January 26, 2025

A 27-year-old man with pain, fever, marked swelling in the jaw, and inability to open mouth

By Med-Challenger · 1 minute read

A 27-year-old man is admitted with pain, fever, marked swelling in the jaw, and an inability to open his mouth for 14 hours. His temperature is 102.8°F, pulse is 100 beats/minute, blood pressure is 110/70 mm Hg, and respiratory rate is 23 breaths/minute. Mouth opening is limited. There is prominent induration of the swelling in the mandible (see figure).

image (71)

The most likely origin of this patient’s condition is which of the following?

peritonsillar abscess
odontogenic infection
infectious thyroiditis
suppurative parotitis

The correct answer is:

odontogenic infection

The patient has Ludwig angina, which is a loose term that refers to a bilateral submandibular infection, characterized by "woody" or prominent induration, but usually without abscess formation. The infection most commonly arises from an odontogenic source, but it may also occur from peritonsillar abscess or suppurative parotitis. Patients typically present with fever, chills, drooling, and dysphagia. Treatment includes protection of the airway and antibiotics. Surgery may be necessary if fluid collections develop.

References:

Barton ED, Bair AE. Ludwig's angina. J Emerg Med. 2008;34(2):163-169.

Boscolo-Rizzo P, Da Mosto MC. Submandibular space infection: a potentially lethal infection. Int J Infect Dis. 2009;13(3):327-333.

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