Submental Space Research Articles

Defining the Shape of the Mylohyoid Muscle: A Morphometric Imaging Study.

Implantable hypoglossal nerve stimulation (HNS) therapy is an evolving therapeutic alternative for patients with refractory obstructive sleep apnea (OSA). The muscular anatomy of this region has implications for surgical access through this zone as well as positioning and anchoring of hardware in this area. The purpose of this study was to radiologically describe the topography of the mylohyoid muscle and adjacent structures across a wide age spectrum. We retrospectively evaluated computed tomography scans of the neck in 102 patients who were imaged for reasons unrelated to the floor of mouth or submental space. Patients with prior surgery or pathology in the area of interest were excluded. Fourteen relevant muscle measurements were made on a midline sagittal image and a coronal image positioned at the midpoint between the hyoid bone and the mandible. We included 49 men and 53 women with an average age of 44 years (range 19-70). The average mylohyoid length was 42 mm; the average distance between the anterior digastric bellies was 17 mm. The average angle of the central mylohyoid was 174° in the sagittal plane and 164° in the coronal plane. Several measurements were significantly correlated with patient age, including the angle measurements and the distance between the digastric muscles. Aberrant digastric anatomy was common. The mylohyoid muscle has multiple radiologically distinct segments with predictable curvatures. An understanding of submental muscular anatomy, along with its variability between patients, may be beneficial to the development of bilateral implantable neurostimulation technology for the treatment of refractory OSA. N/A Laryngoscope, 134:2970-2975, 2024.

Multispace Maxillofacial Space Infections Involving Orbit: Report of a Rare Case.

Peri-apical infection is a prevalent form of odontogenic infection, typically following the path of least resistance through cancellous bone towards the cortical plate. This infection begins as cellulitis and may progress to an abscess, sometimes involving various anatomically potential spaces. While frontal space infection is a rare complication of odontogenic infection spread, it can occur in conjunction with buccal space, sub-mental space, and orbital space involvement. In this report, we present the case of a 62-year-old man with a history of tooth pain and diabetes mellitus for the past decade. The patient exhibited symptoms of swelling, multiple draining sinuses, pain, proptosis, and fever. Prompt action was taken to drain the multiple abscesses, and the causative teeth were subsequently extracted. This case illustrates one of the severe complications associated with odontogenic infection, which has the potential to be life-threatening.

Ludwig's Angina, Clinical Challenge in Pediatrics. – A Case Report

BACKGROUND: Ludwig's angina is a rapidly progressing cellulitis that occurs in the sublingual, submandibular, and submental spaces, with a high mortality rate due to its potential to obstruct the airway. Its primary cause is odontogenic, with polymicrobial infection being the most common scenario. The occurrence of this condition is less common in the pediatric population, but children are more susceptible to life-threatening complications. THE CASE: A two-year-old male preschooler, with no significant medical history, presented with a clinical picture evolving over six days. This was characterized by recurrent fever spikes (up to a maximum of 38.7 degrees Celsius) and a growing, stony, painful mass in the right cervical region measuring 5cm x 5cm. The patient had not shown improvement despite self-medication with amoxicillin at home. Upon admission to a regional hospital, a fixed, painful, stony mass was found in the right submandibular region. Blood tests revealed leukocytosis with a left shift, positive acute-phase reactants, and a neck ultrasound indicating upper cervical adenitis without abscess formation. Antibiotic treatment was initiated for six days. However, the fever persisted, and there was an increase in the size of the lesion, along with the formation of an abscess and limited neck rotation. Consequently, on the 12th day of illness, the patient was referred to a tertiary-level hospital where a large, fixed, stony lesion was observed in neck regions II and III, with no exclusion of a neoplastic process. The patient also experienced difficulty swallowing, necessitating a liquid diet. It was decided to perform drainage under sedation and a biopsy, which revealed a stony mass in the right neck region II extending into the submental space and midline. There were severe inflammatory changes in the subcutaneous tissue, necrotic lymph nodes, but no abscess was found. Pathological examination showed inflammatory infiltrate, recent hemorrhage and vascular congestion, with the initial suspicion being an infectious process. Flow cytometry of the cervical lymph node showed no alterations in the lymphoid series but an elevation of neutrophils. However, due to the characteristics and location of the lesion, a consultation with pediatric hematologic-oncology was sought, and they considered a low likelihood of malignancy. A tuberculin test was requested and returned negative results. A culture of the lesion also yielded negative results. During hospitalization, the condition was considered Ludwig's angina, and the patient continued to show a progressive reduction in temperature and adenitis. On the 21st day, the patient exhibited a reduction of approximately 90% in the size of the lesion, leading to the discontinuation of antibiotic treatment and subsequent medical discharge. CONCLUSION: Ludwig's angina is an infection that primarily affects the floor of the mouth, progressing rapidly and potentially compromising the patient's airways, thus warranting a medical emergency status. It is uncommon and can be mistaken for neoplastic diseases or other infections, highlighting the need for knowledge about this condition and a high degree of suspicion due to its potentially life-threatening consequences. The goal is to establish appropriate management through a multidisciplinary team, given the complexity of its manifestations.

