Conservative Management of Submandibular Space Infection in a 5-Year-Old Child: A Case Report

Submandibular space infection is a potentially fatal infection that could arise as a result of odontogenic or non-odontogenic infections. The management should be prompt as the infection can spread rapidly leading to airway obstruction. A 5-year-old child reported with a complaint of swelling on the left side of the face for four days. On examination, patient had a diffuse swelling involving the left submandibular region with decreased mouth opening secondary to carious 75. The patient was administered intravenous (i.v) fluids, antibiotics and analgesics. Incision and drainage of the abscess was done extraorally under i.v sedation using midazolam with local anaesthesia followed by rubber drain placement. Patient responded to the treatment with progressive decrease in the swelling. Pulpectomy of 75 was performed followed by stainless-steel crown placement. This case highlights the importance of prompt appropriate treatment supplemented by salvage treatment to overcome the associated morbidity at this very young age.

Factors Affecting Patients with Concurrent Deep Neck Infection and Acute Epiglottitis

Deep neck infection (DNI) is a serious disease of deep neck spaces that can lead to morbidities and mortality. Acute epiglottitis (AE) is a severe infection of the epiglottis, which can lead to airway obstruction. However, there have been no studies of risk factors in patients with concurrent DNI and AE. This study was performed to investigate this issue. A total of 502 subjects with DNI were enrolled in the study between June 2016 and August 2021. Among these patients, 30 had concurrent DNI and AE. The relevant clinical variables were assessed. In a univariate analysis, involvement of the parapharyngeal space (OR = 21.50, 95% CI: 2.905–158.7, p < 0.001) and involvement of the submandibular space (OR = 2.064, 95% CI: 0.961–4.434, p < 0.001) were significant risk factors for concurrent DNI and AE. In a multivariate analysis, involvement of the parapharyngeal space (OR = 23.69, 95% CI: 3.187–175.4, p = 0.002) and involvement of the submandibular space (OR = 2.465, 95% CI: 1.131–5.375, p < 0.023) were independent risk factors for patients with concurrent DNI and AE. There were no differences in pathogens, therapeutic managements (tracheostomy, intubation, surgical drainage), or hospital staying period between the 30 patients with concurrent DNI and AE and the 472 patients with DNI alone (all p > 0.05). However, we believe it is significant that DNI and AE are concurrent because both DNI and AE potentially cause airway obstruction, and concurrence of these two diseases make airway protection more difficult. The infections in critical spaces may cause the coincidence of these two diseases. Involvement of the parapharyngeal space and involvement of the submandibular space were independent risk factors associated with concurrent DNI and AE. There were no differences in pathogens between the concurrent DNI and AE group and the DNI alone group.

Dilute initial dentofacial abscess of buccal space: a technical note

The treatment of the dentofacial abscess was always surgical because the evacuation of the purulent collection and removal of the cause are mandatory. Large abscesses, especially those that reach the submandibular space, require laboratory and imaging exams, but small abscesses restricted to the buccal space can be successfully treated by diluting the purulent collection with saline solution using needle and syringe.

Hypoglossal schwannoma masquerading as a submandibular gland tumor: a case report

Background: Hypoglossal nerve schwannoma in the submandibular space is rare. This case report presents the treatment of a young patient affected by an unusual hypoglossal nerve schwannoma at the right side of the submandibular region. Case representation: A 31-year-old female presented to our department with complaints of a right-sided submandibular region mass. None calculi was observed by CBCT. An MRI of the neck demonstrating a 18×12mm mass located at the submandibular region. Based on clinical presentation and imaging, a diagnosis of a submandibular gland tumor was conferred and the patient scheduled for excision. Intraoperatively, the mass was noted to arise from the hypoglossal nerve, remaining independent of the submandibular gland. On histopathologic analysis, the mass was determined to be consistent with hypoglossal schwannoma. Conclusion: Though rare, the hypoglossal schwannoma should remain a consideration in the evaluation of a submandibular space mass. During operation, it might be better to explore the mass before managing the submandibular gland.

Hypoglossal Schwannoma Masquerading as a Submandibular Gland Tumor: a Case Report

Background: Hypoglossal nerve schwannoma in the submandibular space is rare. This case report presents the treatment of a young patient affected by an unusual hypoglossal nerve schwannoma at the right side of the submandibular region. Case representation: A 31-year-old female presented to our department with complaints of a right-sided submandibular region mass. None calculi was observed by CBCT. An MRI of the neck demonstrating a 18×12mm mass located at the submandibular region. Based on clinical presentation and imaging, a diagnosis of a submandibular gland tumor was conferred and the patient scheduled for excision. Intraoperatively, the mass was noted to arise from the hypoglossal nerve, remaining independent of the submandibular gland. On histopathologic analysis, the mass was determined to be consistent with hypoglossal schwannoma. Conclusion: Though rare, the hypoglossal schwannoma should remain a consideration in the evaluation of a submandibular space mass. During operation, it might be better to explore the mass before managing the submandibular gland.

Spindle Cell Lipoma Occurring in the Submandibular Space: Fifth Case Reported along with a Concise Review of the Literature

Spindle cell lipoma (SCL) is an uncommon histological variant of lipoma that accounts for 1.5% of all adipose tumors. It rarely occurs in the oral cavity. The most common sites of involvement are the buccal mucosa, tongue, lip, alveolar mucosa, gingiva, and palate. Submandibular space is a very rare site of occurrence for SCL. When occurs in this site, SCL mainly involves the 4th–7th decade with a female predominance. Due to wide communications of submandibular space, the actual extent and appearance of the lesions present here gets masked up especially those involving the deeper tissues leading to an inaccurate diagnosis. Wide overlap of clinical and histopathological features of SCL to other clinical pathologies leads to a challenging task for the clinicians to reach an accurate diagnosis. To our knowledge, only four cases of intraoral SCL involving the submandibular region directly or indirectly have been reported in the literature. Here we represent another rare case of SCL in an 18-year-old male patient along with a concise review of the literature. This case appears to be quite rare due to its location (submandibular space), age, and sex of the patient (18/M).

Clinicopathological study and management of infective swellings of neck in pediatric age group patients

<p><strong>Background:</strong> Neck swellings are common presenting complaint in paediatric age group patients attending ENT department and are cause of concern for both doctors and parents because they are considered as red flag.</p><p><strong>Methods</strong>: This prospective study was conducted among 102 paediatric patients of both genders attending the OPD of department of ENT, Vijayanagar institute of medical sciences, Bellary, Karnataka, between July 2018 to March 2020.</p><p><strong>Results</strong>: Out of 102 patients in our study, majority of them were reactive lymphadenopathy 47 (46%). Out of 41 deep neck space infections, submandibular space is the most commonly involved space 27 (65.8%). Twenty-nine (70.7%) DNSI’s needed institutional management hence got admitted and among them 20 (48.7%) were submandibular space infection and 7 (17%) were Ludwig’s angina which was statistically significant (p=0.001). Among 27 submandibular space infection, 24 (88.8%) had fever, 19 (70.3%) had local pain, 4 (14.8%) had dysphagia which was statistically significant (p&lt;0.05).</p><p><strong>Conclusions:</strong> In the infective neck swellings of paediatric age group the submandibular space infection needs the zenith of active institutional management among both the genders, and the Ludwig’s angina warrants its treatment on institutional admission which is frequent in this age group.</p>