Infection of the submandibular space under the tongue, often arising from infection of second or third molars, may cause airway obstruction. This condition is known as:

• A. Ludwig’s angina
• B. Peritonsillar abscess
• C. Epiglottitis
• D. Retropharyngeal abscess

Answer: (A)

Ludwig's angina is a rapidly spreading cellulitis of the floor of the mouth, involving the submandibular and often the sublingual spaces. It most often stems from infection of a mandibular molar, with the infection spreading from the tooth root into these deep neck spaces. The swelling beneath the tongue and in the floor of the mouth can push the tongue upward and backward, narrowing or blocking the airway and creating a true emergency.

Because this is a deep-space infection, securing the airway is the priority, followed by broad-spectrum IV antibiotics and source control. Other head-and-neck infections have different typical locations and presentations: a peritonsillar abscess is around the tonsil and often presents with a muffled voice and unilateral swelling; epiglottitis involves swelling of the epiglottis with drooling and airway distress; a retropharyngeal abscess lies behind the pharynx and often features neck stiffness and fever, especially in children.