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Abscesses represent a common reason for emergency room visits in dogs. They form as pockets of white blood cells (pus) that accumulate in response to a source of inflammation or infection. While abscesses can occur anywhere in the body, those affecting the soft tissues of the cervical (neck/lower jaw) region can pose several unique considerations in diagnosis and treatment.
The most noticeable sign of a cervical abscess is an often rapidly progressive, hot, and painful swelling in the neck region, which can rupture and result in drainage of fluid and pus from the site. In some cases, an obvious swelling may not be evident early on, and signs can be non-specific, including fever, lack of appetite, lethargy, restlessness or signs of discomfort, or sudden difficulty chewing or swallowing food. Noisy breathing or increased breathing effort may also be seen in severe cases where the swelling places additional pressure on the upper airways.
Abscesses form as pockets of white blood cells that congregate in response to inflammation or infection, most commonly resulting from the introduction of bacteria from a wound or foreign material, with bite wounds from other animals being one of the more common causes. In some cases, a piece of foreign material may still be present within the abscess and serve as a source for persistent or recurring infection.
In the Northeastern United States, cervical abscesses of unknown cause (idiopathic) have also been frequently documented. These idiopathic abscesses occur with the highest frequency in young, large-breed dogs and are most often seen in the fall, with September being the highest month of occurrence. While a definitive cause of these idiopathic abscesses has not been identified, they typically do not involve any external injuries or draining tracts and are theorized to be related to exposure to a currently unknown organic/plant material in the environment. Stick chewing or retrieval have been noted in the history of multiple dogs seen for idiopathic cervical abscess and are well documented as causes of trauma to the mouth and oropharynx.
Abscesses are not the only cause of swelling within the neck region. Certain types of cancerous processes, cysts, cellulitis/generalized tissue inflammation, lymph node enlargement, and mucoceles associated with the salivary glands may result in similar signs, making further evaluation and diagnostics essential to initiate the appropriate treatment. Abscesses can also form as the result of other underlying causes, such as foreign material (i.e., stick fragments or migrating grass awns) trapped within the site that can subsequently predispose to a secondary infection.
After an initial physical exam and history, additional diagnostics, such as baseline bloodwork to assess systemic levels of inflammation and organ function, along with a culture of material collected from the abscess site are often performed. Culture allows for the assessment of bacterial growth and antibiotic susceptibility, helping to guide the most effective selection of antibiotics during treatment. Diagnostic imaging is likewise recommended (often a CT scan and/or an ultrasound of the region) to further evaluate for underlying causes of the abscess and evaluate its extent within deeper structures of the neck. Cytology, or microscopic evaluation of material from the abscess, is also occasionally used to confirm the presence of white blood cells within the swelling. These diagnostics serve both to confirm diagnosis of an abscess and rule out other potential underlying causes.
Treatment of cervical abscesses involves draining or removing of any accumulated pus, identifying and addressing the underlying cause of the abscess (if present), and administering antibiotics. Removal of pus is accomplished through a surgical procedure done under heavy sedation or anesthesia and involves creating an incision into the abscess site. Removal of any identifiable foreign material and/or debridement of any chronic or unhealthy tissue in the region may be required. In many cases, a surgical drain is placed following cleaning/flushing of the abscess. These drains usually remain in place for 3–4 days and help facilitate the removal of residual accumulations of pus and bacteria, before being removed and allowing the site to heal. Antibiotics and medications to help reduce inflammation and control pain are the mainstays of medical management. In most uncomplicated abscess cases, we generally expect the site and the skin incision to heal in approximately 14 days.
Prognosis for cervical abscesses is generally good, with most patients making a full recovery following treatment. However, complications during recovery can occur, including development of antibiotic resistant and chronic infections at the site, resulting in abscess recurrence.
During treatment, monitoring that the site of an abscess is healing appropriately is crucial to ensure that further intervention is not necessary. This includes monitoring skin coloration, amount and character of any discharge, swelling, and the pet’s comfort. Dogs are generally sent home with an Elizabethan collar (e-collar) to prevent licking or scratching at the site, as these actions can delay healing or introduce additional bacteria. It is important to keep the e-collar in place until otherwise directed. Activity restriction is also recommended to avoid placing further stress on the abscess site as it heals. Pets with drains placed are generally expected to have small amounts of often red-tinged liquid discharge collecting from the drain for a few days after the procedure. Any discoloration of the skin, progressive discharge, further swelling, or general health concerns (such as lethargy, vomiting, diarrhea, or breathing changes) warrant prompt veterinary re-evaluation. If the pet is healing well at home, a recheck with their primary care veterinarian is generally recommended in around two weeks to ensure that the abscess site has completely and appropriately healed.
