| Sublingual space | |
|---|---|
 Sublingual space situated deep to mylohyoid muscle | |
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| Anatomical terminology |
The sublingual space is a fascial space of the head and neck (sometimes also termed fascial spaces or tissue spaces). It is a potential space [1] located below the mouth and above the mylohyoid muscle, and is part of the suprahyoid group of fascial spaces.
The sublingual space is V-shaped, with the apex pointing to the anterior. Its boundaries are: [2]
The sublingual space communicates posteriorly around the posterior free border of the mylohyoid muscle with the submandibular space. [2] Infections of the sublingual space may also erode through the mylohyoid, or spread via the lymphatics to the submandibular and submental spaces.
The sublingual space contains: [2]
This space may be created by pathology, such as the spread of pus in an infection, e.g. odontogenic infections. A periapical abscess may spread into the sublingual space if the apex of the tooth is above the level of attachment of mylohyoid, and the infection erodes through the lingual cortical plate of the mandible.
Signs and symptoms of a sublingual space infection might include a firm, painful swelling in the anterior part of the floor of the mouth. A sublingual abscess may elevate the tongue and cause drooling or dysphagia (difficulty swallowing). There is usually little swelling visible on the face outside the mouth.
If the space contains pus, the usual treatment is by incision and drainage. The site of the incision is intra-oral, made lateral to sublingual plica. Incision of the plica itself can result in a ranula, or an incision placed medial to the plica can damage Wharton's duct, the sublingual artery and veins and the lingual nerve.
Pathology arising from the sublingual gland is rare, however, sublingual gland neoplasms are predominantly malignant and thus important to recognize.
Ludwig's angina is a serious infection involving the submandibular, sublingual and submental spaces bilaterally. [3] Ludwig's angina may extend into the pharyngeal and cervical spaces, and the swelling can compress the airway and cause dyspnoea (difficulty breathing). [3] Collectively, the submandibular, sublingual and submental spaces are sometimes termed the perimandibular spaces, or the submaxillary space. [4]
The parotid gland is a major salivary gland in many animals. In humans, the two parotid glands are present on either side of the mouth and in front of both ears. They are the largest of the salivary glands. Each parotid is wrapped around the mandibular ramus, and secretes serous saliva through the parotid duct into the mouth, to facilitate mastication and swallowing and to begin the digestion of starches. There are also two other types of salivary glands; they are submandibular and sublingual glands. Sometimes accessory parotid glands are found close to the main parotid glands.
The paired submandibular glands are major salivary glands located beneath the floor of the mouth. In adult humans, they each weigh about 15 grams and contribute some 60–67% of unstimulated saliva secretion; on stimulation their contribution decreases in proportion as parotid gland secretion rises to 50%. The average length of the normal adult human submandibular salivary gland is approximately 27 mm, while the average width is approximately 14.3 mm.
The sublingual gland is a seromucous polystomatic exocrine gland. Located underneath the oral diaphragm, the sublingual gland is the smallest and most diffuse of the three major salivary glands of the oral cavity, with the other two being the submandibular and parotid. The sublingual gland provides approximately 3-5% of the total salivary volume.
Ludwig's angina is a type of severe cellulitis involving the floor of the mouth and is often caused by bacterial sources. Early in the infection, the floor of the mouth raises due to swelling, leading to difficulty swallowing saliva. As a result, patients may present with drooling and difficulty speaking. As the condition worsens, the airway may be compromised and hardening of the spaces on both sides of the tongue may develop. Overall, this condition has a rapid onset over a few hours.
The mylohyoid muscle or diaphragma oris is a paired muscle of the neck. It runs from the mandible to the hyoid bone, forming the floor of the oral cavity of the mouth. It is named after its two attachments near the molar teeth. It forms the floor of the submental triangle. It elevates the hyoid bone and the tongue, important during swallowing and speaking.
The hyoglossus is a thin and quadrilateral extrinsic muscle of the tongue. It originates from the hyoid bone; it inserts onto the side of the tongue. It is innervated by the hypoglossal nerve. It acts to depress and retract the tongue.
A ranula is a mucus extravasation cyst involving a sublingual gland and is a type of mucocele found on the floor of the mouth. Ranulae present as a swelling of connective tissue consisting of collected mucin from a ruptured salivary gland caused by local trauma. If small and asymptomatic further treatment may not be needed, otherwise minor oral surgery may be indicated.
The lingual artery arises from the external carotid artery between the superior thyroid artery and facial artery. It can be located easily in the tongue.
The submandibular duct is one of the salivary excretory ducts. It is about 5 cm long, and its wall is much thinner than that of the parotid duct. It drains saliva from each bilateral submandibular gland and sublingual gland to the sublingual caruncle in the floor of the mouth.
