Fouad A Al-Belasy1. 1. Department of Oral Surgery , Faculty of Dentistry, Mansoura University, Mansoura, Egypt. AlBelasy@netscape.net
Abstract
PURPOSE: The oral approach for incision and drainage (I and D) in patients presenting with submasseteric space (SMS) abscesses and marked trismus is more difficult and requires a general anesthetic, necessitating an anesthetist experienced in fiberoptic-guided nasal intubation. In such patients, ultrasound-guided drainage (USGD) has been attempted to obviate this need. The purpose of this trial was to report our experience with the surgical management of 11 SMS abscesses, with special reference to their USGD. MATERIALS AND METHODS: Seven men and 4 women ranging in age from 18 to 41 years (average age, 25 years) participated in this trial. They were initially examined with US, and their abscesses were subsequently drained under US guidance using a 16-gauge intravenous catheter. An antibiotic regimen was prescribed, and arrangements were made to see the patients daily for 5 days. USGD was repeated after 24 hours, and 24 hours later the infection course was monitored in each patient. Patients with nonresolving infection had their abscesses formally incised and drained extraorally. The source of infection was removed as soon as the acute phase of infection passed and the interincisal opening (IIO) allowed. The catheter or corrugated drain was removed when the discharge ceased or became minimal. Patients were then instructed to continue a 3-day course of an antibiotic and to return after 1 week and then after 1 month. RESULTS: Resolution of infection was successfully achieved by USGD with no need for I and D in 8 of the 11 patients (73%). In those patients, the average total amount of pus removed was 8.5 mL, and the average IIO was 17.4 mm immediately after an average initial aspirate of 4.5 mL of pus. I and D was required in the remaining 3 patients (27%). In those patients the average total amount of pus removed was 17.5 mL, and the average IIO was 7.7 mm immediately after an average initial aspirate of 9.3 mL of pus. CONCLUSIONS: Resolution of infection with USGD is more probable if there was an immediate improvement of the IIO to about 1.5 cm or more after an initial aspiration of 5 mL of pus.
PURPOSE: The oral approach for incision and drainage (I and D) in patients presenting with submasseteric space (SMS) abscesses and marked trismus is more difficult and requires a general anesthetic, necessitating an anesthetist experienced in fiberoptic-guided nasal intubation. In such patients, ultrasound-guided drainage (USGD) has been attempted to obviate this need. The purpose of this trial was to report our experience with the surgical management of 11 SMS abscesses, with special reference to their USGD. MATERIALS AND METHODS: Seven men and 4 women ranging in age from 18 to 41 years (average age, 25 years) participated in this trial. They were initially examined with US, and their abscesses were subsequently drained under US guidance using a 16-gauge intravenous catheter. An antibiotic regimen was prescribed, and arrangements were made to see the patients daily for 5 days. USGD was repeated after 24 hours, and 24 hours later the infection course was monitored in each patient. Patients with nonresolving infection had their abscesses formally incised and drained extraorally. The source of infection was removed as soon as the acute phase of infection passed and the interincisal opening (IIO) allowed. The catheter or corrugated drain was removed when the discharge ceased or became minimal. Patients were then instructed to continue a 3-day course of an antibiotic and to return after 1 week and then after 1 month. RESULTS: Resolution of infection was successfully achieved by USGD with no need for I and D in 8 of the 11 patients (73%). In those patients, the average total amount of pus removed was 8.5 mL, and the average IIO was 17.4 mm immediately after an average initial aspirate of 4.5 mL of pus. I and D was required in the remaining 3 patients (27%). In those patients the average total amount of pus removed was 17.5 mL, and the average IIO was 7.7 mm immediately after an average initial aspirate of 9.3 mL of pus. CONCLUSIONS: Resolution of infection with USGD is more probable if there was an immediate improvement of the IIO to about 1.5 cm or more after an initial aspiration of 5 mL of pus.