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    Abses Submental

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    SilviaSuminto
    This document presents a case study of a 3-year-old female patient presenting with swelling below the chin. On examination, the patient was found to have swelling, tenderness, and fluctuation in the submental region, with fever and elevated white blood cell count. Based on the physical findings and laboratory results, a working diagnosis of submental abscess was made. The patient was treated with intravenous antibiotics, drainage, and curettage of the abscess. The document then reviews the relevant anatomy, etiology, risk factors, pathophysiology, clinical manifestations, diagnostic workup, treatment approaches, complications, and prognosis of submental abscess.

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    Abses Submental

    Uploaded by

    SilviaSuminto
    77 views11 pages
    This document presents a case study of a 3-year-old female patient presenting with swelling below the chin. On examination, the patient was found to have swelling, tenderness, and fluctuation in the submental region, with fever and elevated white blood cell count. Based on the physical findings and laboratory results, a working diagnosis of submental abscess was made. The patient was treated with intravenous antibiotics, drainage, and curettage of the abscess. The document then reviews the relevant anatomy, etiology, risk factors, pathophysiology, clinical manifestations, diagnostic workup, treatment approaches, complications, and prognosis of submental abscess.

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    Abses submental

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    This document presents a case study of a 3-year-old female patient presenting with swelling below the chin. On examination, the patient was found to have swelling, tenderness, and fluctuation in the submental region, with fever and elevated white blood cell count. Based on the physical findings and laboratory results, a working diagnosis of submental abscess was made. The patient was treated with intravenous antibiotics, drainage, and curettage of the abscess. The document then reviews the relevant anatomy, etiology, risk factors, pathophysiology, clinical manifestations, diagnostic workup, treatment approaches, complications, and prognosis of submental abscess.

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    77 views11 pages

    Abses Submental

    Uploaded by

    SilviaSuminto
    This document presents a case study of a 3-year-old female patient presenting with swelling below the chin. On examination, the patient was found to have swelling, tenderness, and fluctuation in the submental region, with fever and elevated white blood cell count. Based on the physical findings and laboratory results, a working diagnosis of submental abscess was made. The patient was treated with intravenous antibiotics, drainage, and curettage of the abscess. The document then reviews the relevant anatomy, etiology, risk factors, pathophysiology, clinical manifestations, diagnostic workup, treatment approaches, complications, and prognosis of submental abscess.

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    of 11

    CASE PRESENTATION

    SUBMENTAL ABSCESS

    Supervisor:
    dr. H. Oscar Djauhari, Sp. THT-KL

    Penyusun:
    Ranetta Putri

    2012.061.011

    Gabriella Sabrina

    2012.061.012

    Cintyadewi W

    2012.061.013

    Ilmu Kesehatan Telinga Hidung Tenggorok Kepala Leher


    Fakultas Kedokteran Unika Atma Jaya Jakarta
    RSUD Syamsudin, S.H., Sukabumi
    Period 03 June 2013 06 July 2013

    BAB I
    CASE DISCUSSION
    A. Patients Identity
    Name: Nadira
    Gender: female
    Age: 3 years old
    Occupation: B. Complaint
    Chief complaint: swelling below the chin
    Additional complaint: fever, tenderness, expand continuously
    History of Present Illness
    The patient came with swelling below the chin as chief complain. The
    swelling started 6 days ago. Initial swelling arised after high fever the day before. The
    swelling expanded continuously. The swelling appears red with fluctuation. History of
    sorethroat, cold, dental infection or any trauma was denied. History of dysphagia was
    denied. The patient can eat and drink normally.
    C. Physical Examination
    i. General examination
    General Condition

    : appear ill

    Awareness

    : compos mentis

    Pulse rate

    : 100x/minute

    Respiration rate

    : 27x/minute

    Temperature

    : 37,4oC

    Lymph node

    swelling
    tenderness,

    ii. ENT examination


    Auris dextra et sinistra
    -

    Auricle

    External auditory canal:

