IMPORTANT ANATOMICAL CONSIDERATIONS IN PERIODONTAL SURGERY AND IMPLANTS

1. IMPORTANT ANATOMICAL
CONSIDERATIONS IN
PERIODONTAL SURGERY AND
IMPLANTS
DR. SHRUTI PATIL
DEPARTMENT OF PERIODONTICS

2. CONTENTS
1. Introduction.
2. Mandible - Anatomy ,relations ,attachments and age changes.
3. Maxilla - Anatomy , relations and attachments and age
changes.
4. TMJ
5. Exostoses.
6. Muscles .
7. Anatomic spaces.
8. Conclusion
9. references

3. INTRODUCTION
• A VARIETY OF SURGICAL PROCEDURES have been devised for
the treatment of periodontal disease and associated abnormalities.
• Such procedures may be accompanied by certain operative hazards
related to the presence and location of important anatomic structures.
• Limits may be imposed on the scope of periodontal therapy by local
and individual anatomical features.
• Effective planning and execution of surgical therapy is based on a
clear knowledge of the anatomy of the superficial and deep
structures encountered during surgical intervention.
Clarke MA, Bueltmann KW. Anatomical considerations in periodontal
surgery.J Periodontol. 1971 Oct;42(10):610-25

4. MANDIBLE
• Horseshoe shaped bone connected to the skull by the
temporomandibular joints.
BD Chaurasia's Human Anatomy Regional and Applied
Dissection and Clinical: Vol. 3: Head-Neck Brain

5.  MANDIBULAR CANAL :
• Occupied by inferior alveolar nerve and vessels.
• Begins at the mandibular foramen on the medial surface of the
mandibular ramus and curves downward and forward until it
becomes horizontal below the apices of the molars.

6. • The distance from the canal to the apices of the teeth is shortest
in the third molar area.
• A small percentage of mandibular canals bifurcates in the body
of the mandible, thereby resulting in two canals and two mental
foramina.
Garay, Ivonne. (2013). Accessory Mental Foramina Assessed by Cone-Beam Computed Tomography:
Report of Unilateral and Bilateral Detection. International Journal of Morphology. 31. 1104-1108.
10.4067/S0717-95022013000300052

7. • In premolar area , the mandibular canal divides into two
branches: exiting the mandible and the other continuing
anteriorly : the incisive canal which continues horizontally to
midline and the mental canal , which turns upward and opens in
the mental foramen.
Newman and Carranza's Clinical Periodontology

8. • Vertical mandibular canal (MC) positions can be divided into
four categories:
1. High MC ( within 2mm of the apices of the first and second
molar)
2. Intermediate MC
3. Low MC
4. Other variations: duplication or division of canal , apparent
partial or complete absence of canal or lack of symmetry.

9. o inferior alveolar nerve injury :
• implant drill
• implant itself
• bone debris (foreign body) .
• hematoma in the mandibular canal (MC) below the implant.
• In case of partial intrusion of the drill or dental implant into
MC intraoperative as well as indirect nerve injury due to
hematoma, compression and secondary ischemia.

10. A = partial implant drill intrusion into
mandibular canal can cause direct
mechanical IAN trauma - encroach, or
laceration and primary ischemia.
B = full implant drill intrusion into
mandibular canal can cause direct IAN
transection and primary ischemia.
C = partial implant drill intrusion into
mandibular canal can cause indirect
trauma due to hematoma and secondary
ischemia.
D = thermal stimuli can evoke periimplant
bone necrosis and postoperative secondary
IAN damage.
E = thermal stimuli can evoke primary
IAN damage.
Juodzbalys G, Wang HL, Sabalys G. Injury of the
Inferior Alveolar Nerve during Implant Placement: a
Literature Review. J Oral Maxillofac Res.
2011;2(1):e1. Published 2011 Apr 1.
doi:10.5037/jomr.2011.2101

11. • nerve pressure increased rapidly with a bone density decrease.
A low mandibular cortical bone density caused a major nerve
pressure increase.
• In conclusion, they suggested a distance of 1.5 mm to prevent
implant damage to the underlying inferior alveolar nerve when
biomechanical loading was taken into consideration.
• The minimal distance between 2 implants should be at least 3
mm .
• minimal distances between implants and natural roots should
be at least 1.5 mm
Juodzbalys G, Kubilius M. Clinical and radiological classification of the jawbone
anatomy in endosseous dental implant treatment. J Oral Maxillofac Res.
2013;4(2):e2. Published 2013 Jul 1. doi:10.5037/jomr.2013.4202

