From the Guidelines
Treatment for a submental abscess involves prompt surgical drainage combined with antibiotics, as the infection can spread to deeper neck spaces or the mediastinum, potentially causing airway compromise or sepsis 1. The procedure requires making an incision under the chin to evacuate the pus, followed by placement of a drain for continued drainage.
- The infection commonly originates from dental sources, particularly mandibular molars, or from infected sublingual or submandibular glands.
- Empiric antibiotic therapy should begin immediately with amoxicillin-clavulanate 875/125 mg twice daily or clindamycin 300-450 mg four times daily for 7-10 days if penicillin-allergic.
- For severe cases, consider intravenous antibiotics such as ampicillin-sulbactam 3 g every 6 hours or clindamycin 600-900 mg every 8 hours.
- Patients should be monitored for signs of spreading infection including difficulty breathing, fever, or increasing swelling.
- Warm compresses and pain management with acetaminophen or ibuprofen can provide symptomatic relief.
- Complete resolution typically occurs within 7-10 days with appropriate treatment. Key considerations for treatment include:
- Incision and drainage is the primary treatment for simple abscesses or boils, and antibiotics are not needed for simple abscesses 1.
- Antibiotic therapy is recommended for abscesses associated with severe or extensive disease, rapid progression, signs and symptoms of systemic illness, associated comorbidities or immunosuppression, extremes of age, abscess in an area difficult to drain, associated septic phlebitis, and lack of response to incision and drainage alone 1.
- Empiric therapy for community-acquired MRSA (CA-MRSA) should be recommended for patients at risk for CA-MRSA or who do not respond to first line therapy 1.
From the Research
Diagnosis of Submental Abscess
- The diagnosis of a submental abscess can be challenging and may require special studies, including ultrasonography, CT scans, and MR imaging, to clarify the extent of infection and the presence of an abscess 2.
- A submental abscess may be difficult to differentiate from uncomplicated cellulitis or may be confused with other conditions such as pseudoaneurysms, hematoma, phlegmon, or thrombosed vein 2.
Treatment of Submental Abscess
- The treatment of a submental abscess typically involves incision and drainage, which is a prerequisite for successful outcome 3, 2.
- Antibiotic therapy may be necessary in some cases, but its use should be approached individually and with consideration of the risk of resistance associated with antibiotic overuse 4.
- The use of high-frequency ultrasound can be helpful in the clinical management of recurrent submental abscess formation, particularly in cases where filler placement is involved 5.
- In some cases, abscess drainage may be necessary, and the therapy may involve antibiotics, such as Ceftriaxone and Vancomycin, followed by oral Amoxicillin 6.