Question:medium
This patient gives a history of toothache for one week. What is the diagnosis?
This patient gives a history of toothache for one week. What is the diagnosis?
Show Hint
A week of toothache leading to a hard floor-of-mouth swelling that lifts the tongue points to one space infection.
Updated On: Jun 23, 2026
- Acute parotitis
- Angioneurotic edema
- Ludwig's angina
- Parapharyngeal abscess
Show Solution
The Correct Option is C
Solution and Explanation
Link the toothache to the space. A spreading, firm swelling of the floor of the mouth and submandibular area after a week of dental pain is Ludwig's angina, a cellulitis of the submandibular space whose commonest cause is dental caries.
Anatomy pearl: the mylohyoid (oral diaphragm) splits the submandibular space into the sublingual space above and the submaxillary and submental spaces below. Infection from a premolar drains into the sublingual space, while carious molars seed the submaxillary space; either way the tongue is pushed up and back, threatening the airway.
Elimination: acute parotitis gives a tender swelling over the angle of the jaw and cheek with pus at the Stensen duct, not the floor of the mouth; angioneurotic (angioneurotic) oedema is a sudden, painless, allergic swelling of lips and face with no dental trigger; a parapharyngeal abscess presents as a lateral neck mass with medial bulging of the pharyngeal wall. The dental origin plus brawny floor-of-mouth swelling confirms Ludwig's angina, option C. Ref: Scott-Brown's Otorhinolaryngology, 8e, Vol 3, p.628.
Anatomy pearl: the mylohyoid (oral diaphragm) splits the submandibular space into the sublingual space above and the submaxillary and submental spaces below. Infection from a premolar drains into the sublingual space, while carious molars seed the submaxillary space; either way the tongue is pushed up and back, threatening the airway.
Elimination: acute parotitis gives a tender swelling over the angle of the jaw and cheek with pus at the Stensen duct, not the floor of the mouth; angioneurotic (angioneurotic) oedema is a sudden, painless, allergic swelling of lips and face with no dental trigger; a parapharyngeal abscess presents as a lateral neck mass with medial bulging of the pharyngeal wall. The dental origin plus brawny floor-of-mouth swelling confirms Ludwig's angina, option C. Ref: Scott-Brown's Otorhinolaryngology, 8e, Vol 3, p.628.
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