Definition — Buccal Space Subcutaneous Abscess with Cellulitis: A localized collection of pus within the subcutaneous compartment of the buccal space associated with surrounding soft-tissue cellulitis. Commonly odontogenic in origin, it presents with focal fluctuance or a focal hypoechoic collection on imaging with adjacent inflammatory edema. Prompt identification and drainage are important to prevent spread to deep facial spaces and airway compromise.
Ultrasound Report- Line: Shows diffuse hyperechoic thickening of subcutaneous fat with linear hypoechoic streaks (“cobblestoning”), increased echogenicity of fascial planes, and ill-defined hypoechoic fluid pockets compatible withabsces measuring approximately 20 × 22 × 18 mm. Color Doppler shows hyperemia. In abscesses, focal complex fluid collections with irregular walls and peripheral vascularity are seen.
Conclusion: Sonographic appearances consistent with buccal space subcutaneous abscess with surrounding cellulitis.
Recommendation: obtain contrast CT/MRI if deeper space extension suspected; observe airway and follow up in 24–48 hours.
Sonographic Features — Buccal Space Subcutaneous Abscess with Cellulitis:
- Abscess cavity: Well-defined hypoechoic/anechoic collection, often with internal echoes/debris and posterior acoustic enhancement.
- Wall: Peripheral thickened wall may be seen; rim vascularity on color Doppler.
- Surrounding cellulitis: Ill-defined hyperechoic fat with hypoechoic streaks and soft-tissue edema extending into the buccal fat pad.
- Fascial plane: Loss or blurring of normal fascial plane delineation between buccal fat pad and adjacent soft tissues.
- Vascularity: Peripheral/juxta-lesional hyperemia; increased flow in adjacent inflamed tissues on color Doppler.
- Deep extension: Lack of clear sonographic involvement of deeper facial spaces should not exclude extension — CT/MRI if clinically suspected.
Ultrasound Examination:
High-frequency linear probe (7–12 MHz) used with graded compression and multiple orthogonal scans over the buccal region. Color and power Doppler applied to assess vascularity and rim hyperemia. Measurements of collection (max dimensions) and depth noted.
- Max dimensions of collection: -- × -- mm (measure and replace).
- Depth from skin surface: -- mm.
- Relationship to oral cavity / teeth: suggest odontogenic source if contiguous with periapical region.
Causes / Etiology — Buccal Space Abscess:
- Odontogenic infection (periapical / periodontal origin) — most common.
- Penetrating trauma, insect bite, or infected skin lesion.
- Spread from adjacent infected spaces (submandibular, canine space) or surgical site infection.
- Immunosuppression or poorly controlled diabetes increasing risk of aggressive infection.
Symptoms / Clinical Features — Buccal Space Abscess with Cellulitis:
- Focal cheek swelling with localized tenderness and erythema.
- Fluctuance or palpable mass when abscess superficial.
- Fever, malaise, trismus if adjacent muscles involved.
- Possible odynophagia, dysphagia or airway symptoms if extension occurs.
Diagnostic Strategy — Buccal Space Abscess:
- Ultrasound: First-line for superficial collections — identifies size, loculation, internal echoes and peripheral vascularity; useful for guided aspiration.
- Contrast CT / MRI: Recommended to evaluate deep-space extension, involvement of masticator or parapharyngeal spaces, and assessment prior to surgery if clinically indicated.
- Microbiology: Aspirate for Gram stain and culture to guide antibiotic therapy.
- Differential diagnosis: Hematoma, infected cyst, neoplasm, lymphadenitis.
Management Recommendations:
• Urgent ENT / Maxillofacial / Dental consultation for source control and definitive drainage.
• Perform ultrasound-guided needle aspiration or incision & drainage as appropriate; send pus for Gram stain, aerobic & anaerobic culture and sensitivity.
• Start empiric antibiotics targeting oral flora (example regimens: IV amoxicillin-clavulanate or IV clindamycin if penicillin allergy) — tailor to local antibiogram and culture results.
• Provide analgesia, hydration, and optimize glycemic control in diabetics.
• Obtain contrast CT/MRI if there is clinical suspicion of deep-space extension, trismus, systemic toxicity, or failure to improve after drainage.
• Monitor airway; escalate care immediately for dysphagia, dyspnea, drooling, or voice change.
• Follow-up clinical review and repeat ultrasound within 24–48 hours after intervention or sooner if worsening.
Prognosis:
With timely drainage and appropriate antibiotics most superficial buccal space abscesses resolve without sequelae. Delayed or inadequate treatment may result in spread to deeper fascial spaces, systemic sepsis, or airway compromise.
Declaration:
I, R. K. Mouj, hereby declare that the material presented in this document titled "Buccal Space — Subcutaneous Abscess with Cellulitis: Definition, Sonographic Features, Case Management and Recommendations" has been prepared and compiled by me for educational and reporting purposes. Clinical correlation and appropriate specialist referral are advised.
Ethics / Patient Data Statement: Any patient images, case material, or ultrasound examples included here are for academic use only, anonymised, and used with ethical consideration.
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