Abscess
This is generally an acute condition which, if treated appropriately, should quickly resolve if the pus is drained and the cause removed.
Dental abscess (simple, localised to gum)
Time-lines short term: responds within 24 hours.
Time-lines medium term: all signs of infection resolved within 7 days.
Time-lines long term: only applicable if the cause is not removed. If the cause is not dealt with the abscess will recur over a period of months and years, possibly forming a chronic draining sinus called an odontogenic sinus.
Cervicofacial abscess
Time-lines short term: after drainage the drain may have to remain for 2-3 days to ensure there is no recollection of pus. The source must be removed. There is usually a lot of limitation of mouth opening, stiffness of the surrounding skin and discomfort even though you are getting better. There may be more swelling even though the pus has gone. Despite more swelling you usually find the pain improves rapidly, if it doesn’t there is likely to be a recollection of pus or it is not all drained.
Time-lines medium term: it can take 2 weeks to start to feel more “normal” after an abscess like this and for the swelling to settle by about 90%. At this stage it is not unusual to still have quite limited mouth opening.
Time-lines long term: dependingon where the abscess was it can take weeks to months for normal mouth opening and jaw movement to occur. This is especially true with collections of pus underneath the large, powerful jaw closing muscles when it can take up to 6 months for full (normal for you) movement to happen.
Ludwig’s angina
Time-lines short term: this can be a life threatening condition and you may be in hospital for 7-10 days after drainage. Some people need the life supporting facilities of intensive care units and a breathing tube inserted through the nose for a few days. This is always preferred to a surgical opening into the airway as if that is needed the recovery time is much longer and the risks are higher.
Time-lines medium term: discharge after 7-10 days but conventional home routine and work will be unlikely for another 2 weeks. Normal chewing, speaking and swallowing are unlikely during this time and may take several more weeks to happen.
Time-lines long term: a month or so after discharge you should be feeling more “normal” and slowly your jaw and mouth function will return. The incision lines where the drains were inserted will scar less well than normal surgical incisions and may have to be “revised” – cut out and done again in a more conventional fashion. This isn’t done the first time around because the pus needs to freely drain through an open wound not one that has been neatly stitched together.
Necrotising fasciitis
Time-lines short term: this is another life-threatening condition and may need a similar length of time in hospital as Ludwig’s angina. The major issue here is that skin and underlying tissue usually has to be cut away because the infection destroys it. This is usually dressed with antiseptic dressings before a planned reconstruction.
Time-lines medium term: depending on the amount of skin and underlying tissue removed you may undergo a second operation while in hospital or go home for a series of weekly dressing changes until the infection is completely resolved and healthy underlying tissue has healed enough to accept a flap or graft.
Time-lines long term: the main issue here is a second operation. The timeline follows that for the healing of a flap or graft.