12. • Bone density
Bone density is a key determinant in treatment planning, implant
design, surgical approach, healing time, and type of loading during
prosthetic reconstruction. It may be determined by the general
location, radiographic evaluation, and tactile sense during surgery.
• buccolingual bone width
The available bone width is measured from the facial cortical plate to
the lingual cortical plate at the crest of the prospective implant site .
The minimum available bone width should be such that >1 mm of
bone should be present on either side of the implant faciolingually to
keep the soft tissue levels stable.
evaluation
Vidya Kamalaksh Shenoy
Single tooth implants: Pretreatment considerations and pretreatment

13.  MENTAL FORAMEN :
• Mental nerve and vessels.
• Location : buccal surface of mandible below the apices of the
premolar ,sometimes closure to the second premolar and
halfway between the lower border of the mandible and the
alveolar margin.
• Opening : oval or round, faces upward and distally .
Moogala S, Sanivarapu S, Boyapati R, Devulapalli NS, Chakrapani S, Kolaparthy L. Anthropometrics of mental
foramen in dry dentate and edentulous mandibles in Coastal Andhra population of Andhra Pradesh State. J Indian Soc
Periodontol. 2014;18(4. ):497–502

14. • The anterior loop is an extension of the inferior alveolar nerve,
anterior to the mental foramen, which loops back to exit the
mental foramen.
• This structure is important in determining a safe interforaminal
area for the placement of dental endosseous implants and other
surgeries such as open reduction of a mandibular fracture and
genioplasty to prevent neurosensory disturbances.
Kheir MK, Sheikhi M. Assessment of the anterior loop of mental nerve in an Iranian population
using cone beam computed tomography scan. Dent Res J (Isfahan). 2017;14(6):418–422.

15. Yu SK, Kim S, Kang SG, et al. Morphological assessment of the anterior loop of
the mandibular canal in Koreans. Anat Cell Biol. 2015;48(1):75–80.

16. Iyengar AR, Patil S, Nagesh KS, Mehkri S, Manchanda A. Detection of anterior loop and other patterns
of entry of mental nerve into the mental foramen: A radiographic study in panoramic images. J Dent
Implant 2013;3:21-5
Radiograph showing straight pattern of entry of
mental nerve into the mental foramen

17. Radiograph showing anterior loop in the
mental foramen region

18. • The anatomy of mandibular premolar region has clinical
significance in pretreatment planning of surgical procedures due
to the presence of the anterior loop.
• Damage to this nerve bundle may cause neurosensory
alterations in the chin and lower lip. Of particular interest has
been the placement of endoosseous implants in the anterior
interforaminal region.
• To maximize the distance between implants, the most posterior
implant should be placed as close as possible to the mental
foramen.

19. • The greater the distance between the interforaminal implants, the
better the anterior implants can counteract the forces generated
on the distal cantilevers of the fixed prosthesis.
• According to Bavitz, et al.,
an implant in the mental region is best positioned, so that its distal
aspect is 1mm anterior to anterior border of mental foramen.
• However, some authors have recommended a minimum
distance of 6 mm between the mental foramen and the most
posterior implant.
• The reason behind this large safety margin is to prevent damage
to the anterior loop of mental nerve that has been documented to
extend anteriorly upto 5 mm.

20. • Mental nerve divides into three branches :
1. Turns forward and downwards to supply the skin of the chin.
2. Other two branches course anteriorly and upward to supply skin
and mucous membrane of the lower lip and the mucosa of the
labial alveolar surface .
Tan F, Schiere S, Reidinga AC, Wit F, Veldman PH3Blockade of the mental nerve for lower lip
surgery as a safe alternative to general anesthesia in two very old patients. Local Reg Anesth. 2015
May 14;8:11-4

21. o Mental nerve injury :
• subject continued to feel numbness after the effect of local
anaesthetic wore off, since it’s the first postoperative alarming
sign.
• Types of Damage :
1. temporary interruption of nerve conduction (neuropraxia)
(sensory disturbances such as burning sensation, pins and
needles, or numbness) usually resolve within a few days to
weeks.
2. degeneration of nerve axons (axonotmesis) .similar but of
longer duration, lasting 6–8 weeks, with the potential for
permanent sensory deficits
3. permanent interruption of nerve conduction (neurotmesis)
most serious nerve damage.
may result in permanent paresthesia or anesthesia.
Shavit I, Juodzbalys G. Inferior alveolar nerve injuries following implant placement - importance of early
diagnosis and treatment: a systematic review. J Oral Maxillofac Res. 2014;5(4):e2. Published 2014 Dec 29.
doi:10.5037/jomr.2014.5402

