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
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
Topographical anatomy of the anterior oral cavity.
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
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
- Headlight or overhead spotlight
- 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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