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Objective Schwannoma is a slowly growing benign neurogenic tumor that develops from the cells of the nerve sheath. The occurrence of schwannoma in the submandibular space is very rare. Materials and Methods From January 2010 to March 2021, we reviewed all patients who had been operated on in the otolaryngology department over 11 years and found 61 patients diagnosed with schwannomas at the final biopsy after surgery. In these patients, only 3 submandibular schwannomas were identified, and their clinical characteristics were analyzed. Results Three schwannomas (4.9%) developed in the submandibular space. The main symptoms were neck swelling followed by neck discomfort. All submandibular schwannomas were removed surgically with a transcervical approach under general anesthesia. Two patients, who were diagnosed preoperative submandibular tumors, were considered to have developed schwannomas from the lingual nerve, and 1 patient was considered to have developed a schwannoma from the hypoglossal nerve. There were no major surgical complications, including postoperative nerve damage. Conclusions Submandibular schwannomas are extremely rare, but they should be included in the differential diagnosis of submandibular tumors.

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).

BACKGROUND Severe eyelid edema and blood accumulation in the submandibular space after preauricular fistula surgery is rarely reported. CASE SUMMARY We report a 4-year-old girl with eyelid edema and swelling of the submandibular region after preauricular fistula resection under general anesthesia. When drug treatment failed, neck computed tomography examination was performed, which confirmed severe bleeding in the submandibular space. Later, exploration and ligation of the superficial temporal artery were performed under general anesthesia to stop the bleeding. The child was successfully treated, and there were no abnormalities over 1 year of follow-up. CONCLUSION When severe bleeding occurs after preauricular fistula surgery, superficial temporal artery rupture should be considered as a cause.

Background Deep neck space infection (DNSI) mostly arise from the local extension of dental, tonsils and parotid gland infections. Early diagnosis and management is the key to avoid associated complications. Objective Our study aimed at evaluating the clinical presentation and factors related to complications of DNSIs at the University Teaching Hospital of Kigali. Methods This cross-sectional study was conducted at the University teaching hospital of Kigali from September 2017 to November 2018. It enrolled 66 participants. Patient information was recorded using a questionnaire and analyzed using Epidata 3.1 software. The data were processed using SPSS 16.0. Comparison of categorical variables were performed using the chi-square test. Associations with p-values=0.05 were considered statistically significant. Results Males accounted for 35 (53%) of DNSIs. The majority (97%) presented with neck pain and 21% with a history of tooth extraction. The submandibular space was the most involved in 33 (50%) cases. The average duration of symptoms at presentation was 11 days. Delayed consultation and advanced age (>40years) were associated with complications and hospital stay with (p value=0.022) and (p=0.015) respectively. Conclusion Neck pain on background of tooth extraction is the most common presentation of patients with DNSIs. Delayed presentation and advanced age are central factors for complications and longer hospital stay. Rwanda J Med Health Sci 2021;4(1):8-19

Displacement of a mandibular third molar into a fascial space is a relatively rare event with potentially serious complications. The surgical procedure to remove a displaced tooth, or part thereof from these spaces may be difficult due to poor access and an abundance of vital structures within these spaces. Here, we present two cases of submandibular displacement, suggest an intra-oral approach and algorithm to help guide practitioners with management of displaced third molars in the submandibular space.

Aim To present the endodontic management of a patient diagnosed with a high-flow arteriovenous malformation (AVM) requiring root canal treatment and to discuss the relevant endodontic literature for this rare but significant problem. Summary AVM is a complex communication of an artery and a vein in which the oxygenated blood is forced away from the intended tissue. The incidence of its occurrence in the face and neck is rare, and when present, the most common sign is gingival bleeding. Arteriovenous malformation is both a diagnostic and therapeutic challenge for dentists. Also, there is ambiguity regarding the precautions to be taken whilst doing endodontic procedures in such cases. Hence, there is a need to understand the disease process and its implications in order to prevent life-threatening complications during treatment. This case report highlights the successful endodontic management of a cariously exposed right maxillary second premolar in a patient diagnosed with high-flow AVM. On an orthopantomogram, the AVM was spreading in the left submandibular space involving the left ramus area. The clinical findings of limited mouth opening with inter-appointment swelling and trismus during treatment made the case unusual and challenging. This paper addresses the current understanding of the classification, diagnosis, clinical features and endodontic management, together with specific guidelines and recommendations whilst performing endodontic procedures in AVM cases. Key learning points The classification and oral manifestations of AVM must be known and understood. Practitioners should be aware of the radiographic appearance of AVM. Recommended precautions should be taken when carrying out restorative and endodontic procedures in a patient with AVM. Antibiotic prophylaxis may be considered before endodontic treatment in a patient with AVM. Multidisciplinary treatment planning may be required.

