Ludwig's angina from odontogenic infection — ORE Part 1 MCQ

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HardOral SurgeryLudwig's angina from odontogenic infectionORE Part 1

A 49-year-old man with uncontrolled diabetes presents with bilateral submandibular swelling after lower molar pain. He has drooling, dysphagia, a raised tongue, fever and a muffled voice. Oxygen saturations are 93% on air and he cannot lie flat. What is the most likely diagnosis?

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Reveal the answer and explanation

Correct answer: C — Ludwig's angina

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

This is Ludwig's angina (answer B). The diagnosis is made clinically in a patient with bilateral submandibular swelling, elevation of the floor of the mouth and tongue, and airway obstruction signs. It classically arises from odontogenic infection of the lower molars in immunocompromised patients (diabetes here) and spreads bilaterally as a diffuse cellulitis involving the sublingual, submandibular, and submental spaces. The clinical red flags—drooling, dysphagia, muffled voice, hypoxia (93%), inability to lie flat—indicate immediate airway compromise, making this a surgical emergency. Option A (localised periodontal abscess) is unilateral and localized, incompatible with bilateral swelling and systemic airway involvement. Option C (alveolar osteitis) is a post-extraction inflammatory condition without airway signs. Options D and E are mucosal ulcerative conditions that do not cause bilateral cellulitis or systemic sepsis.

Reference: Ludwig's Angina - PubMed (2024/2025 case series and reviews); SDCEP Oral Surgery guidance; BDA Emergency Protocols, https://pubmed.ncbi.nlm.nih.gov/38445409/