Neck abscesses (collections of pus) can be located in either a superficial (just under the skin) layer of the neck or deep in the neck.
Superficial neck abscesses are usually the result of an infection in a lymph node in the neck (lymphadenitis) turning into an abscess. The most common cause of these abscesses are Staphylococcus or Streptococcus bacteria. If the abscess will not resolve on antibiotics by mouth, the abscess may need to be drained.
Drainage of a superficial neck abscess is a relatively simple procedure. It is performed under general anesthesia using a “mask” to deliver the “sleepy air”. Local anesthetic (numbing medication) is injected into the area. The physician will then feel the lump caused by the abscess to find the area most full of pus. An incision (surgical cut) is then made to drain the pus and a drain is inserted through the skin to keep the fluid from collecting again.
The pus obtained is then cultured to determine the type of organism causing the infection. A specific antibiotic can then be used to treat the infection.
Complications of this procedure can include minor bleeding. Certain abscesses should not be drained because of fistula (connection to skin) formation. These types of abscesses are treated long term with special antibiotics instead.
The most important factor when draining any deep neck abscess is to make sure that the airway is not obstructed. Therefore, these procedures are always undertaken in a hospital setting where emergency airway management is available.
Deep neck abscesses can be drained through the mouth (orally) or through the neck (transcervically).
The oral (through the mouth) drainage procedure is used for peritonsillar space abscesses and for specific cases of retropharyngeal space abscesses. All other deep neck space abscesses are usually approached through a surgical cut in the neck.
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.
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.
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.
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.