    : normal

    in

    submental

    region,

    fluctuation (+)

    redness,

    heat,

    Skin

    : hiperemic (-/-), oedema (-/-)

    Secretion

    : (-/-)

    Serumen

    : (-/-)

    Mass

    : (-/-)

    Laceration : (-/-)
    -

    Timpanic membrane: intact/intact, light reflex (+/+)

    Retroauricular : normal

    Cavum nasii
    - Septum deviation: - Mucous: hiperemic (-/-) , oedema (-/-)
    - Concha: (-/-)
    - Secretion: (-/-)
    - Mass : (-/-)
    - Laceration : (-/-)
    Nasopharynx and oropharynx
    - Uvula
    : middle
    - Retropharynx
    : hiperemic (-), granule (-)
    - Arcus pharynx
    : symmetrical, hiperemic (-/-)
    Maxillofacial
    : Symmetrical
    Neck

    : mass (+), lymphadenopathy (+)

    D. Work Ups
    1. Laboratory Examination:

    Hb
    Leucocyte
    Thrombocyte
    Bleeding time
    Clotting time

    : 10,4 g/dL
    : 9.600/L
    : 213.000/ L
    : 2
    : 6

    2. Radiography
    Anteroposterior
    Lateral
    E. Working Diagnosis: Submental Abscess
    F. Treatment:

    Paracetamol syr 1x1 cth


    Cefotaxime 0,5 gr IV 2x1
    Metronidazole 500 mg IV 4x1/2
    Drainage and curetase

    BAB II
    LITERATURE STUDY
    2.1 BACKGROUND
    The use of antibiotics has decreased the mortality from deep neck space
    infections, but infections of the deep spaces of the neck still have potential for serious
    and even life threatening complications. Surgery is still considered the main
    treatment. However, early infections can be treated with antibiotics. Delay in
    diagnosis, or a missed diagnosis can lead to serious complication and even death.
    Even in the antibiotic era, a mortality rate 40% has been reported.
    It is important to understand the biology of the disease, and understand the
    anatomic pathways for the spread of infection. The aim is to intervene aggressively,
    both medically and if indicated, surgically, prior to the onset of complications.
    2.2 ANATOMY
    Submandibular Space
    The submandibular space is separated superiorly from the sublingual space by
    the mylohyoid, hyoglossus, and styloglossus muscles medially and by the body of the
    mandible laterally. The lateral border is the overlying skin, superficial fascia,
    platysma muscle, and the superficial layer of the deep cervical fascia. Its inferior
    boundary is formed by the anterior and posterior bellies of the digastric muscle. The
    space communicates freely with the submental space anteriorly; and posteriorly with
    the pharyngeal space. This space contains the submaxillary gland, Wharton's duct, the
    lingual and hypoglossal nerves, the facial artery, and some lymph nodes and fat.
    Submental Space
    The submental space is a triangular space in the midline beneath the mandible,
    with its lateral margins, the anterior bellies of the digastric muscle. The inferior border
    of the space is the mylohyoid muscles, and the superior border is the overlying skin,
    superficial fascia, and platysma muscle. It contains a few scattered lymph nodes and
    fibrofatty tissue.

    2.4 ETIOLOGY
    Most abscess are polymicrobial, such as Staphylococcus aureus, Clostridium
    clostridiforme, dan Prevotella buccae. In infants younger than 9 months of age,
    Staphylococcus aureus is the predominant organism.
    2.5 RISK FACTOR

    Penetrating trauma

    Trauma from surgical instrumentation

    Retained foreign bodies

    Congenital deformities : branchial cleft cysts and fistulae

    2.6 PATHOPHYSIOLOGY
    Most of submental space infection source is by drainage from the mandibular
    incisor teeth as well as their gingival. Because the mylohyoid line obliquely crosses
    the second molar tooth, dental infections originating anterior to this tooth involve the
    sublingual space and submental space while those behind it involve the
    submandibular space. Entry into the space also can occur from an infection in the
    adjacent sublingual and submandibular space.
    2.7 CLINICAL MANIFESTATIONS
    Patients with submental abcess may show presentations such as fever, pain
    and swelling in the submental, and may show fluctuation. Depending on the
    progression of disease, some patients may also have presentations like sore throat,
    dysphagia, and odynophagia to more serious problems such as airway compromise,
    septic shock, and mediastinitis. In one series, the duration of symptoms ranged from
    12 hours to 28 days (average is 5 days).

