Ludwig Angina — ORE Part 1 MCQ

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ModerateOral SurgeryLudwig AnginaORE Part 1

A patient presents with a large swelling in the floor of the mouth crossing the midline. There is tongue elevation and difficulty swallowing. The patient has a temperature of 39°C. What is the most likely diagnosis?

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Correct answer: D — Ludwig angina

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as D · D = shown as E

Ludwig angina is a rapidly spreading, life-threatening cellulitis of the floor of the mouth involving three compartments—sublingual, submental, and submandibular—bilaterally. The key discriminating features in this case are: (1) swelling crossing the midline (bilateral/multispatial involvement), (2) fever (39°C, indicating acute infectious cellulitis), and (3) tongue elevation and dysphagia (classic inflammatory signs). Ranula (B) is a painless, slow-growing mucous cyst without fever or acute inflammation. Sublingual-only abscess (C) would be unilateral and localized. Duct stone (D) causes obstruction but not this acute bilateral pattern. Carcinoma (E) is slowly progressive, not acutely febrile. Fever combined with bilateral midline-crossing submandibular and sublingual swelling is pathognomonic for Ludwig angina and requires urgent airway assessment and broad-spectrum antibiotics ± surgical drainage.

Reference: Atypical Presentation of Ludwig Angina: Diagnostic and Therapeutic Complications in a Rare Case. Cureus. 2025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745298/ and Diagnosis and management of Ludwig's angina: An evidence-based review. PubMed 2021. https://pubmed.ncbi.nlm.nih.gov/33383265/