Microneedling radiofrequency enhances poly-L-lactic acid penetration that effectively improves facial skin laxity without lipolysis.

Microneedle fractional radiofrequency (MFR) is commonly used for skin laxity treatment, and poly-L-lactic acid (PLLA) can stimulate collagen synthesis in the body. However, the synergy of their combination for skin rejuvenation has not been proven. We aimed to evaluate the combined efficacy of PLLA and MRF and the potential mechanism underlying skin laxity. This prospective, randomized study included C57BL/6 mice treated with MFR, MFR+PLLA, and CO2 laser+PLLA and 32 patients who underwent split-face treatments with MFR or MFR+PLLA twice every 2 months. The global aesthetic improvement scale, Facial Laxity Rating scale of the whole face, ECCA grading scale of acne scars, and VISIA parameters on both treated sides were evaluated. Dermatological changes were measured by ultrasonography in the submental space, and adverse events were documented. PLLA was delivered by channels produced by MFR but not CO2 laser in the mice model. Thirty patients were treated with split-face MFRF+PLLA or MFRF, revealing an improvement in VISIA wrinkle percentile (0.020) compared with the age-matched controls (0.000). The thickness of the dermis increased, while the fat layer did not change significantly. No adverse effects were observed. PLLA can be delivered via microchannels produced by MFR. PLLA enhances the efficacy of MFR for skin laxity without lipolysis.

Ultrasound-guided seldinger technique-assisted submental intubation for panfacial trauma-walking off the beaten path.

After introduction of ultrasound, there is paradigm shift towards under vision performance of procedures in anaesthesia. Blind puncture and dissection of submental space may lead to vascular injury and injury to salivary glands. We describe the ultrasound guided Seldinger technique assisted submental intubation for panfacial trauma. Modified ultrasound guided Seldinger technique for submental intubation in 10 patients, who were posted for open reduction and fixation of panfacial fractures. Total procedural time, peri-procedural complications such as bleeding, dislodgment of tube, desaturation and postoperative complications such as injury to sublingual glands/submandibular glands, hematoma, cheloid or hypertrophic scar formation or skin site infection were noted. The mean time to perform submental intubation was 8.9 ± 0.94 minutes (range, 8-11 minutes). Only one patient had minor bleeding during procedure which was stopped after local application of pressure. All patients had a clean scar with no formation of cheloid or hypertrophic scar in the postoperative follow up. Ultrasound assisted submental intubation increases safety of the procedure in patients presenting with maxilla-facial trauma.

Trends and Outcome of Aggressive Fascial Space Infections.

