When Is Drainage Needed?

• Visible, fluctuant swelling with localized pain and redness
• Fever, malaise, or spreading cellulitis despite oral antibiotics
• Difficulty opening mouth (trismus), swallowing, or breathing
• Dental abscesses not resolving with conservative care
• Abscesses in deep neck spaces with risk of airway or mediastinal spread

Common Types & Locations

1. Periapical / Dental Abscess

Originates from infected tooth pulp and commonly causes facial swelling and severe toothache.

2. Periodontal Abscess

Occurs in the supporting structures of the tooth (gums) and may present with gum swelling and pus discharge.

3. Peritonsillar Abscess (Quinsy)

Collection beside the tonsil causing severe sore throat, muffled voice (hot potato), fever, and difficulty swallowing.

4. Submandibular / Ludwig’s Angina

Deep floor-of-mouth infections; Ludwig’s angina is a rapidly spreading cellulitis that can threaten the airway and requires urgent management.

5. Parapharyngeal & Retropharyngeal Abscess

Deep neck space infections with potential airway compromise and mediastinal spread — often need prompt surgical drainage.

6. Salivary Gland Abscess

Infection in parotid or submandibular glands leading to localized swelling and pus from duct opening.

Symptoms of Head & Neck Abscess

• Localized throbbing pain and tenderness
• Swelling, redness, and warmth over the area
• Fever, chills, and general malaise
• Difficulty eating, swallowing, speaking, or opening mouth
• Pus drainage into mouth or through skin (sinus tract)

Diagnosis & Investigation

Accurate localization and assessment of depth are essential before drainage.

• Clinical examination including palpation and intraoral inspection
• Ultrasound for superficial collections
• Contrast-enhanced CT scan for deep neck space infections and surgical planning
• Dental X-rays or OPG for tooth-related abscesses
• Blood tests (CBC, inflammatory markers) and pus culture if drained

How Abscess Drainage Is Performed

The approach depends on location and depth. The aim is complete evacuation of pus, irrigation, and source control (e.g., tooth extraction) with minimal morbidity.

1. Office/Bedside Incision & Drainage

Superficial abscesses may be drained under local anaesthesia. A small incision is made, pus evacuated, cavity irrigated, and a gauze wick or small drain may be placed.

2. Intraoral Drainage

For dental, peritonsillar, or some deep oral cavity abscesses, drainage through the mouth avoids skin incisions and is often performed under local or general anaesthesia.

3. External Surgical Drainage

Deep neck or submandibular collections may require an external cervical incision under general anaesthesia to safely and completely drain the abscess.

4. Image-Guided Drainage

Ultrasound or CT-guided percutaneous drainage may be used for selected deep collections, especially in medically unfit patients.

5. Airway Management

When there is airway compromise (severe swelling, Ludwig’s angina, retropharyngeal abscess), securing the airway (intubation or tracheostomy) may be necessary before drainage.

Medical Treatment

• Broad-spectrum intravenous antibiotics tailored to likely organisms
• Analgesics and antipyretics for pain and fever control
• Hydration, nutrition support, and mouth care
• Adjust antibiotics based on culture and sensitivity results

Post-Operative Care & Follow-up

• Continue prescribed antibiotics and pain relief as directed
• Warm saline mouth rinses and gentle oral hygiene if intraoral drainage performed
• Wound care instructions for external drains; keep dressing clean and dry
• Return for drain removal, suture check, and review of culture results
• Address source control — dental extraction, root canal, or salivary duct procedures when needed

Possible Complications

• Spread of infection to deep neck spaces, mediastinum, or chest
• Airway compromise requiring emergency intervention
• Scarring, fistula formation, or recurrence if capsule not removed
• Sepsis in severe untreated infections

Why Choose Dr. Shrekha Padmakshan?

Dr. Shrekha Padmakshan offers prompt, evidence-based management of oral cavity and head-neck abscesses with emphasis on safety, airway protection, and complete source control to prevent recurrence and serious complications.

• Expertise in both intraoral and external drainage techniques
• Access to CT/US-guided drainage and multidisciplinary care (dental, critical care)
• Quick airway management when required and inpatient support for severe infections
• Follow-up to ensure healing and address definitive treatment like dental care

If you have a painful swelling in the mouth, face, or neck, fever, difficulty swallowing, or trouble breathing — seek urgent evaluation. Early drainage and treatment prevent complications and speed recovery.