PMC2743198_01
23-year-old female, exhibiting a swelling involving the entire right side of the cheek and floor of the mouth.
CRM2009-231947.001.jpg
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fig1
Asymmetry of the face was very conspicuous (Figure 1).
(a) Oral Pantogram showing the impacted third molar on the right lower jaw (arrow head). (b) The denta scan of the lower jaw showing the horizontal lying impacted third molar (arrow).
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fig2
The radiograph and the CT scan revealed the right third molar tooth impacted lying horizontally, deep within the mandibular bone (Figure 2).
(a) and (b) CT scan of the soft tissue showing a diffused swelling involving the carotid and digastric triangle on the right side (*). (c) The swelling extending into the retropharyngeal space on the right side (*).
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fig3
A diffused swelling confined to the right side of the floor of the mouth, which extended into the oropharynx and retropharyngeal space, was observed (Figures 3(a), 3(b), and 3(c)).
(a) Inability to protrude the tongue and on effort protrusion, the tongue deviated to the right. (b) Impacted third molar extracted. (c) Improvement within two weeks of extraction.
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fig4
She felt extreme difficulty in protruding her tongue, and on extreme effort to protrude the tongue, it showed deviation to the right side, almost to a right angle (Figure 4(a)). The impacted tooth was extracted (Figure 4, Binbox). After two weeks the patient showed tremendous recovery in the hypoglossal nerve function, not only the tongue deviation to the right had lessened but also she could push it to the left side too (Figure 4(c)).