30. Abscess and phlegmon of submandibular and submental lodges. Topographic and surgical anatomy, etiology, clinical features,

Question 1

Submandibular space contents

Answer 1

Submandibular salivary gland and lymph nodes

Question 2

Anatomical boundaries and contents of the submandibular space

Answer 2

• Lateral=>Inferior border of the body of the mandible
• Medial=>Anterior belly of the digastric muscle
• Posterior=> Stylohyoid ligament and the posterior belly of the digastric muscle
• Superior=> Mylohyoid and hyoglossus muscles
• Inferior=> Superficial layer of the deep cervical fascia

Question 3

Common causes of submandibular abscesses

Answer 3

• Dental Infections=>mandibular second and third molars=>
• Especially if apices lie beneath the attachment of mylohyoid muscle
• Spread from Adjacent Spaces=> sublingual or submental spaces

Question 4

Clinical presentation of a submandibular abscess

Answer 4

• Swelling=> submandibular area
• Induration and Redness
• Mandibular Angle=> Obliteration
• Pain and Trismus=> During palpation and moderate trismus =>involvement of the medial pterygoid muscle

Question 5

How submandibular abscess treated

Answer 5

• Incision for Drainage=> on the skin=>
• 1 cm beneath and parallel to the inferior border of the mandible
• Exploration and Drainage=> A hemostat is inserted into the cavity =>
• To explore the space and communicate with the infected areas
• Blunt dissection along the medial surface of the mandibular bone
• Drain Placement=> After drainage, rubber drain is placed to facilitate ongoing drainage

During incision- The course of the facial artery and vein, as well as the respective branch of the facial nerve, should be considered (the incision should be made posterior to these structures).

Question 6

Anatomical boundaries submental space

Answer 6

• Superior=>Mylohyoid muscle
• Lateral=> Anterior belly of the digastric muscle on both sides
• Inferior=>Superficial layer of the deep cervical fascia above the hyoid bone
• Superficial=> Platysma muscle and overlying skin

Question 7

Submental space contents

Answer 7

Anterior jugular vein and submental lymph nodes

Question 8

Common causes of submental abscesses

Answer 8

• Dental Infections:=> mandibular anterior teeth
• Spread from Adjacent Spaces=> mental, sublingual, or submandibular spaces

Question 9

Clinical presentation of a submental abscess

Answer 9

• Swelling=>Indurated and painful submental edema
• Spread=>as far as the hyoid bone

Question 10

How submental abscess treated

Answer 10

• Incision for Drainage=>
• on skin beneath the chin, in a horizontal direction and parallel to the anterior border of the chin
• Drainage=> same as other abscesses

Question 11

Potential complications of untreated submandibular and submental abscesses

Answer 11

• Spread of Infection= contiguous spaces, potentially leading to more severe infections
• => Ludwig’s angina
• Airway Obstruction
• Systemic Infections=>sepsis