This document discusses infections of the submandibular space, which is divided into two compartments by the mylohyoid muscle. Dental infections are the most common cause, with roots above or below the mylohyoid muscle leading to sublingual or submaxillary infections, respectively. Symptoms include odynophagia, trismus, and swelling of the submental and submandibular regions. Treatment involves systemic antibiotics, incision and drainage of any abscesses either intraorally or externally, and tracheostomy if the airway is endangered. Complications can arise from spread of infection or airway obstruction.

1. Malik Jauhar
Pre-Final MBBS
Dept. of ENT, ASCOMS

2. Infection of the Submandibular space

3.  Between mucous membrane of the floor of mouth and
tongue on one side and superficial layer of deep cervical
fascia (extending between the hyoid bone and mandible) on
the other.
 2 compartments (divided by the Mylohyoid muscle):
1. Sublingual Compartment
above the Mylohyoid.
2. Submaxillary and
Submental Compartment
below the Mylohyoid.
Compartments are continuous
around the posterior border of
Mylohyoid muscle.

4.  Dental infections: 80% cases
 Roots of premolars often lie above the attachment of
mylohyoid and cause sublingual space infection.
 Roots of molar teeth extend up to or below the
mylohyoid line and cause submaxillary space infection.

5.  Submandibular sialadenitis
 Injuries of oral mucosa
 Fractures of the mandible

6.  Commonly mixed infections involving both
aerobes and anaerobes
 Commonly Alpha-hemolytic Streptococci,
Staphylococci and bacteroides group
 Rarely Haemophilus influenzae, Escherichia coli
and Pseudomonas

7.  Odynophagia with varying degrees of trismus.
 In localized sublingual infection:
Structures in the floor of mouth are swollen
and tongue seems to be pushed up and back.
 In submaxillary space involvement:
Submental and submandibular regions become
swollen and tender, and impart woody-hard feel.
 Usually there is cellulitis rather than frank abscess.
 Tongue is pushed upwards and backwards
threatening the airway.
 Laryngeal oedema.

9. 1. Systemic antibiotics
2. Incision and drainage of abscess.
Intraoral—if infection is still localized
to sublingual space.
External– if infection involves
submaxillary space. A transverse incision
extending from one angle of mandible to the
other is made with vertical opening of midline
musculature of tongue with a blunt haemostat.
Very often it is serous fluid rather than frank
pus that is encountered.
3. Tracheostomy, if airway is endangered.

10.  Spread of infection to parapharyngeal and
retropharyngeal spaces and thence to
mediastinum.
 Airway obstruction due to laryngeal oedema,
or swelling and pushing back of the tongue.
 Septicaemia.
 Aspiration pneumonia.

12. Thank You