22. • In partially or totally edentulous jaws , the disappearance of the
alveolar portion of the mandible brings the mandibular canal and
mental foramen closer to the superior border.
• when these patients are evaluated for the placement of implants
,the distance between the canals and the superior surface of the
bone,as well as the location of the mental foramen ,must be
carefully determined to avoid surgical injury to the nerve
Charalampakis A, Kourkoumelis G, Psari C, Antoniou V, Piagkou M, Demesticha T, Kotsiomitis E, Troupis T. The position of
the mental foramen in dentate and edentulous mandibles: clinical and surgical relevance. Folia Morphol (Warsz). 2017 May 29
The white arrows indicate the extreme
location of both
mental foramina at the alveolar crest (AC)
due to the high degree
of bone resorption (foramina
transposition).

23. AGE CHANGES IN MANDIBLE
B D
Chaurasia's
Human
Anatomy 4
Volume Set

24.  Lingual nerve :
• Branch of posterior division of the mandibular nerve.
• It descends along the mandibular ramus medial to and in front
of the inferior alveolar nerve.
• The lingual nerve lies close to the surface of the oral mucosa
in the third molar area and goes deeper as it travels forward.

25. • It can be damaged during anesthetic injections and during oral
surgery procedures (e.g.,third molar extractions).
• Less often ,the lingual nerve may be injured when a periodontal
partial thickness flap is raised in the third molar region or when
releasing incisions are made in the area.
• To reduce the chance of injuring nerve, some procedures have
been advocated. For example, incisions distal to the third molar
should be made on the buccal aspect of the ridge and always on
the bone. The elevator should be used to protect the nerve in the
flap, and the tissue should be managed gently.
Hsun-Liang Chan, Daylene J. M. Leong, Jia-Hui Fu, Chu-Yuan Yeh, Nikolaos Tatarakis,
Hom-Lay Wang.The significance of the lingual nerve during periodontal/implant
surgery.J Periodontol. 2010 Mar; 81(3): 372–377

26. • Therefore, when performing surgeries at the posterior lingual
region, intrasulcular incisions without vertical releasing
incisions are recommended, especially at the molar region.
• When reflecting lingual flaps, full-thickness flaps should
always be used and every care should be taken so as not to
damage the flap as it may contain the nerve.
• Study by JW Pichler et.al., concluded that ,The use of a lingual
nerve retractor during third molar surgery was associated with
an increased incidence of temporary nerve damage. The
lingual nerve retractor was neither protective nor detrimental
with respect to the incidence of permanent nerve damage.
Pichler J W, Beirne O R. Lingual flap retraction and prevention of lingual nerve damage associated
with third molar surgery: a systematic review of the literature. Oral Surgery, Oral Medicine, Oral
Pathology, Oral Radiology, and Endodontics 2001; 91(4): 395-401.

27.  External oblique ridge :
• Runs downward and forward to the region of the second or
first molar to create shelflike bony area.
• Resective osseous therapy may be difficult or impossible in
this area because of the amount of bone that must be removed
distally toward the ramus to achieve resection of a periodontal
osseous defect on the distal aspect of the mandibular second or
third molar.

28.  Retro molar triangle :
• Distal to the third molar ,the external oblique ridge
circumscribes the retro molar triangle.
• This region is occupied by glandular and adipose tissue and
covered by unattached, nonkeratized mucosa.
• If sufficient space exists distal to the last molar, a band of
attached gingiva may be present; only in such case can a distal
flap procedure be performed effectively.

