Abscesses of the head and neck region stand for one of the basic problems for general practitioners’ everyday practice (1). They can develop as single-space or multiple-space abscess (2). The most frequently involved are the submandibular, buccal, submental or canine spaces (2, 3). The crucial step is the right diagnosis enabling to assess the risk of purulent changes, which would further determine the proper treatment protocol: ambulatory treatment or the need of specialist surgical procedure (4, 5). Below we would like to present a case report of our teenage patient, who developed left-sided buccal abscess that required surgical intervention due to the emphasized local complaints and the evidence of an abscess in the ultrasound. Unfortunately, we could not identify one clear factor underlying for the observed inflammatory process.

Seventeen-year-old patient was admitted to our department during emergency service due to increasing swelling of the left cheek for the last few days with associated pain, without fever. She had no problems with breathing, had slightly deformed voice and suffered from problems with eating and drinking (mostly because of the pain discomfort). Physical examination on admission showed emphasized redness and edema of the left cheek, on palpation an inflammatory infiltration sized about 4 x 3 cm with fluid-filled area on pressing in its lower parts, localized superficially, was remarkable. Apart from that pronounced acnes on the face was noticeable. In laryngological examination of the mouth mucous was unremarkable, there were no carious lesions, no dental or gingival abnormalities. According to our patient she is regularly checked up by her dentist, has had no interventions recently. Her hair was dyed in various colors, she had a lot of earrings in her auricles, but denied self-piercing or other interventions in her cheek. She did not suffer from any chronic illnesses. She admitted to drinking alcohol occasionally on social meetings and smoking cigarettes, but denied drug in-take. One day before admission she was prescribed ambulatorily Amoxicillin/Clavulanic acid 1.0 g, one pill two times daily, but due to worsening of the complaints she referred to the emergency unit.

On ultrasound on admission (fig. 1, 2) an oval lesion sized 15 x 19 x 13 mm with hypoechoic, heterogenous, thick contents reflecting abscess characteristics within edematous soft tissues with marked vessels and enhanced blood-flow was described. The center of the lesion was localized superficially, about 5 mm beneath the skin surface. On laboratory tests WBC was normal, CRP was at the boundary of the norm (1.0 with the norm 0.0-1.0).

Continuation of the introduced ambulatorily Amoxicillin/Clavulanic acid in a does 1.2 g, 3 times daily, intravenously with additional Clindamycin 900 mg 3 times daily was planned. Moreover, our patient was qualified for the drainage of the abscess. The surgical intervention from the intraoral access was performed on the 2^nd day of hospitalizations in general anesthesia as soon as we got SARS-CoV-2 results. A large amount of thick pus was drained from the lesion and sent for microbiological examination. During procedure ultrasound navigation was not used. The puncture of the lesion, followed by a drainage were performed after palpation and fixation of the cheek in the position, in which the lesion was best marked. The abscess’s cavity and the mouth were rinsed generously with Octenidine dihydrochloride (Octenisept), and then 0.9% natrium saline. Regular rinsing of the mouth with the solution of Octenidine dihydrochloride (Octenisept) and 0.9% natrium saline in a ratio 1:1 three times daily together with mechanical broadening of the abscess cavity were continued on the ward. Pus combined with blood was obtained till the 3^rd day post-operatively during mechanical broadening when a serous content appeared and as a result it was decided to stop further interventions. With the course of treatment gradual relief of patient’s complaints and local improvement (diminished edema, inflammatory infiltration and blood flow resulting in reduced redness, no palpable fluid area) were observed. On the 7^th day of antibiotic therapy we received microbiological results, which revealed growth of aerobic bacteria Citrobacter freundii and Enterococcus faecalis, with no resistance for standard antibiotics and at the same time prone to applied treatment (tab. 1).