PMC6881580_01
(a) Initial clinical aspect showing swelling in the submandibular region. (b) Panoramic radiograph taken after removal of the left mandibular third molar.
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A 37-year-old male patient presented at the emergency service of oral and maxillofacial surgery of a private hospital in Recife, Brazil, with complaints of a painful hard swelling in the submandibular region (Figure 1(a)). He had undergone extraction of the left third molar seven days before presentation (Figure 1(b)).
Computed tomography axial view showing the initial aspect of the patient's face.
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A computed tomography revealed a hypodense image in the submandibular region accompanied by the presence of gas in their interior (Figure 2).
(a, b) Computed tomography of the face and cervical region revealing soft tissue enlargement associated with subcutaneous emphysema between muscular planes. Purulent mediastinal collections with gaseous contents and tracheal deviation can be seen.
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A new contrast-computed tomography of the face, neck, and chest clearly showed the presence of a purulent collection in pharyngeal spaces, with a descending path to the mediastinum and marked deviation of the trachea (Figure 3).
Submandibular incision and purulent collection drainage.
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In view of the emergency situation, after antisepsis of the region, bilateral drainage of the submandibular and submental regions, and tissue divulsion, irrigation with copious amounts of 0.9% saline solution to serve as drainage orifices was performed on the 5th day of hospitalization (Figure 4).