Question

This patient gives a history of toothache for one week. What is the diagnosis?

• A. Acute parotitis
• B. Angioneurotic edema
• C. Ludwig's angina
• D. Parapharyngeal abscess

Hint:

A week of toothache leading to a hard floor-of-mouth swelling that lifts the tongue points to one space infection.

Answer 1

The Correct Option is C

Step 1: A tense, brawny swelling of the floor of the mouth and submandibular region following a week of toothache is Ludwig's angina.
Step 2: It is a rapidly spreading cellulitis of the submandibular space (floor of the mouth), most commonly arising from dental caries, typically of the lower molars. The mylohyoid muscle divides the space into the sublingual (above) and submaxillary plus submental (below) compartments; infection from a premolar enters the sublingual space and from carious molars the submaxillary space.
Step 3: The dental source and bilateral floor-of-mouth swelling that elevates the tongue distinguish it. Acute parotitis swells the cheek over the parotid, angioneurotic oedema is a sudden allergic facial or lip swelling without a dental cause, and a parapharyngeal abscess is a lateral neck and pharyngeal swelling. So the answer is Ludwig's angina, option C. Ref: Scott-Brown's Otorhinolaryngology, 8e, Vol 3, p.628.