From the Guidelines
The recommended treatment for a lingual abscess typically involves prompt incision and drainage of the abscess, combined with antibiotic therapy. The procedure should be performed by a healthcare professional who will make a small incision in the abscess to allow pus to drain. Empiric antibiotic therapy should be started immediately, with common regimens including amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days), clindamycin (300-450 mg four times daily for 7-10 days), or in severe cases, a combination of a penicillin and metronidazole 1.
Key Considerations
- Incision and drainage is the primary treatment for simple abscesses or boils, and antibiotics are not always needed 1.
- For complicated cases, such as those with significant swelling, systemic illness, or failure to respond to initial treatment, broader antibiotic coverage may be necessary, including coverage for MRSA 1.
- Pain management with acetaminophen or NSAIDs is also important, as well as maintaining good oral hygiene and staying hydrated.
- Warm salt water rinses (1/2 teaspoon salt in 8 ounces of warm water) several times daily can help with healing.
Antibiotic Options
- Amoxicillin-clavulanate: 875/125 mg twice daily for 7-10 days
- Clindamycin: 300-450 mg four times daily for 7-10 days
- Penicillin and metronidazole: for severe cases
Important Notes
- The treatment should be individualized based on the patient's clinical response and the results of culture and sensitivity testing, if available 1.
- In cases where the abscess causes significant swelling that compromises the airway, immediate medical attention is crucial, and airway management may be necessary.
- The most recent and highest quality study 1 supports the use of incision and drainage as the primary treatment for simple abscesses, with antibiotic therapy reserved for more complicated cases.
From the Research
Treatment of Lingual Abscess
The recommended treatment for a lingual abscess involves a combination of approaches, including:
- Protecting the airway, especially in cases where there is a risk of airway obstruction 2
- Draining the abscess, which can be done through needle aspiration or surgery 3, 2
- Administering antibiotics early in the treatment process 4, 2, 5
Antibiotic Therapy
The choice of antibiotic therapy is crucial in the treatment of lingual abscess, and should provide coverage for both aerobic and anaerobic organisms 4, 5. The most effective antimicrobials against anaerobic organisms include:
- Metronidazole
- Carbapenems (imipenem, meropenem, doripenem, ertapenem)
- Chloramphenicol
- Combinations of a penicillin and a beta-lactamase inhibitor (ampicillin or ticarcillin plus clavulanate, amoxicillin plus sulbactam, piperacillin plus tazobactam)
- Tigecycline
- Clindamycin 4, 5
Surgical Drainage
Surgical drainage is an important aspect of treatment, especially in cases where there is marked tissue edema, deep loculated infection, or airway obstruction 2, 5. This involves debriding necrotic tissue, draining pus, improving circulation, alleviating obstruction, and increasing tissue oxygenation 5.
Diagnostic Approaches
Diagnosis of lingual abscess can be achieved through clinical examination, CT scans, and contrast-enhanced computed tomography, especially for abscesses located at the tongue base and deep space infection 3, 2.