This disease is commonly seen after tooth extraction and is caused by infections in the oral cavity and teeth.

bubble_chart Etiology

Suppurative inflammation of the submandibular gland and submandibular lymph nodes can also cause this condition. Generally, infections from the area anterior to the second mandibular molar often first invade the sublingual space, while infections of the second and third molars tend to initially spread to the submandibular space below the mylohyoid muscle. When the inflammation extends to the entire submandibular space (including the sublingual and submandibular spaces), it becomes suppurative submandibular inflammation (also known as Ludwig's angina). If the infection is not promptly controlled, it can spread posteriorly along the styloglossus muscle to the parapharyngeal and retropharyngeal spaces, then enter the carotid sheath, and via the retropharyngeal space reach the superior mediastinum, potentially leading to severe complications.

bubble_chart Clinical Manifestations

At the onset, there is redness, swelling, and pain in the tissues surrounding the primary inflammatory lesion, affecting chewing and swallowing. As the inflammation progresses, pain in the floor of the mouth develops, accompanied by impaired tongue movement, drooling, and trismus. The submandibular area becomes red and swollen, feeling hard to the touch. Edema in the floor of the mouth causes bulging, and the swollen tongue is pushed upward against the palate, leading to slurred speech and a tendency to choke while eating. If laryngeal edema occurs, hoarseness and difficulty breathing may develop, with severe cases leading to asphyxia. Systemic symptoms include aversion to cold, high fever, and exhaustion, indicative of septicemia.

1. In addition to the application of sufficient antibiotic treatment, timely incision and drainage are crucial. When the abscess is located in the floor of the mouth and has not yet penetrated the mylohyoid muscle to spread to the neck, incision and drainage in the alveolar process or the floor of the mouth can often control the inflammation. Blood vessels and nerves pass through the posterior and lateral areas of the floor of the mouth, so care must be taken to avoid injury during incision.

2. If symptoms do not improve after incision or if suppurative submandibular inflammation has already formed, a transverse incision can be made under local anesthesia above the hyoid bone, parallel to and below the lower border of the mandible. The platysma muscle and the superficial layer of the deep cervical fascia are incised, followed by a vertical incision between the bilateral mylohyoid muscles. Upward dissection then enters the sublingual space. Whether the mucous membrane of the floor of the mouth is incised depends on the degree of tension. The skin incision is left unsutured to reduce tissue tension and alleviate edema. Respiratory status should be closely monitored before and after surgery, with preparations made for a tracheotomy if necessary.

3. Systemic supportive therapy. Pay attention to diet and increase nutrition. Administer medications that can enhance the body's resistance and immunity, such as placental protein, transfer factor, and fresh plasma. Additionally, maintain oral hygiene and dental care.