Objective: During pregnancy, changes occur in the oral environment with gingivitis predominating. The development of odontogenic infections within the period of pregnancy may endanger the life of the mother as well as that of her unborn baby. Materials and methods: A retrospective observational study of cases of cervicofacial infection in women during pregnancy was conducted at the oral and maxillofacial surgery clinic of a northern Nigerian tertiary health care center from January 2006 to June 2018. Results: Seventy women were managed for cervicofacial infection during the period reviewed, out of which 20 women (28.6%) presented during pregnancy. Their mean age was 33.8 ± 9.35 years with a range of 20 to 55 years. The 30-39 years age bracket had the highest frequency (40%) and the mean duration of pregnancy at presentation was 24.9 ± 11.12 weeks with a range between 10 to 36 weeks. Majority (n=15, 75.0%) presented in the 3rd trimester. At presentation, the frequently involved fascial space was unilateral submandibular space (n=10; 50.0%), All the patients had incision/drainage/decompression on the dental chair under local anesthesia (2% lidocaine with 1:80,000 adrenaline). The mean length of hospital stay was 13.9 ± 6.2 days with a range of 6 to 26 days. The mortality rate was 15% (n=3 cases). Conclusion: There is a need for oral health evaluation in pregnant women during ante-natal visits to prevent these complications. Oral health education should also form part of teachings received by women both in the ante-natal and postnatal clinics.

Iatrogenic tooth displacement is a rather unusual but significant complication during extractions' procedures. The most common anatomic positions of displacement for the lower teeth include the pterygomandibular, submandibular, sublingual, and lateral pharyngeal spaces. A retrospective analysis of three cases of tooth displacement to adjacent anatomic sites is presented. These patients were treated at the Oral and Maxillofacial Surgery Department, G. Papanikolaou General Hospital of Thessaloniki, Greece. Two cases refer to displaced roots in the submandibular space, and one refers to a lower third molar displaced in the lateral pharyngeal space. Third molar displacement is a clinical complication that should be considered during mandibular third molar extraction, and proper preventive measures should be taken into consideration.

Maxillofacial space infection (MSI) experience review is beneficial for its management. To identify potential risk factors predisposing to the exacerbation of MSI and a prolonged length of stay (LOS). We performed a comprehensive retrospective review of medical records of 222 MSI patients admitted in Center of Stomatology during 1993–2019. About 63.5% of 222 patients had an odontogenic infection, and submandibular space was the most involved space. Streptococcus spp. was the most common organism isolated (72.4%). Multiple-space cases had more systemic diseases, respiratory difficulty, and life-threatening complications and exhibited worse clinical characteristics (higher white-blood-cell-count, higher body temperature, and restricted mouth opening) than single-space cases (P

This study aims to describe the current epidemiological and etiological trends for deep neck space infections (DNIs) with an objective to understand the intricacies of their management. In this retrospective analytical study records of 52 patients with DNIs were reviewed. Patients having superficial abscess, peritonsillar abscess and abscess due to trauma/surgical procedure were excluded. Various epidemiological and etiological parameters (Demography, site, presentation, etiology, association with co-morbidities, bacteriology) and management guidelines (need for surgical interventions for DNIs and airway management, hospital stay duration, treatment outcome and complications) were reviewed and analyzed. Study recorded preponderance of DNIs in males (male:female = 1.6:1) and in younger generation (50% of patients presenting in first 2 decades). Commonest etiology being odontogenic infections (38.46%) followed by URTIs and tonsillopharyngitis (19.23%). Submandibular space involvement was noted in 42.3% cases followed by parapharyngeal space involvement in 21.15%. Nearly 55% cases of submandibular space involvement were because of odontogenic causes. 69.23% culture specimens reported no growth. 61.53% patients were diagnosed with anaemia. Up to 80% required open surgical drainage. All received broad spectrum antibiotics as a starting regime. No severe complications were recorded. Understanding the current epidemiological and etiological trends can help in early and definitive diagnosis of DNIs. Empirical starting treatment regime including broad spectrum antibiotics (till sensitivity pattern is availed) and maintaining low threshold for required surgical intervention are required to manage DNIs satisfactorily. Selected cases should be given conservative trials with close monitoring.