29. • If the presence of RMF(retromolar foramen) is not detected prior
to mucoperiosteal flap elevation, damage may occur to the
neurovascular contents of the RMC(retromolar canal), leading to
paresthesia of the areas supplied by the retromolar nerve. The
greater the area supplied by the retromolar nerve, the greater the
risk of injury and loss of sensation
Truong MK, He P, Adeeb N, Oskouian RJ, Tubbs RS, Iwanaga J. Clinical Anatomy and Significance of
the Retromolar Foramina and Their Canals: A Literature Review. Cureus. 2017;9(10):e1781. Published
2017 Oct 17. doi:10.7759/cureus.1781

30. Lingula of mandible
• Lingula of the mandible gives attachment to the
sphenomandibular ligament
B D
Chaurasia'
s Human
Anatomy
4 Volume
Set

31. MAXILLA
• Paired bone
• Four processes :
1. alveolar process
2. Palatine process
3. Zygomatic process
4. Frontal process

32.  Incisive papillae and incisive canal : terminal branches of
nasopalatine nerve and vessels.

33.  Greater palatine foramen :
• 3 to 4 mm anterior to the posterior border of the hard pallate .
• Greater pallatine nerve and vessels

34. • Profuse haemorrhage may ensue if vessels are damaged at
palatine foramen hence, Palatal flaps and donor sites for
gingival grafts should be carefully performed and selected to
avoid invading these areas .
• Avoid Vertical incisions in molar region.

35. MAXILLARY SINUS
• Largest of paranasal sinuses.
• Pyramidal in shape ,with its apex in zygomatic arch and its
base at the lateral wall of nasal cavity.
• Subdivided into recesses by one or more septa.
• Lined by scheneiderian membrane.
• Drains into middle meatus of nasal cavity by maxillary duct .

36. • Floor of maxillary sinus – extends down below the level of the
nasal cavity into the alveolar process.
• Expands with increasing age.
• Blood supply - maxillary artery.
• Venous drainage – pterygoid plexus

37. • When sinuses are are severely pneumatized ,the ability to
perform periodontal osseous surgery in posterior maxilla is
limited.
• Extraction of teeth with roots exposed into the maxillary sinus
can result in oro antral communication.
Clinical
photograph and
radiograph
illustrating a
severely
pneumatized
maxillary sinus
grafted with
OCS-H.
Ki-Tae Koo, Jang-Yeol Park Clinical presentation of a horse-derived biomaterial
and its Biocompatibility: A Clinical Case Report.DOI: 10.5051/jkape.2009.39.S.287

38. • Knowledge of arterial blood supply is important when
considering a lateral window approach to sinus floor elevation
and bone augmentation.
• Bleeding is one of complication seen in lateral window
approach for sinus elevation.

39. • Determination of the extension of maxillary sinus into surgical
site to avoide creating oroantral communication eg., osseous
reduction in periodontal surgery ,surgical procedure for bone
augmentation or placement of implants.
• Determination of amount of bone available in the anterior area
below the floor of nasal cavity - for implant placement.

40. AGE CHANGES IN MAXILLA
• AT BIRTH OR IN INFANTS :
1. transverse and anteroposterior diameter > vertical
2. Body consist of little more than alveolar process
3. Tooth sockets close to orbit
4. Maxillary sinus is mere furrow
• ADULTS :
1. More vertical diameter
2. Developed alveolar process
3. Increased size of maxilary sinus
• IN OLD :
1. Resorption of alveolar bone
2. Maxillary sinus pneumatization and thus resulting in
exposure of roots through the bony floor into the sinus.

41. Arterial supply of maxilla and mandible
• Blood supply of the maxilla. (A) Nasopalatine artery, (B)
Descending palatine artery, (C) Greater palatine artery, (D)
Lesser palatine artery, (E) Maxillary artery, (F) Ascending
pharyngeal artery, (G) Ascending palatine artery, (H) Facial
artery, (I) External carotid artery, (J) Le Fort I downfracture.

42. ARTERIAL SUPPLY
• The pterygoid plexus is a venous plexus of considerable size,
and is situated between the temporalis muscle and lateral
pterygoid muscle, and partly between the two pterygoid
muscles.