Background: Odontogenic infections are common and self-limiting in most cases; however, they can lead to severe consequences, considerable morbidity and can even be fatal despite modern medical therapy. Patients and Methods: This retrospective study included patients with severe deep fascial space infections treated in the Maxillofacial Surgery Unit, General Surgery Department, Faculty of Medicine, Sohag University, Sohag Governorate, Egypt, and the Department of Oral and Maxillofacial Surgery, King Fahd Specialist Hospital (tertiary referral center), Burayda City, Qassim Province, Saudi Arabia, from June 2017 to June 2022. Results: This study included 296 patients, 161 (54.4%) males, 135 (45.6%) females. The fifth decade of life was the most common vulnerable age group. Forty-three percent of patients had diabetes mellitus, 26.6% were hypertensive, and 13.3% were on long-term steroid therapy. In 83% of patients, the offending tooth was identified but in 17% of patients no dental cause was identified. The lower third molar tooth was most commonly involved. Sixty-nine (23.3%) patients had submandibular space infections. Fifty-three (17.9%) patients had canine space infections. Thirty (10.1%) patients had submasseteric space infection. Twenty-eight (9.5%) patients had submental space infections. Twenty-three (7.8%) patients had combined infection of the submasseteric, submandibular, and pterygomandibular spaces, whereas 19 (6.4%) patients presented with Ludwig's angina. Conclusions: Odontogenic infections are common. The submandibular space is the most commonly affected single space. These infections could lead to lethal complications in immunocompromised patients, especially patients with diabetes mellitus. These infections require urgent surgical intervention to decrease hospital stays and avoid potentially lethal complications.

Current scenario of suppurative head and neck infections in patients of tertiary care centre in COVID era

<p class="abstract"><strong>Background:</strong> In the COVID era, when self treatment and social media treatment gained popularity, diagnosis of suppurative infections was delayed and rampant misuse of antibiotics significantly increased. Hence this study is necessary to enlighten the current trend of organisms causing suppurative head and neck infections and their presentation.</p><p class="abstract"><strong>Methods: </strong>Prospective observational study in 110 patients with suppurative head and neck infections who came to Department of Otorhinolaryngology and Head And Neck Surgery of NSCB Medical College, Jabalpur within a period of 18 months ie from March 2020 to August 2021.After detailed clinical examination, under strict aseptic precautions, sample was collected and sent for investigations.</p><p class="abstract"><strong>Results: </strong>Of 110 patients, 75 were male and 35 were female, maximum in their fourth to fifth decade of life. Diabetes the most common risk factor. The commonest symptom of presentation was swelling, being maximum in submandibular area. Odontogenic the most common etiology. Submental and submandibular space infections presenting as Ludwig’s Angina is the commonest space infection. Prior antibiotic history before visit to our hospital seen in 61.8%, still only 22.8% were sterile.61.8% showed bacterial growth,10.9% fungal and 4.5% tubercular. Psuedomonas aeruginosa was most commonly isolated with site predilection to oral cavity followed by E. coli.</p><p class="abstract"><strong>Conclusions: </strong>Public education about head and neck infections, oral hygiene, non-communicable diseases should be implemented as step of primordial prevention. Culture specific antibiotic therapy for the correct amount of time should be mainstay of treatment. Prescription by a registered medical practitioner must be made mandatory for providing antibiotics to any layman to reduce the rampant overuse and misuse of antibiotics</p>

Management of Ludwig's Angina at a Tertiary Care Hospital in Western Region of India

IntroductionLudwig’s angina is cellulitis of submandibular space, submental space, and sublingual space. The main causative factors include dental infections (dental caries with atypical periodontitis, pericoronitis, and dental procedures). Other predisposing conditions include poor dental hygiene, dental caries, malnutrition, diabetes mellitus, AIDS, and various other immunocompromised states. It presents as an acute onset and spreads very rapidly causing bilateral diffuse neck swelling, edema of floor of mouth, pain, fever, trismus, foul-smelling pus discharge, difficulty in swallowing, airway edema, and tongue displacement creating a compromised airway with stridor. So it requires early diagnosis and aggressive management.Material and methodsClinical data of all patients with clinical diagnosis of Ludwig’s angina managed at the Department of Otorhinolaryngology-Head and Neck Surgery, Sir Takhatsinhji (T) General Hospital and Government Medical College, Bhavnagar, India, from 2015 to 2019 were analyzed retrospectively in this study.ResultOver the review period, 30 cases were diagnosed as Ludwig’s angina, out of which 12 (40%) were males and 18 (60%) were females; male to female ratio was 1:1.5. The age of the patients ranged from six months to 64 years, with a mean age of 38.86 years. Fever, neck swelling, and neck pain were present in all patients.In 16 patients, incision and drainage were done under general anesthesia while the rest five patients required only local anesthesia. In six patients (20%), for maintenance of airway, tracheostomy was required. The most common complication was necrotizing fasciitis and death followed by septicemia. Mortality was observed in three patients (10%) in this study.ConclusionDespite improved outcomes compare to pre-antibiotic era, Ludwig's angina still remains a potentially life-threatening disease in ENT at present. Dental caries, uncontrolled diabetes mellitus, and malnutrition are commonly associated conditions. With early diagnosis, close airway observation, aggressive intravenous antibiotic treatment, and timely surgical intervention, morbidity, and mortality can be reduced.

