In Ludwig's angina (bilateral submandibular space infection), the infection spreads preferentially because the mylohyoid muscle acts as a barrier. Pus below the mylohyoid spreads into which space?

• A Sublingual space into submandibular space, then inferiorly to paravisceral neck ✓
• B Pterygomandibular space
• C Parapharyngeal space
• D Submental space only

Explanation

In Ludwig's angina, odontogenic infection (commonly mandibular second or third molars) initially enters the sublingual space (above mylohyoid), then spreads through the mylohyoid into the submandibular space (below mylohyoid). From there it can spread posteriorly into the retropharyngeal space and then inferiorly into the mediastinum — a life-threatening complication. The mylohyoid acts as the floor of the mouth; its posterior free border allows communication between sublingual and submandibular spaces without a true anatomical barrier.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.