43. • Greater Palatine Artery: beware with a shallow palatal vault
• Nasal Palatine Artery: usually not a problem
• Pterygoid Plexus of Veins: PSA injections
• Mental Vessels
• Inferior Alveolar and Lingual Artery (and branches): rare but
potentially catastrophic
Local measures in haematoma:
• Pressure
• Local anesthetic with epinephrine
• Electrocautery
• Oxidized Cellulose (Surgicel)
• Absorbable Collagen Sponge (Gelfoam)
• Collagen Plug (Collaplug)
• Bone wax
• Bone punch/crush
• Acrylic stent
• Ligation

44. • Nerve injury :
• Usually lingual or mental nerve
• Mucoperiosteal flaps are rarely elevated to level of mental nerve
• Atrophy of mandibular ridge should be taken into account
• The mental nerve can be visualized and isolated if necessary
• Lingual nerve injuries are rare with proper surgical technique and
good judgement
• Diagnosis of IAN injury should be done based on the patient’s
complaints and clinical symptoms, in combination with different
techniques. Patients’ sensations vary from case to case. Nerve injury
can lead to anaesthesias, paraesthesias, and dysaesthesias. As has
been already mentioned, timing in such circumstances is of high
importance. Moreover, Khawaja and Renton [5] made a conclusion
based on 4 case studies: early removal of implants associated with
IAN injury (less than 36 hours post-injury) may assist in minimising
or even resolving IAN neuropathy, while delayed diagnosis and
removal

45. TEMPOROMANDIBULAR JOINT
• bilateral synovial articulation between the temporal bone of
the skull above and the mandible below
• Sensory innervation - auriculotemporal and masseteric
branches of trigeminal nerve
• Blood supply - ECA

46. • unilateral mastication due to chronic periodontitis could
induce pain and structural TMJ changes , if adequate treatment
is not administered and supported within a short time from the
onset of the condition.
• Therefore, immediate treatment of chronic periodontitis is
recommended to prevent the primary progress of periodontal
disease and secondary TMJ-related problems.
• subjects who have suffered chronic long-term periodontitis
without treatment should be urged to undergo a TMJ
examination.
• Wide mouth opening for long period of time can cause
subluxation
Jeon HM, Ahn YW, Jeong SH, et al. Pattern analysis of patients with
temporomandibular disorders resulting from unilateral mastication due to
chronic periodontitis. J Periodontal Implant Sci. 2017;47(4):211–218.
doi:10.5051/jpis.2017.47.4.211

47. EXOSTOSES
• Exostosis is bony hamartomas, which are asymptomatic,
benign, exophytic nodular outgrowths of dense cortical bone
that are relatively avascular.
• They are mainly of two types: Buccal and palatal exostosis.
These benign growths affect both the jaws.
Chandna S, Sachdeva S, Kochar D, Kapil H. Surgical management of the bilateral maxillary buccal exostosis. J Indian Soc
Periodontol. 2015;19(3):352–355. doi:10.4103/0972-124X.152412

48. • Indications for removal of exostoses :
1. Exostoses hindering removal of plaque by the patient.
2. Improve prognosis of neighbouring teeth.
3. Inability to comfortably wear removable prosthesis.
4. Interfering with speech and deglutition.
5. Traumatized mucosa over torus.
Scott D. Bennett, in Diagnosis and Management of Lameness in the Horse
(Second Edition), 2011

49. MUSCLES
• Several muscles can be encountered when performing
periodontal and implant flap surgery, particularly during
mucogingival surgery and implant placement.
• Provide mobility to lips and cheeks.
Mentalis
Depressor labii inferioris
Depressor angulii oris
Buccinator muscle

51. ANATOMICAL SPACES
• Potential spaces that become opened or expanded by invading
infection that intervenes between the structures surrounding
the space.
• They may serve as pathways for spread of infection from one
region to other.
Primary
spaces
Submental
submandi
bular
Secondary
spaces
massetric
pterygoman
dibular
Superfacial and
deep temporal

52. o Massetric space :
• located between the lateral aspect of the mandible and the
medial aspect of the masseter muscle and its investing fascia.
• Sometimes mandibular fractures in the region of the angle of
the mandible may cause an infection of the submasseteric
space.
• pericoronal abscess associated with an impacted mandibular
third molar (lower wisdom tooth) when the apices of the tooth
lie very close to or within the space

53. • Clinical features :
1. swelling of face
2. severe trismus
3. pain
4. difficulty and discomfort when moving tongue and
swallowing
Rai A, Rajput R, Khatua RK, Singh M. Submasseteric abscess: A rare head and
neck abscess. Indian J Dent Res 2011;22:166-

54. o Canine space :
• Infra orbital space.
• paired on either side.
• It is located between the levator anguli oris muscle inferiorly
and the levator labii superioris muscle superiorly.
• infections originating from the maxillary canine tooth

