(BMJ)—A man in his mid-50s who had type 2 DM and HTN presented w/ a 4-day hx of fever and worsening neck pain and swelling. In the preceding 12h, sx had progressed to difficulty swallowing and inability to wear dentures. Exam: firm, tender neck swelling; mouth opening reduced to <2 finger breadths; raised floor of mouth; normal vital signs. The pt appeared comfortable when reclining, w/o stridor. What’s the dx?
Ludwig angina
Epiglottitis
Diphtheria
Angioedema
Retropharyngeal abscess
You are correct. CT of the pt’s neck following fiberoptic intubation showed fluid collection involving the L platysma muscle, which confirmed the presence of an abscess. Also present were edema and fat stranding that extended into the submental space, typical of Ludwig angina. The most common cause of this bilateral deep neck infxn of the submandibular space is an infxn of the 2nd or 3rd lower molar tooth. This pt’s only remaining native tooth was his lower L 1st molar. He had intraoral and extraoral drainage of the abscess, and his infected tooth was extracted. He was discharged home 6 days later, following tx w/ IV abx. Ludwig angina is a life-threatening medical and surgical emergency because it can cause rapid airway obstruction if not promptly recognized and treated. Maintenance of a patent airway is the primary objective of initial mgmt.

BMJ 2020;371:m3395