DISEASE SUMMARY PAGE

Facial Abscesses (including Periapical Abscesses) in Rabbits

Facial abscess. Click here for full page view with caption Facial abscess. Click here for full page view with caption Facial abscess. Click here for full page view with caption Facial abscess surgery. Click here for full page view with caption Facial abscess recovering after surgery. Click here for full page view with caption After ear amputation and lateral wall resection. Click here for full page view with caption

Summary Information
Diseases / List of Bacterial Diseases / Disease summary
Alternative Names See also:
Disease Agents
  • Spikes of cheek teeth penetrating the inside of the cheek. (J15.19.w3)
  • Penetrating foreign bodies. (B600.8.w8, B601.18.w18)
  • Bite wounds from predators. (B600.8.w8)
  • Fight wounds from other rabbits. (B600.8.w8)
  • A study published in 2002 found that the bacteria involved in rabbit tooth-associated mandibular and maxillary abscesses included anaerobic gram-negative rods (particularly Fusobacterium nucleatum), anaerobic gram-positive spore-forming rods (especially Actinomyces spp.) and aerobic cocci, particularly from the Streptococcus milleri group. Pasteurella multocida was not isolated in this study. (J93.40.w5)
Infectious Agent(s)

In one study (J93.40.w5):

  • Achromobacter (Alcaligenes) xylosoxidans subsp. xylosoxidans
  • Actinomyces israelii
  • Arcanobacterium haemolyticum
  • Bacillus sp.
  • Desulfomonas pigra
  • Eubacterium brachy
  • Fusobacterium nucleatum
  • Neisseria weaverii
  • Prevotella heparinolytica
  • Prevotella spp.
  • Peptostreptococcus micros
  • Staphylococcus saccharolyticus
  • Staphylococcus warnerii
  • Streptococcus intermedius
  • Streptococcus anginosus
  • Streptococcus milleri group
Non-infectious Agent(s) --
Physical Agent(s) --
General Description
  • Facial swelling. (B602.34.w34b)
  • The rabbit may not appear to be in pain, may be eating well and not depressed. (B600.8.w8)
  • Exopthalmos may be noted with retrobulbar abscesses. (B600.8.w8)
Diagnosis
  • Physical examination
    • Abscesses associated with penetrating wounds (including penetrating foreign bodies) from outside (i.e. through the skin) are usually superficial, encapsulated and mobile. (B600.8.w8)
    • Abscesses from fight wounds or from tooth spikes may be deeper, with evident subcutaneous swelling. (B600.8.w8)
    • Soft tissue abscesses are associated with sharp tooth spikes penetrating the inside of the cheek in the area of the abscess. (B601.18.w18, J15.19.w3)
    • Commonly, facial abscesses are periapical in origin. (B600.8.w8)
      • Periapical abscesses associated with the mandibular teeth may be palpated as slow-growing subcutaneous swellings, mobile or attached to deeper tissue, along the mandible. (B600.8.w8)
      • Periapical abscesses of maxillary teeth may not be palpable until the surrounding bone has been distorted, as they invade the nasal passages or periorbital space. (B600.8.w8)
  • Radiography:
    • With periapical infections and osteomyelitis there may be proliferative osteolytic bone; this is not a feature of a soft tissue abscess. (J15.19.w3)

Differential diagnoses

  • Neoplasia. (B600.8.w8)
Further Information
Treatment
  • Periapical abscesses involve the presence of osteomyelitis and necrotic tissue (soft tissue, tooth and/or bone) as well as the presence of a thick capsule; these features make purely medical treatment ineffective. (J29.17.w3)

Remove the offending object, if still present (including tooth spikes causing soft tissue abscesses or teeth associated with periapical abscesses). (B600.8.w, B601.18.w18)

