Hilton’s method of drainage of an odontogenic abscess.. Buccal space Subcutaneous
Incision and drainage helps:
1-To get rid of toxic purulent material.
2-To decompress the oedematous tissues.
3-To allow better perfusion of blood,containing antibiotic and defensive elements.
4-To increase oxygenation of the infected area.
Oral & Maxillofacial Surgery, Tishreen University , Lattakia –Syria
Dr.Osama Makkia – Ompero 2014
Depending upon the site of abscess, incisions are made along the line of blood vessels and nerves and not across it. Where possible natural skin crease is selected in a dependent area. Most often the point where it fluctuates the most may be utilised. The length of the incision will depend upon the width and depth of the abscess. Generally, incision is made through most of the width of the abscess.
An opening is made into the abscess using a sinus forceps or a closed blunt hemostat and when the abscess is entered open the jaws of the sinus forceps or hemostat allowing the purulent material to escape (Hilton’s method). For an abscess of larger size, the index finger is inserted through the opening into the abscess cavity and pus is evacuated carefully palpating for deep pockets if any. Make sure that the finger does not open normal tissue space. Once all the purulent material is evacuated the cavity may be irrigated with normal saline using a bulb syringe. At this point the cavity could be packed with saline gauze part of which hangs out of the wound and also a corrugated rubber drain may be utilised for deeper pockets. Initial dressings are best managed by packing with saline gauze, Gamji pads and bandages or adhesive tapes as necessary. Abscesses are preferably dressed at least once a day and as often as necessary when it gets soaked with purulent drainages with each dressing further saline irrigation may be carried out particularly if the pockets are deep. Local application of antibiotics or use of betadine or chlorhexidine in the cavity does not seem to help particularly where abscesses have been adequately drained and dressed with saline gauze. Dressings can be facilitated particularly in the extremities utilising warm saline soaks in clean bowls. Elevation of the extremities involved, above the level of the heart adds to the comfort of the patient and helps in early healing.
It is always desirable to get a culture and sensitivity of the purulent material drained and while awaiting the final report, antibiotic is started. At times a gram stain may indicate the nature of the organisms and help in the selection of antibiotics.