Submandibular and Sublingual Spaces

Imaging evaluation of the benign and malignant lesions of the floor of the mouth: Pictorial review

The floor of the mouth is an important anatomical region of the oral cavity where primary benign and malignant disease processes can originate or secondary pathologies can extend into adjacent spaces. Knowledge of the anatomy is crucial for accurate localisation of pathology and understanding the spread of disease. The sublingual space is the dominant component of the floor of the mouth, bounded inferiorly by the mylohyoid muscle that separates it from the submandibular space. Imaging is immensely important to characterise and map the extent of disease, considering the fact that the bulk of the disease may be submucosal and not visible on clinical inspection.

Contribution

The floor of the mouth is a complex anatomical region for radiological evaluation. The purpose of this pictorial review is to present an understanding of the relevant anatomy and to demonstrate the role and appropriate application of different imaging modalities. This article highlights the imaging spectrum of a wide range of various benign conditions including normal variants and a variety of malignant lesions at different tumour stages, with an aim to establish the correct diagnosis, avoid misinterpretation and help in treatment planning.

Imaging Features of isolated hypoglossal nerve palsy

The hypoglossal nerve gives motor innervation to the intrinsic and extrinsic muscles of the tongue. Pathology of this nerve affects the balanced action of the genioglossus muscle causing tongue deviation toward the weak side. Clinically, hypoglossal nerve palsy manifests with difficulty chewing, swallowing and with dysarthric speech herein, we review the anatomy of the hypoglossal nerve as well as common and infrequent lesions that can affect this nerve along its course.

Imaging of Submandibular and Sublingual Salivary Glands

The submandibular and sublingual salivary glands are major salivary glands with a wide spectrum of pathologic conditions. The corresponding spaces along the floor of mouth have complex anatomy, best evaluated with cross-sectional imaging. The spectrum of diseases in these regions varies from simple infection to advanced malignancy, not just from the gland itself but also from the surrounding structures. The most common abnormalities in these spaces are inflammatory and infectious, and computed tomography is currently the most common imaging modality used. The anatomy of these spaces is much better depicted with MR; however, all the modalities have their unique roles.

Imaging of the sublingual and submandibular spaces

Abstract

Divided by the mylohyoid muscle, the sublingual and submandibular spaces represent a relatively small part of the oral cavity, but account for a disproportionate amount of pathological processes. These entities are traditionally separated into congenital, infectious/inflammatory, vascular and neoplastic aetiologies. This article reviews the relevant anatomy, clinical highlights and distinguishing imaging features necessary for accurate characterisation.

Teaching Points

• The mylohyoid sling is a key anatomical landmark useful in surgical planning.

• Congenital lesions and infectious/inflammatory processes constitute the majority of pathology.

• Depth of invasion is key when staging tumours in the oral cavity.

Extensive Epidermoid Cyst and Breathing Difficulty

Epidermoid cysts are common cystic lesions in the skin, ovaries, and testicles, but their occurrence in the oral cavity is uncommon. They consist of cysts delimited by a fibrous capsule without cutaneous annexes and are lined by stratified squamous epithelium. The differential diagnosis includes ranula, dermoid cysts, and lingual thyroid. Despite their benign presentation, these cysts can cause functional limitations, requiring special clinical attention for extensive lesions located in regions that preserve vital structures. This paper aims to report a case of epidermoid cyst in patient with swallowing and breathing difficulty, highlighting the clinical and surgical planning.

Accidental displacement of third molar into the sublingual space: a case report

BACKGROUND

Successful extraction of third molars depends on preoperative diagnosis and planning. Gold standard preoperative examinations are performed through computed tomography, decreasing risks and avoiding potential accidents. The present report highlights the value of preoperative examinations in face of accidentally displaced third molars.

METHODS

An 18-years-old female patient underwent a third mandibular molar extraction with a general dentist. Accidentally, the mandibular left third molar was displaced into the sublingual space, making necessary a second surgical step. The surgery was interrupted and the patient was referred to an expert in maxillofacial surgery.

RESULTS

After 21 days awaiting an asymptomatic health status, the second surgical step was successfully performed using multislice computed tomography as preoperative imaging guide.

CONCLUSIONS

The present case report highlights the clinical usefulness of imaging planning and informed consents in face of legal and ethic potential complaints.