A 25 year old patient complaints of fever, chills and pain in relation to lower left tooth region. On examination the patient has bilateral swelling and induration in the floor of the mouth, with protruding tongue. Bilateral submandibular nodes are palpable. Intraorally the patient has a deep caries lesion in relation to 37. What is the likely diagnosis?

a. Angioedema

b. periapical abscess

c. Ludwig's angina

d. Masseteric space infection

Ans: Ludwig's angina

Ludwig’s angina is a diffuse cellulitis in the submandibular, sublingual, and submental spaces, characterized by its propensity to spread rapidly to the surrounding tissues.

It is characterised by swelling, pain, elevation of the tongue, malaise, fever, neck swelling, and dysphagia, the submandibular area can be indurated, sometimes with palpable crepitus. Inability to swallow saliva and stridor raise concern because of imminent
airway compromise.

The majority of cases of Ludwig's angina are odontogenic in etiology, primarily resulting from infections of the second and third molars. Other causes include peritonsillar or parapharangeal abscesses, mandibular fractures, oral lacerations/piercing or submandibular sialadenitis, and oral malignancy