous antibiotics to eliminating
sources of infection

5. Case report
I 40 years old male was admitted to Hospital in
february 4th 2018 with main complaint of lump below the
lower jaw
The patient also had complaints of jaw pain, lethargy,
and fever.
Pain on swallowing was found, but there was no
complaint about difficulty in breathing

6. Case report
During examination we found submandibular mass
extending submental region with size of 8cm x 5cm x
3cm, hyperemic, fluctuating, and found pain at
pressure
In the physical eximination, the patient was compos
mentis, with blood pressure of 120/70 mmHg, pulse of
80times/minute,temperature of 38,50C
The patient also had a history of toothache, bad oral
hygiene, and dental cavities

7. Case report
We ordered AP and lateral soft tissue imaging and
found soft tissue swelling with pneumatization in the
submandibular and submental region
A PA chest x-ray showed normal findings and without
signs of medistinitis
Laboratory findings showed leukocytosis (21.000
mm3) .

8. We diagnosed this
patient with
submandibular
abcess
Then patient
underwent dacess
drainage at
February 4 2018

9. • AP and Lateral Soft Tissue Imaging (with an arrow pointing to neck
soft tissue swelling)

10. Pehacain infiltration
was done on the area
to be incised.
The abscess was
drained and washed up
with NaCl 0,9% solution
until clean.
segment incision
parallel to the
mandibula was done
on the most fluctuated
area.

11. Penrose drainage was installed
and suture was done to the
incision
after the incision and abscess
drainage, antibiotic
medication was continued,
and abscess evacuation and
evaluation were done daily
until it dried. .

12. Submandibular Abcess
 Deep Neck Space Infection (DNSI) means infection in the potential spaces and
facial planes of the neck, either with abscess formation or cellulitis
 The most common primary sources of DNSI are the dentition, tonsils, salivary
glands, foreign bodies DNSI often occur following preceding infections like
dental caries, tonsillitis, pharyngitis, trauma to head and neck
 DNSI are usually polymicrobial. Streptococci, Peptostreptococcus species,
Staphylococcus aureus, and anaerobes are the commonly cultured
organisms from DNSI
 Majority of patients were in age group of 31-40 years werw males more than
female
 The clinical picture of infection with edema of the neck, odynophagia, fever,
trismus, a poor health status. Sometimes they are accompanied by agitation,
cough, dehydration, drooling, snoring, stridor, torticollis, and rigid neck.

13. Ro- Photo, Ct scan,MRI, USG are imaging modality to
evaluation of deep neck infection.
Thorax photo may be helpful to evaluation of
complication such as mediastinitis.
Blood check to see if any sign of sepsis or multi organ
failure.

14.  Odontogenic cause was found to be the commonest cause of deep neck
infections seen in 40% patients.Its reported prevalenceis 22.7 to 43% and
most commonly due to mandibular and molar teeth
 Some important questions to ask in history taking are duration, development
of symptoms, previous upper respiratory tract infection, previous
intervention associated with regions around the neck such as tooth
intervention and intubation, previous use of antibiotic, MRSA risk factor, and
the possibility of immunocompromised patient
 In addition to the proper antimicrobial therapy , surgical drainage is
imperative in most deep neck infections. The principles of management of
deep neck abscess patients are maintaining the airway patency, precise
and adequate antibiotic medication, hydration, adequate nutrition, and
abscess evacuation either under local or general anesthesia.

15. Conclusion
• We have reported a case of
submandibular abcess
• The patient was treated with a abcess
drainage with a good result