55. • Clinical features :
1. Swelling of upper lip obliterating nasolabial fold
2. Also upper and lower eyelids which closes the eye.
Muhammad H. Chandha*Canina fossa abscess and treatment.Journal of
Dentomaxillofacial Science Number 1: 54-57

56. o Buccal space :
• Buccinator space
• Infections originating in either maxillary or mandibular teeth
can spread into the buccal space, usually maxillary molars
(most commonly) and premolars or mandibular premolars.
Textbook Of Oral And Maxillofacial Surgery. Malik Neelima Anil

57. • Clinical features :
1. Swelling of cheek extending to temporal space or
submandibular space
Ansari MK, Amjad S, Alam S, Rahman T (2018) Management of Odontogenic
Buccal Space Infection in Patient with Severe Hemophilia A - Case Report. Int
Arch Oral Maxillofac Surg 2:008.. doi.org/10.23937/iaoms-2017/171000

58. • The palatal abscess typically represents the palatally directed
drainage of an infection of pulpal or periodontal origin. The
most common source is from the involvement of a palatal root
of a maxillary molar tooth.
Sumer AP, Celenk P. Palatal abscess in a pediatric patient: report of a case. Eur J
Dent. 2008 Oct;2(4):291-3

59. o Submandibular space :
• paired on either side.
• located on the superficial surface of the mylohyoid muscle
between the anterior and posterior bellies of the digastric
muscle.
• roots of the posterior teeth are more likely to be below
mylohyoid than above.
• TT : incision and drainage. The site of the incision is extra-
oral, and usually made 2–3 cm below, and parallel to, the
inferior border of the mandible

60. Stevan H. Thompson, Alison Y.
Yeung.Anatomy Relevant to Head, Neck,

61. • Clinical features :
1. Pain on swallowing
2. Ludwig angina : severe form of infection
extends to submental and sublingual space
hardening of floor of mouth
asphyxiation from edema of neck and glottis

62. o Sublingual space :
• located below the mouth and above the mylohyoid muscle,
and is part of the suprahyoid group of fascial spaces.

63. • Clinical features :
1. Raised floor of mouth
2. Displaces tongue
3. Pain
4. Difficulty in swallowing
5. Little facial swelling
Brad W. Neville DDS, ... Angela C. Chi DMD, in Color Atlas of Oral and
Maxillofacial Diseases, 2019

64. o Submental space :
• located between the mylohyoid muscle superiorly, the
platysma muscle inferiorly, under the chin in the midline.
• Odontogenic infection of the mandibular anterior teeth .
• If the level at which the infection breaks out of the mandible is
below the attachment of the mylohyoid, then it will spread into
the submental space.

65. • Clinical features :
1. A firm swelling below the chin.
2. dysphagia (difficulty swallowing).
3. Treatment : surgical incision and drainage, with the incision
running transversely in a skin crease behind the chin.

66. • All these anatomic spaces are found close to operative field of
periodontal and implant surgery sides.
• But they can be easily distended by haemorrhage,
inflammatory fluid and infection.
• surgical invansion results in dangerous hemorrhage (intra
operative) and infection (post operative )

67. CONCLUSION
• A sound knowledge of the anatomy of the periodontium and
the surrounding hard and soft tissue structures is essential to
determine the scope and possibilities of periodontal and
implant surgical procedures and to minimizw their risks.
• The spatial relationship of bones, muscles , blood vessels and
nerves as well as the anatomic spaces located in the vicinity of
periodontal or implant surgical field is important

68. REFERENCES
• Newman and Carranza's Clinical Periodontology - 13th
Edition.
• B D Chaurasia's Human Anatomy 4 Volume Set
• Ki-Tae Koo, Jang-Yeol Park Clinical presentation of a horse-
derived biomaterial and its Biocompatibility: A Clinical Case
Report.DOI: 10.5051/jkape.2009.39.S.287
• Truong MK, He P, Adeeb N, Oskouian RJ, Tubbs RS, Iwanaga
J. Clinical Anatomy and Significance of the Retromolar
Foramina and Their Canals: A Literature Review. Cureus.
2017;9(10):e1781. Published 2017 Oct 17.
doi:10.7759/cureus.1781

69. • Scott D. Bennett, in Diagnosis and Management of Lameness
in the Horse (Second Edition), 2011
• Rai A, Rajput R, Khatua RK, Singh M. Submasseteric abscess:
A rare head and neck abscess. Indian J Dent Res 2011;22:166