Surgery and Healing in the Developing World - Dartmouth-Hitchcock

35
362 Surgery and Healing in the Developing World
Figure 3. Head-down position to drain paratonsillar or pharyngeal abscesses in a child.
adults and older children is drainage under local anesthesia with the patient sitting.
For small children, Ketamine or general anesthesia may be required. If the abscess is
large, consider positioning the child with the head hanging upside-down over the
end of the operating table to prevent the child from inhaling pus (Fig. 3). The same
approach can be made for drainage of retropharyngeal abscesses. In all cases, Yankauer
suction must be ready to aspirate the pus.
Dental
Caries and periodontal abscesses are common in poor societies Teeth destroyed
by caries should be extracted unless a dentist is available who may be able to provide
a better solution. Periodontal abscesses can be drained by inserting a probe along the
tooth into the abscess. A persistent mandibular or mental sinuses should prompt
examination of the teeth. Usually there will be a severely carious tooth above the
sinus (Fig. 4A, B). When the tooth has been extracted, the sinus will close. Repeated
curretting of the sinus will not solve the problem until the tooth is extracted.
Parotitis
Acute bacterial parotitis presents as a hot, tender, painful mass in front of the ear.
Usually there is obstruction of the salivary duct and pus and redness may be seen at
the duct opening in the cheek adjacent to the second upper molar tooth. Penicillin,
A B
Figure 4. A) Chronic mandibular sinus; B) Carious tooth causing the mandibular sinus.