Chapter 152

Odontogenic infections are frequently evaluated in the Emergency Department. The vast majority of odontogenic infections require minimal intervention. The spread of such infections from the mandibular premolars and first molar can lead to the development of a sublingual abscess.

The topographical anatomy of the anterior oral cavity is rather simple (Figure 152-1). The sublingual space is located between the oral mucosa and the mylohyoid muscle (Figure 152-2). The posterior boundary of this space is open, allowing communication with the submandibular space. It is important to remember that the posterolateral regions on each side of the floor of the mouth contain the lingual artery, vein, and nerve. These areas must be avoided when draining a sublingual abscess.

###### Figure 152-1

Topographical anatomy of the anterior oral cavity.

###### Figure 152-2

Anatomy of the sublingual space and the surrounding structures. A. Midsagittal view. B. Anterior view of a coronal section between the first and second molar. C. The medial surface of the mandible.

Patients will usually complain of swelling of floor of the mouth. There may be significant tongue elevation in cases of bilateral involvement. The accumulation of purulence in this area of the mouth is typically a result of the spread of an infection from the mandibular premolars and the first molar (Figure 152-3). The most common organisms involved are Streptococcus, Peptostreptococcus, Eubacterium, Porphyromonas, Prevotella, and Fusobacterium. Antibiotics typically used post-procedurally include penicillin, clindamycin, or metronidazole.1

###### Figure 152-3

A sublingual space, between the oral mucosa and the mylohyoid muscle, abscess originating from a mandibular tooth.

All patients presenting with a sublingual abscess require intraoral incision and drainage.

There are no absolute contraindications to draining a sublingual abscess. Patients with severe trismus limiting visibility and access may require intravenous analgesics and muscle relaxants, procedural sedation, or intraoperative drainage.2 Consult an Otolaryngologist for all patients who are coagulopathic, taking oral anticoagulants, or with a known bleeding disorder. These patients are at risk for bleeding and associated complications. Admit children to the hospital for intravenous antibiotics, incision and drainage under general anesthesia, and observation.

• Gauze 4×4 squares
• Suction source
• Yankauer or Frazier suction catheter
• #11 scalpel blade on a handle
• Mosquito hemostat
• Sterile Penrose drain
• Ribbon gauze
• Culturette or culture bottles
• 4–0 silk suture
• Suture scissors
• Oral rinse solution, hydrogen peroxide or Peridex
• Topical anesthetic spray (lidocaine, tetracaine, or benzocaine)
• Local anesthetic solution containing epinephrine
• 5 mL syringe
• 25 ...

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