Sialolithiasis is a crystallopathy where a calcified mass or sialolith forms within a salivary gland, usually in the duct of the submandibular gland. Less commonly the parotid gland or rarely the sublingual gland or a minor salivary gland may develop salivary stones.
The buccal space is a fascial space of the head and neck. It is a potential space in the cheek, and is paired on each side. The buccal space is superficial to the buccinator muscle and deep to the platysma muscle and the skin. The buccal space is part of the subcutaneous space, which is continuous from head to toe.
Mouth infections, also known as oral infections, are a group of infections that occur around the oral cavity. They include dental infection, dental abscess, and Ludwig's angina. Mouth infections typically originate from dental caries at the root of molars and premolars that spread to adjacent structures. In otherwise healthy patients, removing the offending tooth to allow drainage will usually resolve the infection. In cases that spread to adjacent structures or in immunocompromised patients, surgical drainage and systemic antibiotics may be required in addition to tooth extraction. Since bacteria that normally reside in the oral cavity cause mouth infections, proper dental hygiene can prevent most cases of infection. As such, mouth infections are more common in populations with poor access to dental care or populations with health-related behaviors that damage one's teeth and oral mucosa. This is a common problem, representing nearly 36% of all encounters within the emergency department related to dental conditions.
The submandibular space is a fascial space of the head and neck. It is a potential space, and is paired on either side, located on the superficial surface of the mylohyoid muscle between the anterior and posterior bellies of the digastric muscle. The space corresponds to the anatomic region termed the submandibular triangle, part of the anterior triangle of the neck.
The submental space is a fascial space of the head and neck. It is a potential space located between the mylohyoid muscle superiorly, the platysma muscle inferiorly, under the chin in the midline. The space coincides with the anatomic region termed the submental triangle, part of the anterior triangle of the neck.
Fascial spaces are potential spaces that exist between the fasciae and underlying organs and other tissues. In health, these spaces do not exist; they are only created by pathology, e.g. the spread of pus or cellulitis in an infection. The fascial spaces can also be opened during the dissection of a cadaver. The fascial spaces are different from the fasciae themselves, which are bands of connective tissue that surround structures, e.g. muscles. The opening of fascial spaces may be facilitated by pathogenic bacterial release of enzymes which cause tissue lysis. The spaces filled with loose areolar connective tissue may also be termed clefts. Other contents such as salivary glands, blood vessels, nerves and lymph nodes are dependent upon the location of the space. Those containing neurovascular tissue may also be termed compartments.
The submasseterric space is a fascial space of the head and neck. It is a potential space in the face over the angle of the jaw, and is paired on each side. It is located between the lateral aspect of the mandible and the medial aspect of the masseter muscle and its investing fascia. The term is derived from sub- meaning "under" in Latin and masseteric which refers to the masseter muscle. The submasseteric space is one of the four compartments of the masticator space. Sometimes the submasseteric space is described as a series of spaces, created because the masseter muscle has multiple insertions that cover most of the lateral surface of the ramus of the mandible.
The pterygomandibular space is a fascial space of the head and neck. It is a potential space in the head and is paired on each side. It is located between the medial pterygoid muscle and the medial surface of the ramus of the mandible. The pterygomandibular space is one of the four compartments of the masticator space.
The canine space is a fascial space of the head and neck. It is a thin potential space on the face, and is paired on either side. It is located between the levator anguli oris muscle inferiorly and the levator labii superioris muscle superiorly. The term is derived from the fact that the space is in the region of the canine fossa, and that infections originating from the maxillary canine tooth may spread to involve the space. Infra-orbital is derived from infra- meaning below and orbit which refers to the eye socket.
The infratemporal space is a fascial space of the head and neck. It is a potential space in the side of the head, and is paired on either side. It is located posterior to the maxilla, between the lateral pterygoid plate of the sphenoid bone medially and by the base of skull superiorly. The term is derived from infra- meaning below and temporal which refers to the temporalis muscle.
Salivary gland diseases (SGDs) are multiple and varied in cause. There are three paired major salivary glands in humans: the parotid glands, the submandibular glands, and the sublingual glands. There are also about 800–1,000 minor salivary glands in the mucosa of the mouth. The parotid glands are in front of the ears, one on side, and secrete mostly serous saliva, via the parotid ducts, into the mouth, usually opening roughly opposite the second upper molars. The submandibular gland is medial to the angle of the mandible, and it drains its mixture of serous and mucous saliva via the submandibular duct into the mouth, usually opening in a punctum in the floor of mouth. The sublingual gland is below the tongue, on the floor of the mouth; it drains its mostly mucous saliva into the mouth via about 8–20 ducts, which open along the plica sublingualis, a fold of tissue under the tongue.