Fascial space infection patients reporting to department of oral and maxillofacial surgery at Dasmesh Institute of Research and Dental Sciences, Faridkot

This aim of this study is being conducted to assess the incidence of fascial space infection and its management in patients presenting to department of Oral and Maxillofacial Surgery at Dasmesh Institute of Research and Dental Sciences, Faridkot. This retrospective study was done the in the Department of Oral and Maxillofacial Surgery Dasmesh Institute of Research and Dental Sciences, Faridkot, India, from January 2015 to December 2020. Total 84 fascial space infection record of previous five year patients (reporting to Department of Oral and Maxillofacial Surgery was evaluated. Patients reported with fascial space infection with age group from 16-70 yrs and ASA I & I were included in this study. The age group most commonly involved was in the third and fourth decades of life. The mean age group was 33.55. Males (55.95%) were more commonly involved than females (44.05%). The most commonly involved space was Right submandibular space infection (17.86%) followed by left submandibular space infection 15.48, R buccal space infection (9.52%), Left buccal space infection (7.14%), Right infraorbital space infection (7.14%), Left pterygomandibular space infection (7.14%),Space infection wrt left submandibular space, submental space, left sublingual space(5.95%), Masticatory space infection with impending submandibular + submental cellulitis (5.95%).

A foreign body lodged in the sub-mental space through to the retro-pharyngeal area: a review of anatomical risks and surgical approaches

BackgroundForeign body inclusions are rare in head and neck. They are challenging in regard to anatomical risks and surgical approaches. This is the case of a particular foreign body with a curious trajectory, associated with a brief review of anatomical risks and surgical approaches.Case presentationThis is the case of a 25-year-old male who has been attacked with a sharp object, which caused an inclusion of a part of the foreign body in the sub-mental and pharyngeal areas.The clinical exam showed a painful bulging in the sub-mental area, with moderately hemorrhagic sputum and difficulty while swallowing. The intra-oral exam showed a foreign body that was located at the right side of the base of the tongue, and which goes backwards and outwards to penetrate retro-pharyngeal mucosa.The patients underwent an angio-CT scan, which showed a curious fine and sharp metallic object, without direct signs of lesions to the jugular vein or carotid artery or any collateral branches.The patient underwent extraction through cervical approach, with satisfying bleeding control. Intra-oral exploration showed a retro-pharyngeal lesion of 2 cm, without particular bleeding. The cervical lesion and retro-pharyngeal lesions were closed. The lesion at the base of the tongue was of 1 cm, palpable but not accessible to sutures, and a naso-pharyngeal tube was inserted.The patient presented very satisfying post-operative outcome, without any complications.ConclusionWhen dealing with foreign bodies of head and neck, physicians must be precocious and prepared for the risk of bleeding after extraction. Thorough radiological exploration is necessary as long as the patient is stable. Direct and indirect radiological signs allow the clinician to understand the nature and the trajectory of the object, as well as the damage to collateral structures.

Submandibular Gland Transfer for the Prevention of Radiation Induced Xerostomia in Head and Neck Cancer — Dosimetric Impact With Intensity Modulated Radiotherapy

