29. Abscess of the sublingual area. Topographic and surgical anatomy, etiology, clinics, diagnosis, differential diagnosis, treatment

Question 1

Sublingual abscesses and where are they located

Answer 1

• collections of pus => form in the sublingual spaces=>
• Above the mylohyoid muscle on either side of the midline on the floor of the mouth
• Contents=>
• Submandibular duct (Wharton’s duct), sublingual gland
• Sublingual and lingual nerves
• Terminal branches of the lingual artery, and part of the submandibular gland

Question 2

Sublingual abscesses borders

Answer 2

• Superior Boundary=>Mucosa of the floor of the mouth
• Inferior Boundary=> Mylohyoid muscle
• Anterior and Lateral Boundaries=> Inner surface of the body of the mandible
• Medial Boundary=>Lingual septum
• Posterior Boundary=>Hyoid bone

Question 3

Common etiological factors for sublingual abscesses

Answer 3

• Dental Infections: =>mandibular anterior teeth, premolars, and first molars
• Spread from Contiguous Spaces=>Infections submandibular, submental, and lateral pharyngeal spaces

Question 4

Clinical features of a sublingual abscess

Answer 4

• Swelling=> mucosa of the floor of the mouth=>
• Elevation of the tongue towards the palate and laterally
• Mandibular Lingual Sulcus=> Obliteration
• Mucosa=> bluish tinge
• Speech and Tongue Movement:=> difficult and painful due to edema

Question 5

How sublingual abscess diagnosed

Answer 5

• Diagnosis is primarily clinical
• CT scans=>confirm the extent of the abscess and involvement of adjacent spaces

Question 6

Differential Diagnosis of sublingual abscess

Answer 6

• Ranula=>A mucous cyst in the floor of the mouth
• Ludwig’s Angina=>A more extensive and severe cellulitis of the submandibular space that can spread to the sublingual space
• Sialadenitis=>Inflammation of the salivary glands
• Tumors: Benign or malignant tumors in the floor of the mouth or adjacent structures

Question 7

Treatment approach for sublingual abscess

Answer 7

Incision and Drainage

Question 8

Complications that can arise from untreated sublingual abscesses

Answer 8

• Spread of Infection=> submandibular, submental, and lateral pharyngeal spaces=>
• Severe infections like Ludwig’s angina
• Airway Obstruction
• Systemic Infections=> sepsis