A 40-year-old diabetic man presents with rapidly progressive bilateral submandibular, submental, and sublingual swelling, trismus, drooling, and a raised floor of the mouth. The immediate priority in management is:

• A Securing the airway ✓
• B Incision and drainage of all involved spaces
• C Extraction of the offending tooth
• D High-dose intravenous penicillin alone

Explanation

This is Ludwig's angina, a rapidly spreading cellulitis of the submandibular, sublingual, and submental spaces, usually odontogenic from a lower second or third molar. Elevation and posterior displacement of the tongue can cause sudden asphyxia, so securing the airway by intubation or tracheostomy takes priority over drainage, antibiotics, or dental extraction, which follow once the airway is safe. Antibiotics alone are inadequate given the speed of progression.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.