Saif ud din Khawaja.
Unresolving Submandibular Swelling Following Enucleation of Dermoid Cyst in Mouth Floor.
J Coll Physicians Surg Pak Jan ;11(6):392-3.

A young patient, who had enucleation of dermoid cyst in the floor of mouth more than seven years ago, developed postoperative complications like persistent bulging out of submandibular region on right side, increase in size of swelling and discomfort during meal and intermittent swelling and pain in throat. He was completely eased after removal of Surgical gauze tightly packed and left erroneously in the submandibular space during surgical procedure in the past.

A 32 years old male with beard presented with persistent swelling at the angle of mandible on right side with throat pain, dysphagia, saltish taste and foul smell in mouth. In the past, he was operated through an extra-oral approach by a transverse incision in the submental region for dermoid cyst. Patient developed a huge neck swelling just after surgery which was considered a postoperative hematoma. On 13th postoperative day, stitches were removed and on squeezing the swollen area, pus was drained out through infected wound. Patient was discharged and advised follow-up. Patient repeatedly consulted the operating surgeon as well as other doctors for unresolved persistent postoperative swelling but could not get permanent relief except that the change of medicines sometimes helped to reduce the pain. On extra-oral examination, enlarged right submandibular salivary gland was palpable, while right side of floor of the mouth was found elevated and edematous on intra-oral examination. Bimanual palpation of the floor of the mouth or affected side did not feel as soft as the other side. External approach by upward pushing of the floor of the mouth on affected side, yielded a whitish creamy material of slightly thick consistency discharge through sinus located in the retromolar region. Dental probe was inserted through the sinus opening to evaluate the depth and nature of the sinus tract. It was felt that the probe stucked up in a mass which caused hindrance in its free movement inside the sinus. When probe was pulled back a soft smooth whitish mass, caught by the probe tip, came out smoothly through the sinus. This whitish mass was `surgical gauze` which was then completely removed and the patient got great relief. Enlargement of submandibular gland and other symptoms also subsided within two weeks.

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