Descrita em 1836 como sendo uma celulite tóxica por Wilhelm Frederick Von Ludwig, a Angina de Ludwig pode ser uma celulite extremamente fatal se não houver um diagnóstico preciso e precoce. Tendo vários fatores causal sendo o principal às infecções odontológicas dentre outras como: traumatismos e lacerações dos tecidos bucais, infecções das glândulas salivares, picada de insetos no queixo, neoplasias bucais infectadas, linfadenites, osteonecrose da mandíbula relacionada com o uso de bisfosfonatos. Afetando os espaços fasciais do pescoço, espaço submandibular, espaço submentoniano assim tendo o comprometimento principal as vias aéreas, pacientes imunossuprimidos e com comprometimento na condição sistêmica tendem a ser mais suscetível a Angina de Ludwig. Tendo tratamento a internação imediata e em seguida a prescrição de antibióticos para o controle da infecção e a drenagem cirúrgica para a remoção do material purulento e em seguida a remoção da causa da infecção como extrações e tratamento endodôntico, devido ao comprometimento das vias aéreas em alguns casos mais graves deve se realizar uma traqueostomia ou intubação endotraqueal. Este trabalho visa o melhor entendimento sobre o manejo de pacientes com Angina de Ludwig oferecendo ao leitor um conhecimento sobre a etiologia, diagnóstico e tratamento, bem como o prognostico relativo ao tratamento estabelecido.

displacement of impacted third molar tooth or fragment during surgical extraction to adjacent tissue spaces such as submandibular or pterygomandibular is not a common complication. Retrieval of displaced tooth or fragment is complicated by difficult visibility, accessibility and instrumentation. Patient and methods: Referred male patient with displaced decapitated lower third molar tooth into submandibular tissue space. The displaced tooth was retrieved intra orally by raising lingual flap, using local anesthesia nerve block. The tooth was removed safely without complications and wound healing was normal. Conclusion: wisdom tooth removal must be done by an expert surgeon with adequate clinical and radiological assessment to avoid inadvertent complications. In case of iatrogenic displacement of the tooth or fragment into tissue space, computed tomography (CT) is a proper tool to estimate its exact location. Introduction: Surgical removal of impacted wisdom teeth is common surgical procedure with minimum complications of about 1% of cases which include bleeding, pain, swelling, infection and nerve parenthesis (lingual, inferior alveolar) either temporary or permanent. 1-4 Displacement of wisdom tooth or fragment into tissue space (submandibular or pterygomandibular) is uncommon complication in practice and in literature.5, 6 Iatrogenic displacement of wisdom occur due to lack of experience, improper preoperative clinical and radiographic estimation, improper treatment plan and uncontrolled application of force specially by elevators.7 This case report showing iatrogenic displacement of decapitated lower left wisdom retrieved surgically by intraoral lingual flap approach under local anesthesia.

Purpose We studied the clinical presentation and microbiology of patients with deep neck space infection in a developing nation to aid in determining the relevant, appropriate, and effective empirical antimicrobial treatment. We have also described the demographic data of pediatric versus adult patients and the predominant age-related subtypes of deep neck space infections. Patients and Methods A retrospective review of the data from patients with deep neck space infections during a 5.5-year period was conducted at the academic teaching hospitals in Johannesburg, South Africa. The diagnosis of deep neck space infection was determined from the clinical, radiographic, and laboratory findings. All the patients had undergone abscess drainage via needle aspiration or surgical drainage using a sterile technique. Aerobic and anaerobic bacterial cultures and cultures for Mycobacterium tuberculosis were performed. The results were recorded, and statistical analysis was performed. Results A total of 107 children and 52 adults with deep neck space infections were included in the present study, with 121 and 70 pus specimens retrieved. The male/female ratio was 1.14:1 for the pediatric group (57 boys [53%] and 50 girls [47%]). The adult group included 33 men (63%) and 19 women (37%). The male/female ratio for the adult group was 1.74:1. In the pediatric group, the mean age was 5.8 years (range, 2 months to 15 years). The age distribution was subcategorized into younger than 2, 2 to 10, and older than 10 years. Of the 107 children, 51 were younger than 2, 50 were aged 2 to 10, and 6 were older than 10 years. The age of the adult patients ranged from 19 to 77 years (mean, 40.9 ± 15.5). Multispace involvement of the deep neck infection was present in 8 pediatric cases (7.5%) and 31 adult cases (59.6%). The submandibular space was the most commonly affected site (73.9%) in both groups. Conclusions Deep neck space infections differ in clinical presentation and microbiology between adults and children. The specimens from the pediatric group predominantly cultured Staphylococcus aureus. In contrast, the specimens from the adult group were mainly polymicrobial. The adult population had poorer patient outcomes, with a greater number of intensive care unit admissions, operating theater visits, and prolonged hospital stays.

