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Abscess, Periapical (Tooth Root) 7

• Contrast CT or MRI: to identify foreign ○ Open drainage decreases likelihood of • Evaluate the surgical site in 10-14 days for
body and extent of lesion • Bacterial culture and susceptibility • Remove feeding tube once the pharynx has
formation of secondary abscess pockets.
wound healing.
VetBooks.ir TREATMENT ○ Use broad-spectrum antibiotics (e.g., healed. Diseases and Disorders
amoxicillin-clavulanic acid) until definitive
Treatment Overview
To resolve abscess and prevent recurrence, it culture results are obtained. Presence of PROGNOSIS & OUTCOME
Actinomyces spp. and/or Nocardia spp.
is necessary to explore, debride, and lavage necessitates antibiotic therapy for 2-3 Good if the foreign body is removed and
the abscess cavity; remove all foreign mate- months. adequate surgical drainage is provided
rial; provide postoperative drainage; allow
the pharyngeal wound to heal; and provide Chronic Treatment PEARLS & CONSIDERATIONS
appropriate antibiotic therapy and nutritional • Open wound management
support. ○ Appropriate bandaging is difficult in this Comments
area of the body. Primary closure of the wound should not be
Acute General Treatment ○ May require the use of tie-over bandages performed without providing drainage; allow
• Oropharyngeal exam under general anesthesia or vacuum-assisted closure therapy drain site to heal by second intention.
○ Identify the puncture site. • Percutaneous endoscopic gastrostomy tube
○ Identify alternative causes of retropharyn- or esophagostomy tube (pp. 1107 and 1109) Technician Tips
geal swelling (e.g., pharyngeal salivary ○ Indicated to bypass the oropharynx for Familiarity with closed-suction drain manage-
mucocele, tonsillar tumor). healing purposes and to provide medica- ment and bandaging techniques, including
• Endoscopic examination of the penetration tion and nutritional feeding tie-over bandages, is imperative for postopera-
site, if possible, to identify and remove any tive care.
foreign body Possible Complications
• Surgical exploration, debridement, and lavage • Recurrence of the abscess or reformation of Client Education
of the abscess a draining tract Avoid letting dogs chew or play with sticks
○ Foreign body may no longer be present. ○ Failure to remove a foreign body that could lead to penetration of the pharyngeal
○ May be difficult to remove the entire ○ Primary closure of abscess can lead to region.
abscess because of close proximity to vital dehiscence
structures in the head and neck • Extension of the abscess into the thoracic SUGGESTED READING
• Postoperative drainage cavity (pyothorax) and/or mediastinum Doran IP, et al: Acute oropharyngeal and esophageal
○ Closed-suction drain if entire abscess stick injury in forty-one dogs. Vet Surg 37:781-785,
excised. Allow abscess to drain and heal Recommended Monitoring 2008.
by second intention if unable to excise • Patient should be rechecked for bandage EDITOR: Elizabeth A. Swanson, DVM, MS, DACVS
entire abscess. changes. AUTHOR: Otto I. Lanz, DVM, DACVS

Abscess, Periapical (Tooth Root) Client Education
Sheet

BASIC INFORMATION Clinical Presentation with or without draining tracts); regional
lymphadenitis; fever
Definition DISEASE FORMS/SUBTYPES • Chronic periapical abscess: generally presents
Suppurative process of the periapical region of • Acute with no clinical signs (essentially a mild,
a tooth, which is a relatively common disorder • Chronic (more common) well-circumscribed area of suppuration).
of dogs and cats • Acute abscesses may over time become • Others (appearing variably in acute or
chronic; exacerbated chronic abscesses may chronic abscesses)
Synonyms take on features of acute abscesses. ○ Fractures and/or discolored tooth crowns
Periradicular abscess, tooth root abscess ○ Severe periodontal disease
HISTORY, CHIEF COMPLAINT ○ Draining tracts (often at mucogingival
Epidemiology • Visible swelling due to the physical presence junction intraorally or at skin covering
SPECIES, AGE, SEX of the abscess the face and jaws extraorally)
No species, age, or sex predisposition • Owner notices discolored or fractured tooth.
• With acute abscess, owner may notice Etiology and Pathophysiology
RISK FACTORS anorexia or a reluctance to eat. • The primary cause is dental trauma, resulting
• Dental trauma (infective, mechanical, in irreversible pulpitis and pulp necrosis.
thermal, chemical) PHYSICAL EXAM FINDINGS • If untreated, the inflammatory reaction
• Endodontic and periapical disease • Fever, regional lymphadenopathy, maxillo- spreads to involve the periapical region.
• Periodontal disease facial swelling, intraoral or extraoral draining • A number of different tissue reactions
tracts are possible. (granuloma, cyst, abscess) may occur around
ASSOCIATED DISORDERS • Acute periapical abscess: affected tooth is the apex of the involved tooth.
Tooth fractures (p. 980), tooth displace- very painful and slightly extruded from its • Periapical lesions do not represent distinct
ment injuries, and periodontal disease alveolar socket; localized swelling or cellulitis entities. In most cases, there is a subtle trans-
(p. 776) may be present (e.g., maxillofacial swelling formation from one type of lesion to another.

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