2022 Volume 115 Issue 2 Pages 127-131
We report the case of a patient who was diagnosed as having a subcutaneous abscess after bruise-related buccal trauma, in the absence of evidence of fracture/wound/foreign body insertion on imaging. Herein, we present the case with a review of the literature.
The patient was a 3-year-old girl. After sustaining a fall-related left buccal bruise/injury, she developed left buccal swelling. Examination revealed marked left buccal swelling/edema, suggestive of left buccal cellulitis. However, no fracture of the left buccal bone was found on computed tomography (CT) of the facial bones. Furthermore, ultrasonography early after the initial consultation did not demonstrate abscess formation. The patient was admitted on the same day, and started on intravenous antimicrobial drug therapy. Follow-up was continued.
Transient reduction of the left buccal swelling was observed by 8 days after the injury, but the swelling subsequently increased in size. The site of the swelling was punctured for drainage 12 days after injury. Culture of the abscess fluid grew Streptococcus pyogenes. Puncture/drainage and antimicrobial drug administration were continued, which resulted in improvement of the physical symptoms and inflammatory response, and the patient was discharged.
Although there was no fracture line on the facial bone CT, the results of abscess culture were consistent with those of pharyngeal culture on admission; therefore, it was considered that a hematogenous infection from sinusitis caused by a microfracture, which was not clearly visualized on imaging, or a buccal bone vascular perforation may have led to the formation of a subcutaneous hematoma, and subsequently, to the abscess formation.
We report the case of a child who developed a buccal subcutaneous abscess after sustaining trauma. This care emphasized the need for extra attention close monitoring to prevent progressive enlargement and exacerbation of the hematoma and formation of an abscess, as in the present case, after facial trauma. In this patient, fine needle aspiration was performed after consultation with a plastic surgeon. Considering importance of maintain an esthetic facial appearance in all age groups, including children, cooperation with other departments is needed during the treatment of such patients.
