31. Perimandibular abscess. Topographic and surgical anatomy, etiology, clinical features, diagnosis, differential diagnosis, treatment

Question 1

Topographic anatomy of a perimandibular abscess

Answer 1

Inner and outer sections of the inferior part of the body of the mandible

Question 2

Common causes (etiology) of perimandibular abscesses

Answer 2

• Periodontitis=> mandibular molars
• Fracture=> mandible
• Infected Cyst
• Impacted Tooth=>Infection

Question 3

Clinical stages of an odontogenic perimandibular abscess

Answer 3

1. Endosteal Phase=> Untreated periapical abscess penetrates the bone
2. Subperiosteal Phase=>Abscess passes through bone and accumulates below the periosteum=>
   * severe pain => pressure on periosteum
3. Submucosal Phase=> abscess accumulates below the mucosa=>
   * Pain relief due to decreased pressure
4. Phlegmon Phase=>spreads to other spaces

Question 4

Potential locations for pus accumulation in perimandibular abscess

Answer 4

• Vestibulum=> Least dangerous location
• Sulcus Mandibularis Lingualis=>Along inner mandible
• Lower Margin of the Mandible=> common
• Deep in the Submandibular Space=> more serious and harder-to-treat

Question 5

Common clinical features of a perimandibular abscess

Answer 5

• Swelling=>Submandibular and/or cervical lymphadenopathy
• Erythema and Heat
• Tenderness=>over abscess
• Pain=> Severe pain in subperiosteal phase
• Trismus=> muscle involvement.

Question 6

Treatment approach for perimandibular abscess

Answer 6

• Incision and Drainage
• Antibiotics
• Endodontic Treatment

Important Structures to Avoid: Care must be taken to avoid the lingual nerve, facial artery and vein, and the submandibular salivary glands during surgery

Question 7

Complications of a perimandibular abscess

Answer 7

• Spread of Infection=> other anatomical spaces
• Airway Obstruction
  Systemic Infections=> sepsis