Endoscopic retrograde cholangiopancreatography (ERCP) had become the favored method to access the pancreaticobiliary system because it is a safer and less invasive method compared to surgery. However, as with any procedure, ERCP comes with its own risks and potential complications. We present a unique case of a patient who underwent ERCP and developed necrotizing infection of the neck and a submandibular abscess. The patient is a 66-year-old female who presented to an outside hospital with complaint of right upper quadrant abdominal pain, workup of which revealed choledocholithiasis. ERCP was attempted; however, cannulation was unsuccessful. The patient was discharged home after the procedure, but within 48 h she presented to our institution complaining of left-sided neck pain, dysphagia, and drooling. CT of the neck revealed extensive gas and fluid collections at the left submandibular space. The patient was taken to the operating room for drainage of the left neck abscess. Drainage and irrigation of the abscess yielded Streptococcus mitis and Hemophilus parainfluenza. The rest of patient’s hospital course was uncomplicated, and she was discharged with appropriate follow-up. In the case of our patient, ERCP was complicated by a perforation of the hypopharynx. Pharyngeal perforation can be subclassified into supraglottic and infraglottic. The most frequent cause of perforations is due to increased pressure in an intrinsically weak anatomical region of the pharynx. Such perforations are commonly due to the advancement of the endotracheal tube or transthoracic echo probe, but can also be due to advancement of an endoscope.

As taxas de complicacoes na remocao de terceiros molares impactados varia de 4,6% a 30,9%. Mesmo que as complicacoes estejam sujeitas a acontecer, para evitar a incidencia das mesmas, o diagnostico cuidadoso e planejamento pre-cirurgico e de fundamental importância. O deslocamento dental para espacos fasciais contiguos, e um acidente raro com poucos casos descritos na literatura, tal condicao ocorre por exames clinico-radiograficos inadequados, a falta de conhecimentos da anatomia local, a acessos cirurgicos inadequados e a movimentos cirurgicos excessivos ou descontrolados. Quando tal situacao, se apresenta e necessario avaliacao meticulosa riscos/beneficios da remocao do elemento dentario, como estruturas anatomicas possivelmente envolvidas, risco de infeccao, tipo de acesso e possiveis complicacoes transcirurgico na busca do elemento dentario. O presente artigo relata o caso de remocao de terceiro molar do espaco submandibular devido a iatrogenia ocorrida durante o processo de extracao do mesmo, em um paciente jovem do genero masculino.

The aim of this study was to determine the adequacy and safety of needle aspiration (NA) as an alternative to open surgical drainage for oral-maxillofacial abscesses. Fifteen consecutive patients who were diagnosed with oral-maxillofacial abscesses via contrast-enhanced CT from January 2020 to December 2020 were included. All patients were on antibiotics and treated with NA under local anaesthesia using a 20 mL syringe. Data collection included patient characteristics, signs and symptoms, physical examinations, laboratory tests, imaging findings, and outcomes. Next-generation sequencing (NGS) was used to identify the infectious microorganisms from the abscess samples. The study included 15 patients with oral-maxillofacial abscesses. None of our 15 patients required surgical incision and drainage, although repeat aspiration was required. However, after the first NA, the pain was reportedly extremely relieved for all patients. The average duration of antibiotic treatment was 9.20 ± 5.15 days (range 4–23 days). The abscess-affected spaces mainly included the masseter space and submandibular space. Odontogenic infection was the most common aetiology in 15 patients (10/15). The average volume of the abscesses on CT was 5866.26 ± 3627.18 mm3. The main pathogens identified in this study were Prevotella oris (5/15), Peptostreptococcus stomatis (4/15) and Porphyromonas endodontalis (2/15). According to the results of our study, the data support the use of NA as an effective, minimally invasive treatment modality for oral-maxillofacial abscesses. Surgeons should familiarise themselves with this technique, as it can easily be performed in the clinic using local anaesthesia, culture samples may be obtained, and airway obstruction and pain may be relieved.

