Presentation
Recent tooth extraction, worsening anterior neck pain and swelling, fevers.
Patient Data
Recent extraction of 46 as evidenced by an empty socket. A defect in the inner mandibular surface is noted which communicates with the socket.
Extensive necrotizing soft tissue infection of the floor of the mouth with trans-spatial involvement of deep spaces of the neck. Large peripherally-enhancing, fluid and gas-containing collection involving the right submandibular spaces. This extends superiorly to the right parapharyngeal fat space and right carotid space at the level of the nasopharynx, laterally to the right masticator space, and inferiorly through the right visceral space, anterior cervical space and carotid space. Gas is seen dissecting through the soft tissue planes posterior to the right sternocleidomastoid muscle and posterior to the right clavicle into the right axilla. Gas is seen insinuating between the right hemithyroid and right common carotid artery.
Associated airway displacement and multifocal narrowing of the hypopharynx and larynx.
Fat stranding is seen extending inferiorly to the retro-manubrial region/superior mediastinum, with no organized collection. Gas extends to the level of the thyroid gland.
No vascular occlusion.
Multiple reactive cervical lymph nodes.
No confluent airspace consolidation.
Case Discussion
Severe case example of Ludwig's angina, with rapidly progressive necrotizing fasciitis. Patient proceeded to urgent surgical debridement and required a tracheostomy.
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