A foreign body in the floor of the mouth
Article Outline
Abstract
A case of unusual presentation of foreign body in the floor of mouth is reported. The patient presented with a history and clinical findings of sublingual ranula. Marsupialisation and sublingual sialadenectomy was planned. After marsupialisation, a foreign body (spray cover) was found between the lumen of the submandibular duct and the ranula.
Keywords: Foreign body, Submandibular duct, Marsupialisation, Ranula
1. Introduction
Foreign body in the floor of mouth is a very uncommon incidence. Review of literatures revealed unusual foreign bodies that induced different presentations. Examples of foreign bodies were wooden stick (Aniece et al., 2005), aluminium silicate (González-García et al., 2007) and black plastic tape (Iqbal et al., 2007). Presentation of foreign body in floor of mouth ranged from asymptomatic discovery, pain, swelling and recurrent infection in submandibular gland region (Iqbal et al., 2007). In our case, the foreign body presented itself as simple sublingual ranula.
In this report, we presented a case of simple sublingual ranula that was planned to be treated by marsupialisation and sublingual gland sialadenectomy. The plan changed perioperatively, as we discovered the neglected unusual foreign body (spray cover).
2. Case presentation
A 23
years old Saudi male patient presented to our clinic with translucent painless sublingual midline swelling, dated back to 5–7months (Fig. 1). Patient was medically fit and well with unknown allergy to medications. There was no history of trauma or symptoms suggestive of salivary gland disease. The swelling showed all features of being simple sublingual ranula. It was a cystic midline lesion 2×2cm with normal overlying mucosa. Bi-digital palpation of submandibular glands revealed no abnormal palpable masses. We noticed diminished salivary flow from right Wharton’s duct. A palpable, hard non tender small lump within right floor of mouth about 0.5×0.5cm was felt. The lump was freely mobile within the loose connective tissue in the floor of mouth.
Figure 1.
Sublingual ranula.
OPG and lower occlusal film revealed no abnormalities (Fig. 2). Complete blood investigations were requested to prepare the patient for surgery. Plan was to marsupialize the sublingual ranula with sublingual sialadenectomy and to explore the nature of the small hard swelling in right side of the floor of mouth.
Figure 2.
Occlual film shows no evidance of radio-opaque lesion in the floor of the mouth.
Patient was anaesthetized via nasal endotracheal intubation. Stay suture was taken from the tip of tongue to soft palate area to retract tongue upward and backward. Surgery started by bilateral horizontal incision at floor of mouth parallel to submandibular duct course. Submandibular ducts were dissected bilaterally and kept at lateral part of surgical field by two stay sutures. Dissection of Wharton’s ducts was facilitated by insertion of two fine lacrimal probes that kept in situ by purse string suture around the distal part of dissected ducts.
All branches of lingual nerve in area were dissected and retracted away from the surgical field. Conventional marsupialisation was carried out for the cystic lesion in sublingual region. Exploration of the right sublingual area revealed a white coloured foreign body; spray cover (Figure 3, Figure 4). The foreign body was in intimate relation to the lateral wall of the ranula while in medial location to right submandibular duct. The spray cover was removed. After proper haemostasis, translocation with marsupialisation of the terminal portion of Wharton’s ducts was achieved using loop magnification 2×. Sublingual sialadenectomy was cancelled. Approximation of mucosal edges using 4/0 vicryl. Patient showed uneventful postoperative recovery, discharged from hospital next day with oral antibiotics, analgesics for two days and follow up appointments.
Figure 3.
Foreign body in the floor of the mouth.
Figure 4.
Spray cover was retrieved from sublingual region.
On follow up appointments, the wound in the floor of the mouth showed satisfactory healing with no evidence of local complications. Patient was scheduled for follow up appointment every month for one year.
3. Discussion
Foreign bodies may be ingested, inserted into a body cavity or deposited into the body by a traumatic or iatrogenic injury. Motor vehicle accidents, assaults, bullet wounds and iatrogenic surgical fault are the most common causes of traumatic foreign bodies. Tissue reactions to foreign bodies are commonly encountered in the oral cavity (Hunter and Taljanovic, 2003, Stewart and Watson, 1990). Usually, history taking reveals the nature of the foreign body. Introduction of the foreign body into the floor of the oral cavity may cause initial local pain, stay inert (asymptomatic), induce local abscess formation or spread down to produce deep neck space infection (Danforth and Brown, 1963). In our case, the patient stated, postoperatively, that he was found at the age of 7years with unexplained wound under his tongue. No investigations were carried out to reveal the cause of such trauma. Our explanation that the spray cover was introduced accidentally into the floor of the mouth and remained embedded in its location. Apparently, it induced injury to minor salivary glands or more commonly to the right submandibular gland duct. Slowly over the years, extravasation salivary collection accumulated within the loose connective tissue of the floor of the mouth to produce the unusual presentation of a foreign body as a simple ranula. Operatively, we cancelled the step of sublingual sialadenectomy as we felt that marsupialisation with removal of the foreign body should be enough management for such simple ranula. Marsupialisation of submandibular ducts were achieved to prevent post operative stenosis and to provide free drainage of salivary flow. Lastly, we recommend using loop magnification when managing lesions in the floor of the oral cavity.
References
- . Foreign Body in the Wharton’s Duct, a case report. JK Sci. 2005;7:61–62
- . A foreign body in aetiology of pharyngo-maxillary space abscess. Laryngoscope. 1963;73:1485–1492
- . Migration of aluminium silicate from the oral cavity to the submandibular region, with foreign body granuloma formation: report of a case. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2007;104:45–49
- . Foreign bodies. Radiology. 2003;23:731–757
- . Foreign body in submandibular duct, a case report. JCPSP. 2007;17:626–628
- . Experimental oral foreign bodies’ reactions: Commonly employed dental materials. Oral Surg. Oral Med. Oral Pathol. 1990;69:713–719
PII: S1013-9052(10)00046-5
doi:10.1016/j.sdentj.2010.04.008
© 2010 King Saud University. Published by Elsevier Inc. All rights reserved.