The aim of the study was to demonstrate a novel transoral parapharyngeal approach to the submandibular space. The method used was the clinical case of a patient presenting with an anteriorly based tumor in the left submandibular space. The video shows the transoral robotic technique for access to the submandibular space through the parapharyngeal space for removal of the tumor. This approach allows for high definition visibility and complete access to structures in the submandibular space including the submandibular gland. For robotic head and neck surgeons performing lateral oropharyngectomies, the anatomy is familiar, and the technique avoids potential access issues with traditional floor of mouth incisions. Furthermore, it provides a novel technique for identification of the hypoglossal nerve for potential preservation in oropharyngeal malignancy. The transoral robotic parapharyngeal approach to the submandibular space is safe, reproducible, and avoids unnecessary cervical incisions.

Complications in dental implant surgery are possible. Bleeding complications have been described that may be serious, particularly in the floor of the mouth. We present two cases of sublingual hematomas during dental implant osteotomies that impeded but did not close the airway. The clinical courses of these patient's complications are reviewed. One patient had immediate hematoma formation while the other developed a hematoma overnight, presenting the next day. The treatment rendered was a precautionary in-hospital tracheotomy for the first patient and only compression control for the second. Bleeding complications during dental implant placement in the anterior mandible can be serious issues. There is a potential for sublingual hematoma that could compromise the airway by pressing the tongue against the soft palate into the pharynx. In-hospital treatment may be necessary to prevent an adverse outcome. It must be noted that a hematoma in the submandibular space is life threatening by direct airway compression.

PURPOSE: Odontogenic infections have the potential to develop rapidly into deep-space infections and compromise the airway. This problem is aggravated by pregnancy because of the physiological changes. This study aimed to determine the causes of referral delay for pregnant patients presenting with fascial space infections. METHODS: Ten pregnant patients with severe odontogenic infections reported to the outpatient clinic at Khartoum Teaching Dental Hospital included in the study during the study period included in the study. Patients with any systemic disease excluded. Demographic data were taken followed by history and then extraoral and intraoral examinations. A predesigned case report form was completed for each patient including the cause of referral delay, the offending teeth, space involved, and trimester at the time of presentation. RESULTS: The age range was from 18 to 35 years, and the mean age was 26.5 years SD ± 6.3. The odontogenic infections were most common in the last trimester (60%), followed by the late second trimester (40%).The most common tooth involved was the mandibular wisdom tooth (50%), and the submandibular space was the most frequently involved fascial space (70%). All patients were admitted and treated with incision and drainage under local anesthesia; the offending tooth was extracted and intravenous antibiotic and fluids were administered. Patients were on daily dressing until they were discharged on oral antibiotics. Two patients with Ludwig’s angina progressed to necrotizing fasciitis. CONCLUSION: Misconceptions among women regarding dental treatment during pregnancy were the most common cause of the delay. The myths and misconceptions should be addressed by dentists and prenatal care providers about oral health during pregnancy, and obstetricians’ awareness increased that oral health needs special attention during pregnancy.

Objectives Ludwig's angina is a potentially lethal submandibular space infection. We aim to describe the epidemiological characteristics of Ludwig's angina patients presenting to the emergency department (ED) and to examine outcomes and resource utilization to determine their burden on ED and hospitals. Methods Using the Nationwide Emergency Department Sample database, a nationally representative all-payer database, we retrospectively reviewed all ED visits between 2006 and 2014 for patients admitted with a primary diagnosis of Ludwig's angina (International Classification of Diseases, Ninth Revision, 528.3). We collected information including demographics, ED and inpatient charges, airway interventions, length of stay, and mortality. Results A total of 5,855 patients met our inclusion criteria. In our study population, the mean age was 44.5 years, with 54% males and 46% females. There were 75% insured and 25% uninsured. Overall median ED charges were $1,352 and median inpatient charges were $18,017.54, with a median length of stay of 3 days. As part of their management, 47.2% of the patients received a surgical drainage procedure, 3.3% required a surgical airway, and 4.6% required a nonsurgical airway. The overall mortality rate was 0.3%. Conclusion Ludwig's angina remains a rare and potentially life-threatening condition. The mortality rate appears to be decreased from previous historical accounts, with airway intervention remaining a significant part of management. Level of evidence 3 Laryngoscope, 129:2041-2044, 2019.