Post-radiation xerostomia is an important toxicity of head and neck radiotherapy, contributing to decreased quality of life and other adverse effects. Submandibular gland (SMG) transfer prior to radiation previously demonstrated a statistically significant benefit in xerostomia reduction in the 2/3 dimensional treatment era. In the procedure, the SMG is transposed anteriorly to the submental space. In patients receiving radiation to the level II but not level IB neck, this displacement removes the SMG from the treatment portal, thereby preserving gland function. Herein we evaluate the dosimetric implications of SMG transfer on intensity modulated radiotherapy (IMRT) treatment plans.We conducted a retrospective review of oropharynx cancer patients who underwent SMG transfer surgery followed by curative IMRT at our institution. Pre-surgery computed tomography (CT) scans had previously been fused with the planning CT. Separate scans were fused to the planning CT for 5 patients who had not had previous fusions. Pre-surgery SMG glands were contoured. Dose to the pre-surgery SMG was assessed on the treated clinical plan (TCP). A new plan (NP) was then generated, optimizing based on the pre-surgery SMG. Dosimetry attempted to meet all standard institutional constraints and match the salivary gland mean doses of the TCPs. Mean salivary gland, oral cavity, and larynx doses were collected. We evaluated the differences in plan outcomes using t-tests.18 patients with median age 61.5 years (range 25-74) underwent SMG transfer between 2019 and 2021 (94.4% male and 94.4% received concurrent cisplatin). Mean SMG dose and mean total parotid and SMG gland (TPSG) dose post-transfer was 27.5 Gy and 26.1 Gy (standard deviation (SD) 6.9 and 3.3), respectively; pre-transfer SMG and TPSG mean dose was 40.4 Gy and 27.8 Gy (SD 9.4 and 3.5) and 29.6 Gy and 26.4 Gy (SD 7.7 and 3.9) in TCPs and NPs, respectively. Differences between pre- and post-transfer SMG and TPSG doses in TCPs were statistically significant, as were differences between pre-transfer SMG and TPSG doses in TCPs versus NPs (all P < 0.001). Differences between pre-transfer NP and post-transfer TCP doses were not statistically significant (P > 0.1). Mean oral cavity and larynx doses were 32.9 Gy and 31.4 Gy (SD 6.8 and 9.9) and 33.5 Gy and 30.8 Gy (SD 7.5 and 9.6) in TCPs and NPs, respectively (all P > 0.1).SMG mean dose was lower by ∼2 Gy in TCPs relative to the non-transferred SMG mean dose in reoptimized NPs, although this difference did not reach statistical significance. Inverse planning likely decreases the benefit of SMG transfer to reduce the risk of xerostomia. More investigation is needed to evaluate if patient subsets would benefit more than others based on tumor location (tongue base versus tonsil) and treatment modality (proton versus photon).

Angina ludovici-submandibular swelling

Ludwig's angina is firm, acute, toxic cellulitis of the submandibular and sublingual spaces bilaterally and of the submental space. As early as 1796, extraction of abscessed teeth was considered contraindicated because it might give rise to extensive inflammation and angina in a dangerous degree. Three fs became evident even before the first written description of the disease: it was to be feared, it rarely becomes fluctuant, and it was often fatal. A sensation of chocking and suffocation (angina) often was combined with the name of the author (Ludwig's) who fully described it in 1836. Here we report a case of Ludwig's angina in a 34-year-old female.

Imperforate submandibular duct in an infant

Video S1 Ultrasound of submental space using a high-frequency probe shows dilated left submandibular duct traceable into left submandibular gland. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Clinical features of odontogenic infection requiring extraoral drainage in elderly patients. A single‐institution retrospective study

AbstractElderly people are thought to be more vulnerable to microbial infections because of age‐related changes in the immune system and poorer nutritional status. Furthermore, comorbidities such as diabetes mellitus and medications can influence infection severity and response to treatment. To know more about the characteristics of odontogenic infections in the elderly patients, we compared the clinical characteristics between patients aged &lt;75 years (control group; n = 22) and those aged ≥75 years (elderly group; n = 9), who underwent extraoral surgical drainage for odontogenic infection at our hospital's Department of Oral and Maxillofacial Surgery from 2011 to 2016. The following features were more common in the elderly group than in the control group: hypertension, incisor as the causative tooth, submental space as the site of the abscess, periapical periodontitis as the initial inflammation, and Staphylococci as the isolated bacterium. The elderly group also had lower body mass index, serum albumin level and PNI than the control group, implying poorer nutritional status. There were no significant differences in the duration of hospitalization between the groups. Since comorbidities and malnutrition are still seen to be risk factors in the elderly, we should take care of them paying attention to not only to inflammatory markers, but also to nutrition markers and systemic conditions.

