HPI: 49 year old male with a hx of recent flu-like symptoms (fever, cough, rhinorrhea, myalgias) presenting with neck pain, swelling and erythema. 1 week PTA, he was diagnosed with Ludwig’s angina and treated with IV antibiotics and steroids, followed by PO Clindamycin and Medrol pack, but returns now with continuing/worsening symptoms.
BP 100/66 | HR 53 | Temp 98 °F | Resp 18 | SpO2 98%
Pertinent Labs: WBC 18.2
CT: Progression of abscess in the midline floor of mouth 3.6 x 2.4 x 2.3 cm. Secondary myositis of the mylohyoid and anterior belly of digastric muscle. Normal sublingual spaces b/l. Inflammatory change within the subcutaneous tissues of the submandibular and submental spaces.
Think about the etiology of submandibular space infections, complications that may arise, components of a thorough physical exam and workup, and appropriate management.
- Submandibular space infections are most commonly polymicrobial, caused by extension of dental infections
- Airway obstruction and spread of infection to mediastinum are most concerning complications
- Manage cellulitis and small abscesses with antibiotics (usually PCN+beta lactamase inhibitor) for 48 hours and assess response to treatment. Severe/complicated infections managed by open surgical I&D with antibiotics.
- Boscolo-Rizzo, P and Da Mosto, M. Submandibular Space Infection: A Potentially Lethal Infection. International Journal of Infectious Disease, Nov. 2008
- 2. Hamza, S. et al. Deep Fascial Space Infection of the Neck. South Med J. 2003;96(9)
- Tintinalli. 7th Edition. Infections and Disorders of the Neck and Upper Airway