Throat and Neck Abscesses

Oral Approach Of Neck Abscess Drainage

What is Involved with the Oral (through the mouth) Approach of Peritonsillar Abscess Drainage?

As with any deep abscess drainage, an adequate airway must first be secured. Most cases of peritonsillar abscesses are identified before the airway is obstructed; therefore, breathing tubes are usually not needed.
In younger children, the oral abscess drainage procedure is performed under general anesthesia in hospital setting.
In older children and adults, an anesthetic (numbing) spray is sprayed around the affected area in the back of the throat. This is usually done in the hospital, but in some less severe cases may be done in an office setting. A local anesthetic is then injected around the area that is to be drained. A needle is then placed in the bulging area in the back of the throat, and the pus contained in the abscess is drained out. Complete drainage may require placing the needle in more than one area of the bulge or using a scalpel (knife) to open the abscess. The material drained from the abscess is usually sent for bacterial culture to make sure the correct antibiotic will be used. This procedure usually lasts about 1/2 hour.

After this procedure, the patient usually feels much better and can swallow more easily. Antibiotics are usually given for another three weeks.

Cases in which the peritonsillar abscess recurs may require, a tonsillectomy.

What Are the Complications of the Oral Drainage Technique?

Local bleeding at the surgical site is the most common complication. Although pus will sometimes continue to drain down the throat, this rarely results in any other problem except nausea. Because this abscess occurs near big blood vessels, your physician will take precautions not to puncture too deeply causing damage to the blood vessels.

Surgical Cut Through The Neck (Transcervical) Approach

What is Involved in the Transcervical Approach for Deep Neck Abscess Drainage?

The patient is placed under general anesthesia for this procedure. A surgical cut is made in the neck, and the abscess is located and drained. The drainage is then sent for a bacterial culture. A drain is usually left in the neck so the abscess does not return. The length of this procedure varies with the size and complexity of the location of the deep neck abscess.
Usually, the patient will continue on IV (in the vein) antibiotics in the hospital to ensure complete resolution of the infection. Once the drain is removed and the infection is resolving, the patient may be sent home from the hospital on antibiotics by mouth.

What Are the Complications of This Procedure?

The most common complications are bleeding, reaccumulation of the abscess and damage to nerves. The most common nerve at risk is the marginal mandibular nerve which moves the muscles around the mouth. Special care is taken to protect this nerve during these procedures. Injury to other vital structures in the neck is also a possibility, although uncommon with an experienced surgeon.