A 30-year-old man presents with rapidly progressive bilateral submandibular swelling, trismus, drooling, and difficulty pushing the tongue forward. He is febrile with brawny induration of the submental and sublingual regions. The most frequent odontogenic source of this infection is which tooth?

• A Lower incisor
• B Lower second molar ✓
• C Upper third molar
• D Lower canine

Explanation

Ludwig angina is cellulitis of the submandibular, sublingual, and submental spaces, and its roots lie in infected lower molars. The apex of the lower second molar, like the third molar, lies below the level of the mylohyoid line, so pus spreads directly into the submandibular space and then across the midline. Lower incisor and canine apices lie above the mylohyoid line, so their infections drain into the sublingual space alone. Upper teeth drain into other fascial compartments.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.