Professional Documents
Culture Documents
Lecture Outline
Dr.A.Sabagh
Surgical anatomy:
- Lies below the myelohyoid muscle which separate it from the oral cavity & located
below & medially to the posterior part of the inner aspect of the mandible.
- Bordered posteriorly by:
Hypglossous muscle
Posterior belly of digastric muscle
Medial pterygoid muscle
Contents:
- Submandibular salivary glands. "It has a tongue-like projection that extend into the
sublingual space".
- Submandibular lymph nodes.
Clinical picture:
- Diffuse, enlarged , indurated browny edema (Cellulitis).
- No elevation of lobe of ear (elevated in case of parotid swelling)
Spread of process superiorly and posteriorly elevates floor of mouth and tongue. In
anterior spread, the myoid bone limits spread inferiorly, causing a "bull neck"
appearance.
Signs & symptoms
- Usual systemic signs & symptoms.
- Massive browny swelling along the lower border of the mandible extending posteriorly
to the angle.
- Moderate mandibular limitation.
- The swelling is board-like, tender, indurated, inflammatory red & hot.
The moderate limitation of the mandible arise from the involvement of the medial
pterygoid muscle which extend posteriorly in the space not within the infection.
The difficulty with swallowing arise from the large surface area of myelohyoid muscle
that is involved.
Bounded by:
The mucosa of the floor of the mouth roof
The origin of the myelohyoid muscle floor
The lingual aspect of the mandible laterally
The hyoglossous, genioglossous& geniohyoid muscles medially
Spread of infection:
Apical or periodontal infection related to the incisors, canine & premolars.
Treatment:
Intra-oral incision & drainage
The incision should run postero-anteriorly, lateral to the tongue & sublingual plica.
Contents:
Buccal pad of fat.
Etiology:
Dento-alveolar abscess of posterior teeth:
- If abscess outside the buccinator muscle buccal space infection.
- If abscess inside the buccinator muscle vestibular abscess
Extra-oral manifestation is seen in case of buccinator muscle infection.
Intra-oral manifestation is seen in case of vestibular space infection.
Intraoral horizontal incision low down inside the cheek most likely related to the mucobuccal fold.
The direction should be posterior-anterior to prevent damage of salivary gland ducts.
The incision should be followed by blunt dissection of the buccinator muscle sheet.
Theoretically, the buccal space infection can occur as a result of upper & lower posterior
teeth infection. However, Lower teeth infection is more likely to cause sublingual or
submandibular infection due to the thick buccal plate of bone compared to the upper.
Vestibular infection:
S&S: Intra-oral localized swelling
Tx: Intra-oral horizontal incision (in the same location of linea alba)
Palatal abscess (subperiosteal abscess):
Occasionally involvement of the palatal roots of upper teeth may lead to palatal abscess beneath the
mucosa & periosteum.
Tx: Posterior-anterior incision through the mucosa & the periosteum. We should take care of the
greater palatine bundle.
• Submasseteric space infection:
Anatomy:
Bounded by masseter muscle laterally
The lateral aspect of the mandible ramus medially
The parotid gland is found posteriorly
Spread of infection:
Lower 3rd molar area
Pericoronitis or periapical infection.
Treatment:
- Intraoral incision along the anterior border of the ramus staring from the condylar
process & ending lateral to the ramus.
- In case of severe mandibular lock, even under G.A, extra-oral incision along the
mandibular angle inferiorly can be done.
- In both cases, elimination of the main cause is essential..
Allah Bless You
Muchas Gracias
Strawberry