EARLY MANAGEMENT AND MODERN WOUND DRESSING

SELECTION FOR CANINE FOSSA ABSCESS: A CASE REPORT

Deny Rakhman*, Abel Tasman Yuza**, Melita Sylvana**

*Resident of Oral and Maxillofacial Surgery Department, Faculty of Dentistry

**Staff of Oral and Maxillofacial Surgery Department, Faculty of Dentistry
Universitas Padjadjaran, Bandung, Indonesia
Email: drg_deny_alfaridzie@yahoo.com

Abstract
Fossa canine is a small spasia between the superior levator muscle and the anguli oris levator
(Fragiskos, 2007: 220). This abscess is an extension of infection originating from the upper canines
or sometimes from premolars and incisors. In the clinical sense it is quite important because it is
associated with the cavernous sinus through facial veins, angular and ophthalmic (Pederson, 1996:
197). This condition requires prompt diagnosis, emergency treatment, and precise wound dressing
selection. The objective of this study is to describe early management and modern wound dressing
selection in canine fossa abscess case. A 36-years-old male came with swelling at his upper right
cheek and the right eye region. Patient was diagnosed with canine fossa abscess. Aggressive
necrotomy debridement was done to manage infection. Wound was treated by modern dressing
without requiring skin graft procedure. Patient did not have any complain and fully satisfied with
the treatment result. There are many kinds of wound dressing available that challenges operator to
choose an appropriate one to treat Canine fossa abscess. A correct dressing can decreases healing
time, provides cost-effective care, and improves patient quality of life. In conclusion, appropriate
modern wound dressing selection are very important to improve the clinical outcome and decrease
patient’s long term morbidity.

Key words: Canine fossa abscess, early management ,Modern wound dressing

INTRODUCTION

Odontogenous infections may develop from teeth damaged by caries, pulpal disease, acute
periodontitis1 or, in rare cases, trauma of the lower tooth. Owing to their anatomical and
topographic location at the roots, oral pathogens or inflammatory mediators can quickly infiltrate
adjacent sites (e.g. the trigonum submandibulare or the fossa canine).2 This can result in tissue
liquefaction and abscess formation. These can expand cranially, as in the case of canine fossa
abscess. Obstruction of the upper airways, necrotic fasciitis3, periorbital abscess4 and intracranial
abscess are familiar severe sequelae of ascending infections . Fossa canine is a small spasia
between the superior levator muscle and the anguli oris levator (Fragiskos, 2007: 220). Tooth
infection which often are derived from bacteria associated with abscess. Canina fossa abscess can
lead to the development of secondary and infection incisors and canines of the upper jaw and
maxillary sinusitis infection. The spread of infection to the fossa canina usually originates from
the maxillary canine or the upper premolar teeth, often seen above the bucci-nator muscle. This
swelling removes the nasolabial folds, the space near the lower eyelid, and therefore early
management is very important to avoid circular orbital infections. There is a risk of spread to the
cranial through the external angle of the vein that can lead to thrombosis.
 Aggressive necrotomy debridement was done to manage infection. The wound healing and
granulation may not occur or be delayed with abscesses. Post traumatic hemorrhage remains one
of the most mortal causes of early death with progressive seconder infections in wounds. Wound
was treated by modern dressing without requiring skin graft procedure. Modern wound dressing
have been developed to facilitate the function of the wound rather than just to cover it. These
dressings are focused to keep the wound from dehydration and promote healing. These dressings
act as a barrier against penetration of bacteria to the wound environment.

CASE REPORT

A 36 years old male patient came with swelling at his upper right cheek and the right eye
region. Approximately 5 days prior to admission, the patient complained of toothache at right
upper teeth, but he didn’t seek any treatment. About 3 days prior to admission, there was swelling
appeared at upper right cheek, but he didn’t seek any treatment. 2 days later, the swelling got
bigger and extended to around the right eye, then he was brought to private clinic at Cimahi area,
and was given 2 kind of medicines (Amoxicillin and Mefenamic acid), but there was no
improvement. About 3 hours prior to admission, the swelling got bigger and there was spontaneous
drainage from the mouth and under the right eye, and difficult to open the right eye. Then the
patient was brought to Private hospital at cimahi area again, but nothing was performed there. Then
he was referred to Hasan Sadikin Hospital Emergency Department for further treatment.

Patient felt pain on swallowing with stiffness in the neck. There were no sign of hoarseness,
hot potato voice, and altered voice. History of systemic disease was denied. Examination of vital
signs in emergency room showed patient’s blood pressure rate 120/80 mmHg, heart rate 86
times/minutes, body temperature 37,1 oC, respiratory rate 20 times/minutes, and SpO2 rate 99%
(free air). Extra oral examination revealed the presence of asymmetrical face, swelling at right
cheek extended to right eyelid, right infraorbita region with 4x4x2 cm in size, there was a
spontaneous drainage from the mouth and under the right eye region. The swelling is localized,
reddish colored, followed with febrile temperature and pain on palpation

Figure 1 Extra oral preoperative

Intra oral examination revealed generalized hyperemia of gingiva, gangrene of pulp teeth 12, 16,

37 and gangrene radices of teeth 17 and 28. There were plaques and calculus with mouth opening

was about 4 cm wide.

Figure 2 Intra oral preoperative

The laboratory findings showed white blood count 17.79 /mm3, Hemoglobin (13,5 g/dL),
Hematocrit (38,3 %) and other laboratory findings were within normal limit without any signs of
systemic disease. Some radiographic examinations were performed such as jaw x-ray, neck soft
tissue AP and lateral x-ray. From the chest x-ray, there was no sign of tuberculosis and
cardiomegaly. The neck soft tissue AP and lateral x-ray showed appearance of soft tissue
radiopaque density with radiolucency inside located in submandible and submental region with
the suspicion of abscess