  • If associated with a tooth or teeth, the tooth (or teeth) have to be removed. (B601.18.w18)
  • If a penetrating foreign body has reached an alveolus, removal of the affected tooth is also required. (B600.8.w8)
Local and systemic antibiotic treatment. (B600.8.w8, B601.18.w18)
  • Systemic antibiotics: e.g. cephalexin, enrofloxacin. (B600.8.w8, J513.3.w1, J513.6.w4)
  • Choice of antibiotic should be based on bacterial culture and sensitivity testing. (B601.18.w18) This is particularly important for fast-growing abscesses since unusual organisms may be involved. (B600.8.w8)
    • A study published in 2002 found that the bacteria involved in rabbit tooth-associated mandibular and maxillary abscesses included anaerobic gram-negative rods (particularly Fusobacterium nucleatum), anaerobic gram-positive spore-forming rods (especially Actinomyces spp.) and aerobic cocci, particularly from the Streptococcus milleri group. Pasteurella multocida was not isolated. All of the isolates tested were susceptible to chloramphenicol and to clindamycin, and most (96%) to penicillin, ceftriaxone and cefazolin, with 86% susceptible to azithromycin and tetracycline. However only 54% were susceptible to metronidazole and ciprofloxacin and only 7% to trimethoprim-sulfamethoxole. Clinically, 97 of 104 such abscesses (97%) had not recurred following treatment involving AIPMMA (antibiotic-impregnated polymethyl methacrolate) beads of clindamycin and/or ceftiofur. (J93.40.w5)
PLUS
  • Remove the abscess: complete removal if possible, otherwise (e.g. with bone involvement) use thorough debridement followed by appropriate treatment to remove infection and allow healing. (B600.8.w8, B601.18.w18, J513.2.w1, J513.6.w4)
  • For superficial abscesses: 
    • Excision followed by systemic antibiotics. (B600.8.w8)
  • For deeper subcutaneous abscesses (e.g. following fight wounds or tooth spurs):
    • Excision. (B600.8.w8) OR
    • Lancing and expression of pus (B600.8.w8) followed by aggressive/thorough debridement and
      • Placing of antibiotic-impregnated beads (B600.8.w8, B601.18.w18) OR
      • Marsupialisation and topical treatment with e.g. honey, gentamicin drops. (B600.8.w8)
  • For large, fast growing abscesses with associated skin necrosis:
    • Use systemic antibiotics with good penetration (e.g. cephalexin, enrofloxacin). (B600.8.w8)
    • Provide analgesia (NSAID such as carprofen or meloxicam, and an opioid e.g. buprenorphine). (B600.8.w8)
    • Surgical drainage as above. (B600.8.w8)
  • For mandibular abscessation with bone/tooth involvement:
    • Removal of the whole abscess, including the abscess capsule, together with removal of any teeth involved and curettage of infected/necrotic bone is required for successful treatment. (J513.6.w4)
    • These abscesses are usually associated with acquired dental disease (Acquired Molar Abnormalities in Rabbits) but occasionally may be due to impacted food or splinters entering the periodontal space. (B600.8.w8)
    • Description of surgical procedure:
      • Place the anaesthetised rabbit in dorsal or lateral recumbency (depending on the site of the abscess). (J513.6.w4)
      • Drape over the area - a transparent adhesive drape allows visibility of the head position. (J513.6.w4)
      • Incise the skin over the swelling, taking care not to cut through into the abscess.(J513.6.w4)
      • Carefully dissect through subcutaneous tissue and muscle to free the abscess capsule. (J513.6.w4)
        • A Lone Star retractor system allows optimal access to the site. (J513.6.w4)
      • Use a No. 11 scalpel blade or the tip of a Crossley's luxator to incise between the capsule and mandibular bone. (J513.6.w4)
      • Elevate the lateral wall of the abscess and incise it. (J513.6.w4)
      • Remove the thick pus with cotton-tipped applicators. (J513.6.w4)
      • Debride the bony cavity with a bone curette, removing all pus and infected bone down to bleeding bone. (J513.6.w4)
      • Debride infected/necrotic bone using a small rongeur or needle holders. (J513.6.w4)
      • Remove any teeth or tooth fragments - use a Crossley's luxator or needle to free the tooth from any attachment to bone. (J513.6.w4) See: Extraction of Cheek Teeth in Rabbits - Extraoral approach