    2.8 WORK-UPS
    1. Serial WBC counts: WBC is commonly elevated in patients with abscess.
    2. Radiography:
    a. Plain lateral and anteroposterior radiographs are useful in the diagnosis
    of neck space infections. The presence of radio-opaque foreign bodies,

    tracheal deviation, subcutaneous air, fluid within the soft tissues,


    lymphadenopathy, widening of the mediastinum as in mediastinitis,
    pulmonary edema, and pneumomediastinum may be indicators of
    abscess formation.
    b. Contrast-enhanced CT scans: more sensitive in picking up deep neck
    space infections. It clearly depicts the spaces involved and the
    superior-inferior extension of the process. CT characteristics of an
    abscess include low attenuation (low Hounsfield units), contrast
    enhancement of the abscess wall, tissue edema surrounding the
    abscess, and a cystic or multiloculated appearance.
    3. Blood culture: Performed during incision and drainage. Once the results of
    cultures are obtained, targeted antibiotic therapy is recommended.
    2.9 MANAGEMENTS
    1. High dose antibiotics for both aerobic and non-aerobic bacteria parenterally.
    Most often the infections are polymicrobial (gram positive, gram negative,
    aerobic, and anaerobic) and -lactamase producing organisms must be
    anticipated. Therefore, therapy with ampicillin-sulbactam or clindamycin with
    a third-generation cephalosporin such as cefotaxime is begun while culture
    results are pending. Once the results of cultures are obtained, targeted
    antibiotic therapy is recommended.
    2. Abscess evacuation:

    Evacuation of abscess is peformed with needle

    aspiration under local anasthesia for localized abscess or surgical incision for
    patients with large or deep abcess. Incision itself is is done in the most
    fluctuated area of the abcess or at the level of os hyoid.
    Patients with submandibular or other deep neck abscess need to be hospitalized
    until 1-2 days after symptoms or infection signs lessen.

    2.10 COMPLICATIONS
    Complications that may occur following submental abscess include:
    1. Sepsis
    2. Aspiration (due to spontaneous rupture)
    3. Osteomyelitis of the mandible
    4. Pericarditis
    5. Mediastinitis
    6. Pulmonary edema
    7. Carotid artery erosion and hemorrhage
    Complications most often occur due to delay in diagnosis or delayed treatment
    when the infection spreads from one region to another. Host factors such as reduced
    immunity and systemic diseases such as diabetes also play a role and the medical
    condition of the patient must also be appropriately managed. Complications are the
    result of the anatomic proximity of important structures juxtaposed against the deep

    spaces of the neck. The carotid arteries, jugular veins, sympathetic chain, and cranial
    nerves IX through XII are all at risk.
    2.11 PROGNOSIS
    Deep neck space infections can be life-threatening, and once the diagnosis is
    suspected or made, it is best that the patient be treated on an inpatient basis. However,
    early diagnosis and adequate treatments can modify the presentation of course or the
    disease towards a better result and prevent complications.

    REFERENCES
    -

    Bailey BJ, et al. Head & Neck Surgery: Otolaryngology. 4th ed. Lippincot
    Williams & Wilkin;2006.

    - Soepardi EA et al, editor. Buku Ajar Ilmu Kesehatan Telinga Hidung Tenggorok
    Kepala & Leher. Ed ke-6. Jakarta: Balai Penerbit FKUI; 2008.
    - Ballenger JJ, et al. Ballengers Otolaryngology Head and Neck Surgery. 16thed.
    Spain: BC Decker;2003.

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