What is the treatment for a submandibular abscess?

From the Guidelines

Submandibular abscess treatment requires prompt medical attention and typically involves a combination of surgical drainage and antibiotics. The primary treatment is incision and drainage of the abscess, which should be performed by an oral surgeon, otolaryngologist, or emergency physician. This procedure involves making an incision to release the collected pus, followed by placement of a drain to allow continued drainage. Alongside surgical intervention, empiric antibiotic therapy should be initiated immediately, typically with amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) or, for penicillin-allergic patients, clindamycin (300-450 mg four times daily) 1. In severe cases or those with systemic symptoms, intravenous antibiotics may be necessary, such as ampicillin-sulbactam (3 g every 6 hours) or piperacillin-tazobactam (4.5 g every 6 hours). Pain management with acetaminophen or NSAIDs is also important. Patients should maintain good oral hygiene, stay hydrated, and follow up within 48-72 hours after drainage. Submandibular abscesses are typically caused by bacterial infections originating from dental infections, salivary gland infections, or trauma, with common pathogens including streptococci, staphylococci, and anaerobes. Prompt treatment is essential as these infections can spread to adjacent spaces and potentially lead to life-threatening complications like airway compromise or deep neck infections. Some key considerations for antibiotic therapy include:

• For outpatients with purulent cellulitis, empirical therapy for CA-MRSA is recommended pending culture results 1.
• For outpatients with nonpurulent cellulitis, empirical therapy for infection due to b-hemolytic streptococci is recommended, and coverage for CA-MRSA may be considered in certain cases 1.
• For hospitalized patients with complicated SSTI, empirical therapy for MRSA should be considered pending culture data, with options including IV vancomycin, linezolid, daptomycin, telavancin, and clindamycin 1. It is also important to note that cultures from abscesses and other purulent SSTIs are recommended in certain cases, such as patients treated with antibiotic therapy, severe local infection or signs of systemic illness, and lack of response to initial treatment 1.

From the Research

Submandibular Abscess Treatment

• Submandibular abscesses can be treated with either an external cervical approach or an intraoral drainage approach 2, 3.
• The intraoral drainage approach has been shown to have a better cosmetic outcome and shorter operative time compared to the external cervical approach 2, 3.
• Studies have demonstrated that the intraoral drainage approach can be a successful treatment option for submandibular abscesses, with no significant difference in postoperative hospitalization and days of intravenous antibiotics administration compared to the external approach 2, 3.
• The use of antibiotics, such as moxifloxacin, has been shown to be effective in reducing pain and improving outcomes in patients with odontogenic abscesses and inflammatory infiltrates 4.
• Microbiological analysis has identified the oral pathogens found in odontogenic infections, including viridans group streptococci, Prevotella spp., and Streptococcus anginosus group isolates, and has determined their susceptibilities to various antibiotics 5.

Treatment Options

• Intraoral drainage approach: a minimally invasive technique that can be used to treat submandibular abscesses, with a better cosmetic outcome and shorter operative time compared to the external cervical approach 2, 3.
• External cervical approach: a traditional technique that can be used to treat submandibular abscesses, but may result in a longer operative time and a higher risk of complications 2, 3.
• Antibiotic therapy: can be used to reduce pain and improve outcomes in patients with odontogenic abscesses and inflammatory infiltrates, with moxifloxacin being a effective option 4.

Considerations

• The choice of treatment approach should be based on the individual patient's needs and the severity of the abscess 2, 3.
• The use of antibiotics should be guided by microbiological analysis and susceptibility testing to ensure effective treatment 5.
• Postoperative care should include monitoring for complications and providing adequate pain management 2, 3.