Frequency of Cervicofacial Necrotizing Fasciitis Secondary to Odontogenic Abscess

Introduction: One of the complications of odontogenic abscess is cervicofacial necrotizing fasciitis; which is infrequent in the cervicofacial region. This disease usually occurs in immunosuppressed patients. Treatment is broad spectrum antibiotics and surgery. Material and Method: A research study was conducted with the following characteristics: retrospective, descriptive, cross-sectional and observational, for a year, in the maxillofacial surgery service, of specialty hospital: “Dr. Antonio Fraga Mouret”, national medical center“ La Raza ” (IMSS), Mexico city; all patients (six) diagnosed with necrotizing cervicofacial fasciitis secondary to Odontogenic abscess, older than 18 years were included. The protocol consisted of taking a biopsy, antibiotic, culture with an antibiogram and surgical management. Data were collected to estimate the frequency of this pathology in the maxillofacial surgery service. Results: In one year, 6 patients with a diagnosis of necrotizing cervicofacial fasciitis secondary to odontogenic abscess were treated. No significant differences were found with respect to gender, the mean age was 69.16 years, (86; minimum 40). The mean number of affected aponeurotic spaces was 6.5 (maximum: 14; minimum: 2); the most affected side was the right. The most frequent aponeurotic spaces were: the facial (in turn, more were reported in the submandibular followed by submental and genian aponeurotic space) and one third the cervical. Surgical management was: cannulation and drainage of persistent abscess or purulent collection in four patients, surgical lavage was performed in all, 3 patients required more than 4 surgical washes. Debridement was performed in all patients. Discussion: The importance of this study is to show and report the frequency with which necrotizing cervicofacial fasciitis appears secondary to odontogenic abscess, to continue with the control and report in maxillofacial surgery, as well as improvements and proposals for a better management of patients who are diagnosed with this disease.

A Case Report of a Submental and Submandibular Space Infection

In most of the cases of space infections are secondary to an odontogenic infection. In space infection,spread occurs through the fascial plane because of the degradation of connective tissue by action of differentenzymes produced by microorganisms. Different factors like age, nutritional status of the host, host defense,virulence of the microorganism play an important role in the spread of the infection. Sometimes it may takethe fetal course if not treated on time because of its local and systemic complications. It should be treatedas an emergency condition to prevent its rapid progression leading to fatal outcome. Here the case reportdescribes an old lady suffering from fascial space infection and treated by incision and drainage. Incompleteremoval of any odontogenic infection may cause the recurrence of the infection or infection that may spreadto fascial spaces.

Awareness Of Ludwig’s Angina Among Dental Practitioners

Ludwig's angina is life-threatening cellulitis. It is primarily seen involving the submandibular space followed by secondary involvement of the submental space. This disease has an aggressive character and spreads rapidly causing a compromised airway with little warning. The aim of the study is to determine the level of knowledge and awareness of dental practitioners regarding Ludwig's angina and its management techniques. A total of 10 multiple choice questions were formed and distributed to 100 dental practitoners with more than five years of experience. All ten questions assessed the knowledge of dental practitioners regarding Ludwig's angina and awareness of the various management techniques. After all the participants have given their response, their responses were noted and tabulated. All the respondents were aware of the cause and causative factors of Ludwigs, angina.78% said it is cellulitis. Broad-spectrum antibiotics are the choice in 78% of the respondents.80% are aware this condition involves multiple space infections and 64%said they can diagnose this condition based on clinical features. The awareness of management techniques of Ludwig's angina was high among dental practitioners. The importance regarding knowledge of various disease which mainly affects the head and neck region is crucial for dental practitioners. Thus it is essential for the dental practitioners to have knowledge of the conditions and be aware of the management of these conditions.

