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6 Abscess, Oral

Acute and Chronic Treatment • Care must be taken during surgical manipula- • Medical treatment is needed to stabilize the
• Correction of fluid and electrolyte deficits tion of the affected lung to avoid exudate patient. Ideally, antimicrobial choice is based
VetBooks.ir ○ Oxygen supplementation (p. 1146) Recommended Monitoring • Surgical removal of the affected lobe is
on culture and susceptibility testing as early
entrance into other airways and the endo-
• Respiratory system support if needed
tracheal tube.
in the course of disease as possible.
○ Thoracocentesis (p. 1164) may be required if
associated with pneumothorax or pyothorax.
to remove the source of chronic infection.
• Antimicrobial therapy Survey thoracic radiographs required to obtain definitive diagnosis and
○ Empirical therapy active against aerobic • At completion of antibiotic therapy
and anaerobic bacteria: second-generation • Periodically (q 3 months initially) Technician Tips
cephalosporin (e.g., cefoxitin 22 mg/kg Knowledge of and experience in working with
IV q 6h), amoxicillin (± clavulanic acid) PROGNOSIS & OUTCOME thoracostomy tubes is important in the post-
10-20 mg/kg PO q 12h operative management of patients who have
○ Definitive antimicrobial therapy should Depends on the cause undergone a thoracotomy.
be based on results of aerobic and anaero- • If associated with sepsis and severe systemic
bic bacterial culture and sensitivity testing illness: guarded to poor SUGGESTED READING
(minimum treatment duration: 4 weeks). • If an otherwise stable patient: fair, provided Monnet E: Lungs. In Johnston SA, et al, editors:
• Thoracotomy for removal of affected lung complete excision is possible Veterinary surgery: small animal, ed 2, St. Louis,
lobe and treatment of pyothorax, if present • Non-neoplastic abscessation is associated 2017, Elsevier, pp 1983-1999.
(p. 857) with a better prognosis than neoplastic
abscess. AUTHOR: MaryAnn G. Radlinsky, DVM, MS, DACVS
Possible Complications EDITOR: Elizabeth A. Swanson, DVM, MS, DACVS
Depends on cause PEARLS & CONSIDERATIONS
• Chronic pneumonia
• Abscesses in other lung lobes Comments
• Failure to resolve associated pyothorax (e.g., • Important to determine the underlying cause
failure to entirely remove inciting cause, such for optimal treatment.
as foreign body that migrated outside the
removed lung lobe or resected tissue)

Abscess, Oral Client Education
Sheet

BASIC INFORMATION • Pain on opening of the mouth examination with cytologic analysis of fine-
• Pawing at the mouth needle aspirates strengthens the diagnosis.
Definition
Abscess that develops in the soft tissues cau- PHYSICAL EXAM FINDINGS Differential Diagnosis
dodorsal to the pharynx and dorsal or lateral • Fever ± • Inflammation/cellulitis
to the esophagus • Depression or lethargy • Lymphadenopathy
• Ptyalism • Neoplasia (lymphoma, metastatic disease,
Epidemiology • Halitosis carotid body tumor)
SPECIES, AGE, SEX • Dyspnea • Pharyngeal salivary mucocele
• Most common in young dogs and cats • Painful on manipulation of head and neck
• No sex predisposition or when opening the mouth Initial Database
• Punctures or granulomatous lesions on oral • Complete blood count: leukocytosis, left
RISK FACTORS mucosa shift possible
• Stick chewing • Palpable swelling caudal to the mandible • Cervical radiographs
• Playing fetch with sticks • Draining tract in the cranial cervical ○ Soft tissue mass in the pharyngeal region
• Feeding chicken bones region ○ Ventral deviation of the larynx or esophagus
• Fish hook or sewing needle ingestion ○ Radiopaque foreign body
• Bite wound Etiology and Pathophysiology • Thoracic radiographs
• Penetrating trauma contaminates the retro- ○ Check for thoracic involvement
CONTAGION AND ZOONOSIS pharyngeal area with bacteria. • Cervical ultrasound
If from a bite wound of unknown origin, • Rapid healing of the pharyngeal tissue leads ○ Identify the foreign body or abscess.
transmission of rabies from a wild animal should to a walled-off abscess that develops quickly. ○ Obtain ultrasound-guided aspirate for
be considered. • May be presence of foreign body cytology.
• Bacterial culture and susceptibility
Clinical Presentation ○ Aerobic and anaerobic cultures (Actino-
HISTORY, CHIEF COMPLAINT DIAGNOSIS myces spp., Nocardia spp.)
• History of risk factors (see above) is common. Diagnostic Overview
• Nonspecific complaints: lethargy, inappetence Diagnosis is based on patient signalment, Advanced or Confirmatory Testing
• Dysphagia history, and physical examination. Confirma- • Contrast radiology: if a draining tract is
• Ptyalism tion requires demonstration that the soft tissue present, to identify foreign body and extent
• Reluctance to move head and neck mass in the neck is an abscess. Ultrasound of abscess

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