Deep neck spaces are still common in developing countries like India, even though its less prevalent in developed nations. It can lead to serious complications like jugular vein thrombosis and dissemination of infection if not diagnosed early and intervened. This is a retrospective chart review of 52 patients from 2014 to 2017 in a tertiary care hospital. Only patients with infection deeper to the superficial fascia of neck were included. Submandibular space infection was the most common and precipitating factor being dental infection. Most common comorbid condition was diabetes mellitus. Klebsiella pneumoniae was the most common isolated organism and few patients had mixed culture with anaerobes. Injectable cephalosporin with metronidazole was the most effective antibiotic combination against such infections. Low threshold for early surgical intervention reduce hospital stay and enable quick recovery of patients. Usage of over the counter antibiotics masks the conditions and complicate diagnosis and treatment of this condition.

Aim: The aim of this study was to provide insight about all the common fascial space infections of the neck, their presentation, their etiology, complaints, length of stay, and the treatment given. Patients and Methods: It was conducted in a tertiary center in Nadiad, Gujarat, India. A total of 1034 patients were treated for fascial space infections of the neck in the hospital from 2001 to 2017. There were 63.24% male and 36.75% female with age ranging from 21 days to 96 years having the mean age of 31.4 years. Results: Odontogenic infection with poor oral hygiene as a cause was found in most (78.43%) of the abscesses. Diabetes was the most common comorbid condition found in 98 (9.47%) patients along with HIV found in ten (0.96%) patients. Pain (99.41%), fever (86.07%), swelling (86.94%), and dysphagia/odynophagia (67.21%) were the most common presenting symptoms. Ludwig's angina and submandibular abscess were found to be the most common deep head-and-neck space infection making up for 52% cases. The most common group of microorganisms isolated were Streptococcus sp. (19.82%) and Staphylococcus aureus (18.66%). Conclusion: Treatment was given in the form of incision and drainage of the abscesses (83.69%) and systemic antibiotics (100%). The most common space infection among the deep neck infections is the submandibular space infection (52%). If the etiological factor was not removed which mostly was carious teeth, high chances of recurrence were found (27.27%). Four patients required tracheostomy, and there was one mortality in the entire series.

Background:Deep neck space infection (DNSI) is a potentially fatal condition that more commonly results from dental and tonsillar infections. Timely intervention is, therefore, crucial when such patients present to the managing physician.Objective:The objective of this study is to review the etiology, clinical presentation, and treatment outcome of patients managed for DNSIs over a period of 7 years at National Ear Care Centre, Kaduna.Methodology:The record of patients managed for DNSIs over a 7-year period between January 2010 and December 2016 was reviewed. Data obtained included demographic characteristics such as age, sex, occupation, level of education, main presenting symptoms, duration of symptoms, etiology of the DNSI, location of the infection, comorbidity, bacteriology, duration of hospital stay, and type of treatment given. The data were analyzed using the Statistical Package of the Social Sciences version 23.0.Results:A total of 55 patients presented with DNSIs, and there were 34 (61.8%) females and 21 (38.2%) males, with a sex ratio of 1.6:1. The age range of the patients was 1–71 years, with a mean age of 30.7 years (standard deviation of 18.1). The most common etiologic factor among these patients was tonsillar-related infection which accounted for 24 (43.6%). The most common symptom at presentation was fever (96.4%), followed by odynophagia (60%). Peritonsillar space infection as seen in 25 (45.5%) patients was the most common region affected, followed by submandibular space infection. Of the 35 (64%) patients who had incision and drainage,Staphylococcus aureuswas the most common organism isolated in 16 (45.7%), followed byStreptococcus pneumoniae(11, 31.4%). Majority (38, 69.1%) of the patients spent

The mylohyoid ridges or lines are pairs of anatomical bony structures located on the internal or lingual surface of mandible. They are the origin for the mylohyoid muscle. These bony structures are distinct in the mandibular molar region, well protected and gradually become undiscernible towards anterior mandible. Bilateral, isolated fracture of the mylohyoid ridges without concomitant mandibular fracture is rare and, to the best of the authors knowledge, was never previously described. This case report describes an isolated bilateral mylohyoid groove fracture, where one side of a necrotic bone fragment at the fracture site progress to became a nidus of infection, which later caused submandibular space abscess requiring emergency surgical intervention. Diagnosis, possible theory to explain the occurrence of isolated mylohyoid groove fracture and management of these condition are explained in this report.