By Davan 
Incision and drainage (I&D) of a buccal space infection is a surgical procedure to treat an abscess located between the buccinator muscle and the overlying skin of the cheek. It’s important to understand the anatomy and maintain sterile technique. This is typically performed by oral and maxillofacial surgeons or trained physicians.
Here’s a step-by-step overview of the procedure:
1. Preoperative Preparation
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Clinical assessment: Confirm buccal space involvement via clinical signs (swelling of the cheek, pain, erythema) and possibly imaging (CT scan or ultrasound).
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Medical optimization: Address underlying conditions (e.g., diabetes).
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Informed consent: Discuss risks like nerve injury, scarring, recurrence, or fistula formation.
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Antibiotics: Start empiric IV antibiotics targeting oral flora (e.g., ampicillin-sulbactam, or clindamycin if allergic).
2. Anesthesia
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Local anesthesia: Lidocaine with epinephrine is infiltrated in the area.
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Sedation or general anesthesia may be needed for uncooperative or pediatric patients.
3. Incision Technique
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Intraoral approach (preferred if accessible):
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Make a 1.5–2 cm incision in the mucosa, typically in the maxillary vestibule near the molars, avoiding the parotid (Stensen’s) duct.
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Blunt dissection with a hemostat to reach and break up the abscess cavity.
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Extraoral approach (if intraoral access is not feasible):
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Make a 2–3 cm incision about 1.5 cm below and lateral to the oral commissure, parallel to natural skin creases (cosmetic consideration).
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Blunt dissection through subcutaneous tissue to reach the abscess cavity, taking care to avoid the facial nerve branches and parotid duct.
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4. Drainage and Irrigation
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Express purulent material; culture the pus.
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Irrigate the cavity thoroughly with sterile saline.
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Break up loculations using a hemostat.
5. Drain Placement
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Place a Penrose drain or corrugated drain to allow continuous drainage.
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Secure the drain with a suture.
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For intraoral incisions, passive drainage may be sufficient depending on the cavity.
6. Postoperative Care
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Continue antibiotics.
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Warm compresses to the area.
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Drain care and regular follow-up.
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Remove the drain in 2–5 days when drainage subsides and infection resolves.
Important Considerations
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Avoid vital structures (facial artery, vein, nerve).
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Differentiate buccal space from deeper infections (e.g., masticator or parapharyngeal).
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Consider hospitalization for systemic signs or deep space involvement.
ChatGPT said:
Certainly! Here’s a detailed, step-by-step guide to performing an incision and drainage (I&D) of a buccal space infection, incorporating best practices and anatomical considerations:
🦷 Indications for I&D
Buccal space infections often result from odontogenic sources, such as periapical abscesses or periodontal infections. Clinical signs include:
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Unilateral cheek swelling
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Fluctuant mass in the buccal sulcus
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Pain and erythema
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Difficulty chewing or swallowing
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Trismus (in severe cases)
🧰 Preoperative Preparation
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Clinical assessment: Confirm the diagnosis through history and physical examination.
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Imaging: Obtain a panoramic radiograph or CT scan to assess the extent of the infection.
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Antibiotics: Initiate broad-spectrum antibiotics, such as amoxicillin-clavulanate or clindamycin, if allergic to penicillin.
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Informed consent: Discuss the procedure, potential risks, and benefits with the patient.
🛠️ Surgical Technique
1. Anesthesia
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Local anesthesia: Administer 2% lidocaine with 1:100,000 epinephrine to the proposed incision site.
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Sedation: Consider conscious sedation or general anesthesia for pediatric or anxious patients.
2. Incision
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Intraoral approach (preferred):
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Identify the point of maximum fluctuance in the buccal sulcus.
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Make a 1.5–2 cm incision using a #15 scalpel blade.
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Incise through the mucosa and submucosa, ensuring the incision is directed toward the underlying bone.
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Avoid entering the parotid duct or facial nerve branches.
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Extraoral approach (if intraoral access is inadequate):
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Make a 2–3 cm incision below the lower border of the mandible, following natural skin creases.
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Dissect through subcutaneous tissue to reach the buccal space.
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Be cautious of the facial nerve and mental nerve during dissection.
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3. Drainage
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Gently express purulent material from the abscess cavity.
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Insert a curved hemostat into the cavity and open it to break up loculations.
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Continue to drain until the cavity is clear of pus.
4. Irrigation
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Thoroughly irrigate the cavity with sterile saline to remove debris and residual pus.
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Use a large-bore syringe to gently flush the area.
5. Drain Placement
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Insert a Penrose drain or silastic drain into the abscess cavity to facilitate continuous drainage.
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Secure the drain with a nonabsorbable suture to healthy tissue.
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Avoid suturing the incision closed to allow for ongoing drainage.
🩹 Postoperative Care
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Antibiotics: Continue broad-spectrum antibiotics until clinical resolution.
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Drain care: Monitor the drain for patency and signs of infection.
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Follow-up: Schedule a follow-up appointment in 48–72 hours to assess healing and drain removal.
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Oral hygiene: Instruct the patient to rinse with 0.12% chlorhexidine mouthwash to reduce bacterial load.
⚠️ Potential Complications
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Nerve injury: Damage to the facial nerve or mental nerve can occur if anatomical landmarks are not carefully considered.
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Scarring: Intraoral incisions typically heal with minimal scarring; extraoral incisions may leave visible scars.
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Recurrence: Incomplete drainage or inadequate antibiotic therapy can lead to abscess recurrence.
📚 References
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“Treatment of Oro-facial Infections” – OMFSHO
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“Review of Spaces” – Pocket Dentistry
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“How To Drain a Tooth Abscess” – MSD Manual Professional Edition