Unusual foreign body in submandibular space



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CASE REPORT : FOREIGN BODY IN SUBMANDIBULAR SPACE :

Dr. Anjana Agrawal, Dr. Rashmi Shukla, Dr.Gurchand Singh

DEPT. OF E.N.T, R.D. GARDI MEDICAL COLLEGE, UJJAIN

Abstract:

A rare case report of submandibular space infection secondary to a vegetative foreign body ( stalk of wheat crop ) which penetrated the floor of mouth to reach the submandibular space and resulted in the formation of abscess. The abscess was drained and the stalk of wheat measuring 2.5 cms in length, removed in toto.



Keywords : foreign body, submandibular space, wharton’s duct

Introduction :

Lodgement of a vegetative foreign body in Submandibular space is a rare case.

In chronic and advanced inflammatory process due to foreign body in the gland itself or in the Wharton’s duct, submandibular gland excision is mandatory. This case is reported as submandibular abscess due to lodgement of a stalk of wheat crop, in the submandibular space penetrating into the submandibular gland.

The pathology was attributed to the entry of the straw of wheat crop into the mouth with subsequent migration of the stalk into the submandibular space through the floor of mouth as a result of masticatory movements.



Case Report :

A 40 years old female, farmer by occupation , presented with the complaints of a swelling in the left submandibular region of neck of 15 days duration with pain in the swelling for last 10 days. She gave history of entry of a stalk of wheat crop into the mouth 20 days back while she was cutting the crops. Patient tried to manually remove the stalk with her finger and possibly pushed it deeper, as a result of which the stalk penetrated the floor of mouth and reached the submandibular space. There was no history of increase in the size of swelling during meals.

On local examination, there was a firm, tender, immobile swelling of size 5 X 4 cms in the left submandibular region. The swelling had smooth surface, diffuse margins, raised temperature.

On examination of oral cavity, there was slight edema and congestion in floor of mouth. No ulcer or entry point seen.

Other relevant ENT examination was normal.

FNAC of the swelling was suggestive of an abscess.



The Ultrasonography report showed a hyperechoic foreign body in the left submandibular space penetrating the submandibular gland which was surrounded by oedema and abscess.

Figure 1 : USG showing FB in submandibular space penetrating the submandibular gland

Patient was started on intravenous antibiotics and anti inflammatory drugs. The swelling subsided in 4 days.

Then the patient was planned for surgical removal of the foreign body under general anaesthesia. A fragment of vegetable crop of length about 2.5 cms was found embedded within the submandibular space penetrating the submandibular gland surrounded by abscess.



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