Management of submandibular abscess with limited resources

Though incidence of submandibular abscess is decreasing, from an anaesthesiologist point of view, it is invaluable to understand the disease process as the greatest impact is on the airway and failure of management can lead to catastrophic outcome. Successful management of submandibular abscess requires an accurate diagnosis, understanding the anatomy and spread of infection in the head and neck, airway control, appropriate antibiotic therapy and surgical drainage whenever needed. As an anaesthesiologist to be challenged with a submandibular abscess may not be infrequent particularly in a developing country like India, where dental and oropharyngeal hygiene can be of grave concern. The standardised approach of successful anaesthetic management of submandibular abscess usually involves an awake nasal intubation. But this may not be possible in some situations like an uncooperative patient, an acute emergency with limited resources where fibre optic bronchoscope is unavailable. We describe the successful management of one such case.