Submandibular Abscess

Case Presentation

Supervisor:
dr. H. Oscar Djauhari, Sp. THT
 - A 52 years old woman came to
ENT Clinic with a complaint
Swelling of left lower jaw since 1
week ago.
- She also felt pain in the left lower
The Case jaw since 2 weeks before
admission
- Pain spreading to left head and
left ear, Worsened by opening
mouth, chewing, swallowing or
speaking
 Name : Mrs. A
Gender : Female
Age : 52 years old
Identity
Occupation : Housewife
and
Complaint Addres : salagombong, sukabumi
Chief complaint :
Swelling of left lower jaw
 - Swelling of left lower jaw since 1 week
before admission
- The swelling is progressive and consistent
- At first the swell is small and getting larger
History of - Fever same time as the swelling
Present - Pain in the left lower jaw since 2 weeks
Illness before admission
- Pain spreading to left head and left ear
- Worsened by opening mouth, chewing,
swallowing or speaking
 History of previous illness was
History of denied
Past
Illness History of family illness was
denied
 General condition : Appear moderately ill
Body weight : 65 kg
Physical Height : 155 cm
Examination Blood pressure : 120/80 mmHg
(Generalized
Pulse : 90 beat per minute
Status)
Respiratory rate : 22 times per minute
Temperature : 37,3oC
 Right ear
Auricle : normal
Physical External auditory canal : hyperemic (-
Examination ), edema (-), mass (-), laceration (-)
(Ears) secretion (-) , cerumen (-)
Tymphanic membrane : Intact,
hyperemic (-), light reflex (+)
 Left ear
Auricle : normal
Physical External auditory canal : hyperemic (-
Examination ), edema (-), mass (-), laceration (-)
(Ears) secretion (-) , cerumen (-)
Tymphanic membrane : Intact,
hyperemic (-), light reflex (+)
 Right nose
Mucous membrane:
hyperemic (-), edema (-), mucoid
Physical secretion (-), mass (-), laceration
Examination (-), crust (-)
(Nose) Inferior conchae : eutrophy
Septum : no deviation
Air passage : normal
 Left nose
Mucous membrane:
hyperemic (-), edema (-), mucoid
Physical secretion (-), mass (-), laceration
Examination (-), crust (-)
(Nose) Inferior conchae : eutrophy
Septum : no deviation
Air passage : normal
 Oropharynx
Posterior pharynx : hyperemic (-)
Palatine tonsils : T1 / T1, hyperemic
Physical (-), detritus (-)
Examination Uvula : symmetrical
(Throat and
Dental : Caries dentis with
Neck) pus on M2 and M3 Inferior Sinistra
Maxillofacial : normal

Neck : mass (-),

Edema (+) a/r Left submandibular
Working Left Submandibular Abscess
Diagnosis

Differential
Diagnosis Left Parapharynx Abscess
 Work up:
Blood count including differential
count of white blood cells
Treatment:
Inpatient care
Work up and Liquid diet
Treatment - Antibiotic :
- ceftriaxone 2 x 1 gram IV
- Metronidazole 3 x 500 mg IV
Ranitidine 2x50 mg IV
Ketorolac 2x30 mg IV
Pro incision + submandibular
abscess drainage
LITERATURE REVIEW
Abscess in the potential zone
of submandibular region (part
of abscess of deeper neck)
Submandibular potential zone
sublingual room and
submaxillary which divided by
mylohyoid muscle
 Source of infection can be from:
Odontogen
Etiology
Pharynx
Airway trauma
 Aerob Bacteria:
Streptococcus viridans
Streptococcus pyogenes
Staphylococcus epidermis
Etiology S. aureus

Anaerob Bacteria:
Peptostreptococcus
Fusobacterium
Bacteriodes
 The spreading of deep neck
abscess mouth cavity, face, or
superficial neck infection to deep
neck through lymphatic system

Lymphadenopathy
suppuration and finally
Pathophysiology become local abscess

Most common cause is anaerob

bacteria infection which produce
inflammation exudate
spreading of infection can widely
involve sublingual and
submandibular space
 Otorrhea > 3 weeks
Fever antibiotic, headache
Retroauricular pain
Hearing loss
Clinical Children not specific (diarrhea,
Findings - appetite, fever, irritable)
History
Clinical Swelling of lower mandibular
Findings and/or below tongue
Physical Unilateral or Bilateral (Fluctuative)
Examination
 CT scan (Gold Standard)
Imaging Panoramic Rontgen
Thorax rontgen
 Secure Airway (cricotiroidotomi /
trakeostomi)
High dose Antibiotic (ceftriaxone
metronidazole combination)
parenteral
Abscess evacuation :
Management Local anesthesia if localized and
superficial
General anesthesia if abscess is deep
and wide
Abscess incision at the most
fluctuative area or as high as Hyoid
bone
KOMPLIKASI
 1. Cummings C, Flint P, Haughey B,
Robbins K, Phelps T. Otolaryngology.
Philadelphia, Pennsylvania: Mosby;
2010.
2. Bailey B. Head & neck surgery--
References otolaryngology. Philadelphia:
Lippincott-Raven; 1998.
3. Bradley P, Ludman H. ABC of ear,
nose, and throat.