The spread of infection and the development of an abscess is the result of factors pertaining to host resistence and microbial influences. Host resistance is described by local defenses, cellular, and humoral immunity. Microbial factors are determined by virulence and number of invading organisms. The pathogenic potential changes as the aforementioned factors change. When the microbial factors dominate and the host’s resistance cannot contain the invading microorganisms, the spread of infection will prevail. The inflammatory reaction is then initiated and phagocytic cells and lymphocytes are called into action. Polymorphonuclear leukocytes eliminate bacteria through phagocytosis. Inflammatory mediators such as histamine, serotonin, leukotrienes, prostaglandins, and lysosomal components are released. Mononuclear phagocytes, monocytes, and macrophages will next become involved in the inflammatory process and are involved in removing resistant microorganisms and dead cellular debris. When pus accumulates and swelling ensues as the result of a dental infection, surgical drainage is indicated. Intra and extraoral techniques for the draining of maxillofacial abscesses should be a part of the armamentarium of the modern dentist.
Guidelines for Successful Incision and drainage
1. Use block injection techniques to obtain profound anesthesia.
2. Incisions are made in healthy tissue and not in the center of the height of flocculence.
3. Stab incisions to bone or in soft tissues are never indicated.
4. Make all incisions through skin or mucosa into connective tissue, then use a blunt hemostat to open and explore any compartments within the abscess pocket.
5. Obtain dependent drainage whenever possible.
6. The same drain must not remain in place for more than 72 hours.
7. Suture drains in place.
8. Leave a drain in place only as long as it is productive.
9. Irrigate the drain daily with normal saline or antibiotic solution.
10. Patients with a drain in place should be examined daily.
11. Most infections will not drain through an extraction site or a root canal preparation.
12. When performing extraoral incisions the inferior border of the mandible must be palpated with the curved hemostat as a starting point for orientation to then begin to explore additional spaces.
13. All loculations of the abscess must be explored.
14. When the source of the infection has been removed, drainage obtained, and antibiotic therapy instituted, the infection should begin to resolve within 3 to 4 days. After this time period reevaluation of your therapy must be considered.
Instrument Tray Setup for Incision and Drainage
1. Aspirating syringe for local anesthesia
2. # 15 blade and blade holder
3. Curved and/or straight mosquito hemostat
4. Gauze director
5. Needle holder, suture material, and scissors
6. One-quarter inch Penrose drain
7. Culture bottle and/or a syringe to aspirate pus to send for culture
8. Gauze dressing, bandage, tape, etc.
9. Skin scrub preparation, alcohol sponge, disinfectant