Complicações relativas às infecções odontogênicas: Angina de Ludwig

Descrita em 1836 como sendo uma celulite tóxica por Wilhelm Frederick Von Ludwig, a Angina de Ludwig pode ser uma celulite extremamente fatal se não houver um diagnóstico preciso e precoce. Tendo vários fatores causal sendo o principal às infecções odontológicas dentre outras como: traumatismos e lacerações dos tecidos bucais, infecções das glândulas salivares, picada de insetos no queixo, neoplasias bucais infectadas, linfadenites, osteonecrose da mandíbula relacionada com o uso de bisfosfonatos. Afetando os espaços fasciais do pescoço, espaço submandibular, espaço submentoniano assim tendo o comprometimento principal as vias aéreas, pacientes imunossuprimidos e com comprometimento na condição sistêmica tendem a ser mais suscetível a Angina de Ludwig. Tendo tratamento a internação imediata e em seguida a prescrição de antibióticos para o controle da infecção e a drenagem cirúrgica para a remoção do material purulento e em seguida a remoção da causa da infecção como extrações e tratamento endodôntico, devido ao comprometimento das vias aéreas em alguns casos mais graves deve se realizar uma traqueostomia ou intubação endotraqueal. Este trabalho visa o melhor entendimento sobre o manejo de pacientes com Angina de Ludwig oferecendo ao leitor um conhecimento sobre a etiologia, diagnóstico e tratamento, bem como o prognostico relativo ao tratamento estabelecido.

Use of Superficial Cervical Plexus Block in Submandibular and Submental Space Abscess Drainage

Introduction: Methods for lessening the sensation of pain during surgery date back to ancient times. Although general anesthesia is preferred over locoregional anesthesia in incision and drainage of space infection in neck region, it is expensive, with increased morbidity and mortality. Sometimes, anesthetist experienced in fiber optic-guided nasal intubation may be required due to reduced mouth opening. Hence, in such cases and poor risk patients, Superficial Cervical Plexus Block can be used in association with trigeminal V3 local anesthesia.&#x0D; Objective: To evaluate the efficacy of Superficial Cervical Plexus Block in incision and drainage of submandibular and submental space infection.&#x0D; Methodology: A prospective clinical study was carried out at Nobel Medical College and Teaching Hospital, Biratnagar, Nepal from June 2018 to May 2019 suffering from submandibular and submental space infection arising from odontogenic causes who required incision and drainage. Pain response was measured using Visual Analogue Scale.&#x0D; Result: Out of Twenty four patients sixteen were female and 8 were male. The age ranged from 16 to 82 years with a mean age of 40.5±18.53. The Visual Analogue Scale score ranged from 0 to 8 with a mean score of 1.5 ±1.87. One patient complained of unbearable pain and had to be converted into general anesthesia (4.16%).&#x0D; Conclusion: Superficial Cervical Plexus Block with trigeminal mandibular local anesthesia has a high success rate, low complication rate, and high patient acceptance rate. However, caution should be exercised to ensure a low complication rate.

MANAGEMENT OF PEDIATRIC PLUNGING RANULA: CASE REPORT

Plunging ranula (PR) is a mucus extravasation pseudocyst arising from the sublingual glands that forms following mucus escape that herniates through the mylohyoid muscle along the fascial planes into the cervical, submandibular, or submental space. They are rare in children, and surgical management is the most common performed therapy. We report a case of an 11-year-old female patient who sought dental treatment after a 3-year history of swelling in the right sublingual gland and the floor of the mouth, which was asymptomatic. The patient's medical history was unremarkable. Computed tomography image showed a well-defined ovoid lesion with hypoattenuation in the right sublingual gland measuring 4.5 × 4 cm. The initial diagnosis was PR, which was later confirmed by anatomopathologic analysis. Surgical excision of the right sublingual gland was performed intraorally under general anesthesia, followed by floor of the mouth marsupialization. The patient is currently being followed-up with no signs of local recurrence. Plunging ranula (PR) is a mucus extravasation pseudocyst arising from the sublingual glands that forms following mucus escape that herniates through the mylohyoid muscle along the fascial planes into the cervical, submandibular, or submental space. They are rare in children, and surgical management is the most common performed therapy. We report a case of an 11-year-old female patient who sought dental treatment after a 3-year history of swelling in the right sublingual gland and the floor of the mouth, which was asymptomatic. The patient's medical history was unremarkable. Computed tomography image showed a well-defined ovoid lesion with hypoattenuation in the right sublingual gland measuring 4.5 × 4 cm. The initial diagnosis was PR, which was later confirmed by anatomopathologic analysis. Surgical excision of the right sublingual gland was performed intraorally under general anesthesia, followed by floor of the mouth marsupialization. The patient is currently being followed-up with no signs of local recurrence.