Swellings in the angle of Mandible, Floor of Mouth & Palate

Swellings at the angle of Mandible include: ✍🏻👇🏻

🔅Congenital disease

• Branchial Cleft Cyst

🔅Neoplasm

(i) Benign

  • Hemangioma
  • Lymphangioma, Cystic hygroma
  • Pleomorphic adenoma (mixed tumor)
  • Warthin tumor
  • Neurofibroma
  • Angiolipoma
  • Adenoma
  • Hamartoma
  • Lipoma
  • Oncocytoma

(ii) Malignant

  • Mucoepidermoid carcinoma
  • Squamous cell carcinoma
  • Adenoid cystic carcinoma
  • Acinic cell carcinoma
  • Adenocarcinoma
  • Rhabdomyosarcoma
  • Lymphoma, leukemia
  • Metastatic adenopathy

🔅Inflammation/Infection

  1. Parotitis
  2. Parotid Abscess
  3. Tuberculosis
  4. Sarcoidosis
  5. Sjögren disease
  6. HIV

Detailed View🔍

1) Branchial Cleft Cyst:

  • Failure of involution of clefts and pouches lead to cysts, fistulas or sinus tracts.
  • Its a painless fluctuant swelling
  • First branchial cleft cysts are rare usually located at parotid gland or periparotid region.
  • Second branchial cleft cyst – Type II are the most common
  • Typically, second branchial cleft cysts present as a rounded swelling just below the angle of mandible, anterior to the sternocleidomastoid

2) Hemangiomas:

They are the most common benign salivary gland mass. Capillary hemangiomas involve parotids

3) Lymphangiomas

They are congenital malformations of the lymphatic system that may involve the parotid gland (Soft asymptomatic neck mass associated with facial asymmetry)

4) Pleomorphic Adenoma:

Hard painless slow growing mass

5) Warthin Tumor:

Incorporation of heterotopic salivary gland ductal epithelium within intraparotid & periparotid nodes

6) Parotitis & Parotid Abscess:

  • Most common in children
  • Mumps is the most common viral cause of parotitis
  • The condition manifests tender swelling at the angle of Mandible
  • Sialadenitis is most commonly due to bacterial infections caused by Staphylococcus aureus.
  • Premature neonates and immunosuppressed individuals are affected.

Swellings in the floor of Mouth: 👇🏻✍🏻

Ranula presents as a translucent blue, dome-shaped fluctuant swelling & contains viscid, glairy jelly like fluid
  1. Ranula – a type of mucocele found on the floor of the mouth. Present as a swelling of connective tissue consisting of collected Mucin from a ruptured salivary gland by local trauma.
  2. Swellings in the floor of the mouth are more likely to arise from structures above the Mylohyoid muscle. The commonest swellings in the floor of the mouth are denture induced hyperplasia & salivary calculus.
  3. Swellings in the floor of the mouth may inhibit swallowing & speech.
  4. Mandibular tori produce bony hard swelling lingual to the lower premolars.

Differential diagnosis of swellings of the floor of the mouth or neck (Jham et al., 2007): https://www.researchgate.net/figure/Differential-diagnosis-of-swellings-of-the-floor-of-the-mouth-or-neck-Jham-et-al-2007_tbl1_287206404


Swellings on the Palate: 👇🏻✍🏻

  1. Torus palatinus is an intrinsic bone lesion whereas a dental abscess pointing on the palate (usually from the palatal roots of the 1st & 2nd maxillary molars or from upper lateral incisors) is extrinsic.
  2. Salivary neoplasms
  3. Invasive carcinoma from the maxillary sinus may produce a palatal swelling.
  4. Kaposi’s sarcoma, typical of HIV/AIDS may also present as lump on palate.
  5. Paget’s disease.

Differential diagnosis of palatal swellings: https://www.researchgate.net/figure/Differential-diagnosis-of-palatal-swellings_tbl1_221967546

Dentowesome|@drmehnaz🖊


Image source: Google.com

POSTOPERATIVE CARE AFTER DENTOALVEOLAR SURGERY

Good aftercare to prevent complications and unnecessary suffering, with loss of valuable time, is as important as a good operation.

The main purpose of aftercare is to expedite healing and prevent or relieve pain and swelling.

Rest is necessary for the prompt healing of wounds. Ambulatory patients should be directed to go home & remain quiet for several hours, preferably sitting in a comfortable chair or, if lying down, keeping the head elevated on several pillows.

  • Only liquids and soft solids should be eaten the first day. They may be warm or cold but not extremely hot.
  • Food intake should not begin until several hours after surgery to avoid disturbing the blood clot.
  • If the extractions were limited to one side, chewing can be done on the unoperated side, but when local anesthesia has been used, chewing should be avoided until sensation has returned.
  • Fluids should be taken in greater amounts than usual to prevent dehydration from limited food intake.
  • A normal diet should be resumed as soon as possible, since this facilitates healing.
  • The teeth should be brushed as usual, and on the day after surgery rinsing of the mouth should begin.
  • A saline solution (1/2 teaspoon of salt in a glass of warm water) is best for this purpose.
  • Commercial mouthwashes if used should be diluted with water due to the high alcohol content that can irritate the wound.
  • Hydrogen peroxide rinses should not be used initially as this agent can remove the blood clot.❌
  • Some degree of postoperative pain accompanies many exodontic procedures and begins after the effects of anesthetic have left. This is considered a normal response to the unavoidable trauma of surgery.
  • In most cases, such pain lasts no more than 12 to 24 hours, although a traumatic periostitis may persist for several days.
  • Ordinarily this type of pain can be controlled by the use of cold packs (30 minutes per hour) during the first 24 hours & the proper administration of analgesic drugs.
  • For mild pain, as after a routine extraction, one of the antipyretic analgesics is usually adequate.
  • For moderate pain, such as after removal of an impacted tooth, a drug such as codeine or meperidine (Domerol) should be used.
  • Narcotics are needed only in rare instances.
  • The combination of a sedative drug with an analgesic agent can also be used but barbiturate alone should never be used to relieve pain as it can result in mental disorientation in a patient suffering from extreme pain.
  • The degree of swelling that occurs is generally in direct proportion to the degree of surgical trauma.
  • The application of cold to the operated site helps diminish postoperative swelling. If a rubber ice bag is not available, the ice can be placed in a plastic bag.
  • Cold can be applied intraorally by holding an ice cube in the mouth.
  • Pressure dressings can also be beneficial in limiting postoperative swelling.
  • Once swelling has reached the maximum (usually after 24 to 48 hours), cold is no longer effective, and heat, in the form of moist compresses, should be applied. It too should be used only 30 minutes per hour. The area should be lubricated with petroleum jelly to avoid burning the skin.
  • Intraoral heat is achieved by the use of hot isotonic saline rinses.
  • Cigarette smoking should be avoided after tooth extraction because it has been shown to increase the incidence of alveolar osteitis

Dr. Mehnaz Memon🖊


References: Textbook of Oral Surgery – Daniel M Laskin

How to prevent excessive bleeding during Dentoalveolar Surgery❓

Types of bleeding are:

  1. Primary (during or immediately after surgery)
  2. Reactionary (Upto 48 hours due to a defective suture or as clot in the vessels has got disturbed)
  3. Secondary (8-14 days due to wound getting infected and capillaries have eroded surfaces)

To prevent excessive blood loss during surgery we need to understand the source of bleeding i.e. possible reason for bleeding.


Dr. Mehnaz Memon🖊