In addition, analgesia and adequate hydration must be maintained. Removal of the
cause is essential to cure an orofacial infection arising from a dental source. This
usually means extraction or endodontic therapy.
Institution of drainage and prevention of spread are supportive treatments⎯they are
not definitive cures. Drainage may be obtained during the removal of the cause, for
example, a dental extraction, or may precede definitive treatment if this makes
management easier, for example, incision and drainage of a submandibular abscess.
Drainage may be intra or extraoral. When an extraoral incision is made it is made in a
skin crease parallel to the direction of the facial nerve. In the submandibular region
the incision is made more than one finger's breadth below the angle of the mandible to
avoid the mandibular branch. Once skin has been incised the dissection is carried out
bluntly until the infection has been located. Locules of infection are then ruptured
using blunt dissection and a drain secured to the external surface. Depending on the
amount of drainage the drain is secured for 24-48 hs. Any pus should be sent for
culture and sensitivity testing to the microbiology laboratory. Prevention of spread
may be achieved surgically or by the use of antibiotics. In severe cases intravenous
antibiotics will be used. The antibiotic of choice in children is a penicillin.
It is important to remember that acute infections are painful and that analgesics, as
well as antibiotics, should be prescribed. The use of paracetamol elixir is usually
sufficient. Similarly, it is important that a child suffering from an acute infection is
adequately hydrated. If the infection has restricted the intake of oral fluids due to
dysphagia then admission to hospital for intravenous fluid replacement is required.
1062H
Fig. 15.28 Infection in this region can
spread intracranially. (By kind permission
of Dental Update.)