Abscesses around the mandible

Localization

Specific symptoms

• elevated floor of mouth
• glass-like reddening of the mucosa of the floor of the mouth
• difficulties speaking due to dislocation of the tongue to the healthy side

Treatment

• Incision in the alveolar ridge near the floor of the mouth, touching the periosteum of the affected tooth.
  Caveat! The course of the lingual nerve goes laterally close to the periosteum of the lower wisdom tooth!
• Drainage, rinsing
• Elimination of causes

Localization

• between mylohyoid muscle and superficial fascia colli and the anterior belly of the digastric muscle

Causes

• Periapical periodontitis of molar teeth
• Periapical periodontitis of premolar teeth

Specific symptoms

• reddening and swelling of the inner mandibular surface
• The floor of the mouth is reddened, swollen and hardened dorsally.
• The margin of the mandible is laterally palpable, contours disappear medially.
• occasional trismus

Treatment

• extraoral incision, approx. width 4 cm, parallel to the margin of mandible
• drainage, rinsing
• elimination of causes

Localization

• between masseter muscle and outer surface of mandible

Causes

Specific symptoms

• reddening and pain on pressure in masseter region
• non-movable extraoral swelling
• The margin of mandible can usually not be palpated.
• trismus

Treatment

• intraoral incision in the lateral region of the pterygomandibular plica
• drainage, rinsing
• antibiotic treatment obligatory
• treatment of the affected tooth

Localization

• accumulation of pus laterally from the mandibular body, which encompasses the mandibular margin medially

Causes

• infection usually originates from the mandibular molars

Specific symptoms

• reddening and pain on pressure in the lower buccal region
• non-movable extraoral swelling
• fluctuation
• mandibular margin not palpable
• trismus

Treatment

• extra oral incision (4 cm width) parallel to and below the edge of the mandible
• drainage
• antibiotic treatment obligatory
• treatment of the affected tooth

Location

• accumulation of pus in the ventral mandibular region limited by the mental muscle

Causes

• Periapical periodontitis of incisors

Specific symptoms

• reddening and pain on pressure of the chin
• non-movable, usually central, extraoral swelling above the chin
• intraoral swelling of the oral vestibule

Treatment

• Isolated chin abscess can be incised from an intraoral access.
• drainage, rinsing
• elimination of causes

Localization

• between pterygoid muscle and inner surface of the mandible

Causes

Specific symptoms

• extreme trismus
• minor swelling from outside
• collateral edema in the parotid bed (on occasion)
• pain on pressure at the mandibular angle and retromandibular
• difficulties swallowing
• swelling of the soft palate

Treatment

• extraoral incision, approx. width 4 cm, parallel to the margin of mandible (in rare cases intraoral incision)
• drainage, rinsing
• antibiotic treatment obligatory
• secondary tooth restoration

Localization

• abscess formation at the posterior mandibular margin

Causes

• usually through an inflammation spreading into the masseterico-mandibular space
• abscess formation of a parotitis

Specific symptoms

• swelling of the parotid region (behind the ascending ramus of the mandible) to the sternocleidomastoid muscle
• A fluffy, purulent discharge from the parotid duct is indicative of parotitis.

Treatment

• intra- or extra-oral incision
• drainage, rinsing
• antibiotic treatment

• necrotizing fasciitis
• mediastinitis (Bräuing et al. 1997)

• Bräunig G, Mohr C, Schönfelder B, Weischer T (1997), Suppurative abscess-forming mediastinitis after tooth extraction. Consequences for therapeutic approach, Mund Kiefer Gesichtschir, 1(5):300-4