Vestibular Abscess.pptx

Teaching to residents

1. Dental Vestibular Abscess and Drainage INDIANA UNIVERSITY Mehul Patel Oral & Maxillofacial Surgery

2. Common Etiologies Cysts that become infected Gingival Infections Periodontal/Periapical infections Root fractures Dental Caries

3. Anatomy and Pathophysiology

4. Physical Exam Findings Swelling Erythema Intraoral drainage Foul Taste Fullness/Fluctuance along vestibule Severe pain during palpation/percussion of the tooth

5. Radiographic Findings

6. Radiographic Findings

7. NOT A VESTIBULAR ABSCESS

8. NOT A VESTIBULAR ABSCESS

9. NOT A VESTIBULAR ABSCESS

10. Buzz Words on Impression Reports Subperiosteal abscess Buccal dehiscence Fluid collection/Rim enhancing along buccal cortex

11. Contraindications No absolute contraindications May need to optimize patient with coagulopathies

12. Equipment #15 blade Suction source and tubing Hemostat Suture and ¼’’ penrose drain (optional) Tongue Blade Gauze Light source, overhead, or headlamp

13. Patient Preparation Explain r/b/a and obtain appropriate consent Provide adequate anesthesia Prep and drape the patient (does not have to be completely sterile)

14. Simple Intraoral Incision and Drainage Simple stab incision approx. 1cm-2cm in length down to bone. Insert a closed, curved hemostat into the incision to break up any loculations. Remember to scrape and stay on bone. Express and suction any remaining purulence Silk tie penrose drain (optional) Copious irrigation with NS Apply gauze pressure to obtain hemostasis

15. Simple Intraoral Incision and Drainage Wound cultures are not indicated unless the patient is immunocompromised or the infection is recurrent Be wary of mental nerve which lies just between bicuspids Make sure to stay on bone to avoid excessive bleeding or damage to adjacent structures If cellulitis is present; you may not obtain frank puss

16. Complications Minor postoperative pain, swelling, bleeding, drainage, and possibly bruising can be expected following the incision and drainage of a dental abscess.  Significant postprocedural bleeding can be controlled with pressure, a vasoconstricting local anesthetic agent, or topical Gelfoam .