      • Debride the bony cavity again. (J513.6.w4)
      • Flush with saline and dilute povidone iodine. (J513.6.w4)
      • EITHER Suture the soft tissues of the cavity to the skin (marsupialization) using 3-0 nonabsorbable suture material. (B601.18.w18, J513.6.w4)
        • Fill the bone cavity with povidone iodine/antibiotic ointment at the end of the surgery. (J513.6.w4)
        • Marsupialization allows postoperative flushing and drainage. (B601.18.w18, J513.6.w4)
        • The cavity can heal by second intention, reducing the risk of recurrent infection. (B601.18.w18, J513.6.w4)
        • Flush the site often with saline and povidone iodine, and apply antibiotic ointment. (J513.6.w4)
      • OR implant antibiotic-impregnated methylmethacrylate (PMMA) beads into the cavity. (B600.8.w8, B601.18.w18)
        • Use several small beads rather than a few large beads, to improve local concentrations of antibiotic. (J513.2.w1)
        • Use as few sutures as possible to close the wound (particularly deeper in the wound), and use fine monofilament and small knots, to reduce the chance that suture material will act as a nidus for infection. (B600.8.w8)
        • Leave these for at least four weeks. (B600.8.w8)
        • The beads can be left in place permanently. (B600.8.w8, B601.18.w18)
      • Alternative treatments:
        • Calcium hydroxide paste made up by mixing dry calcium hydroxide powder with 2% lidocaine has been used for filling tooth-related facial abscess cavities (after debridement and removal of teeth), and left for one week (by which time it is hard and dry) before removal. This produces a pH of 12.0, which is bactericidal, and good results have been reported. (J432.12.w1, J513.1.w1)
          • However the high pH can also damage soft tissues of the animal, causing necrosis. (B600.8.w8, B602.34.w34b)
          • Current opinion is that this should not be used. (B602.34.w34b, V.w125)
        • A wound packing technique has been described for use where the size and anatomical location of the abscess makes complete removal of the abscess capsule difficult and risks damage to nerves and blood vessels.
          • After incision into the abscess, the purulent contents are removed using suitable instruments (e.g. sterile cotton-tipped applicators) and capsular margins are reduced. Thin strips of gauze cut from a sterile synthetic gauze square are moistened with an appropriate amount of antibiotic (penicillin or ampicillin if culture and sensitivity results are not yet available). The strips are carefully packed into the abscess cavity using forceps. Once the dead space of the cavity has been filled, the packing material is saturated with the remaining antibiotic solution (total amount is pre-calculated). The skin is closed in a simple interrupted pattern using 3-0 or 4-0 monofilament suture material. Post-operatively, a complementary systemic antibiotic is given, plus NSIAD (meloxicam, 0.3 mg/kg once daily). At intervals of seven days, packing is removed, the cavity inspected, and further packing introduced. If necessary the anitibiotic used is changed based on culture and sensitivity, and on clinical response. (J513.5.w1)
Supportive treatment:
  • Analgesia: NSAID such as carprofen or meloxicam, and an opioid e.g. buprenorphine. (B600.8.w8, J29.17.w3, J513.3.w1, J513.6.w4)
    • Melxoicam at doses as high as 0.7 mg/kg three times daily provides improved analgesia compared with the more conservative doses (e.g. 0.3 mg/kg once daily) seen in the literature. (V.w125)
  • Fluids as required. (J29.17.w3)
  • Supportive feeding as required. (J29.17.w3)

Note: facial abscesses that do not receive surgical treatment:

  • Many facial abscesses are slow growing. 
  • Antibiotic therapy should be continued long term. 
  • Many rabbits will live for several months in comfort even with a relatively large abscess. 

(B609.2.w2) 

Associated Techniques
Host taxa groups /species
Disease Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referees Molly Varga BVetMed DZooMed MRCVS (V.w125)

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