The patient is a 30 year old female patient who comes to the emergency department of CBMF-HGO in general condition presenting with dyspnoea, dysphagia, odynophagia, tachypnoea, dysphonia, limitation of mouth opening to 15 mm, increased volume in the submandibular region extending to the anterior cervical and right supraclavicular region, painful on palpation and with local hyperthermia.

Intraoral clinical examination showed maxillomandibular partial edentulism, unit 4.8 with advanced caries, poor oral hygiene and moderate enlargement of the floor of the mouth leading to glossoptosis. The admission paraclinical reports leukocytosis with 22,800 U/mm3 at the expense of neutrophils (80%), haemoglobin 12 g/dl, haematocrit 35.3% and glycaemia 123 g/dl.
The CT scan showed multiple hypodense images at the level of the sublingual, bilateral submandibular and submentonian space connected to the right supraclavicular and retrosternal region, decreased airway lumen in the cervical and thoracic region with mediastinal displacement to the left.

Definitive diagnosis: Ludwig's angina complicated with mediastinitis. In consultation with the Infectious Diseases and Internal Medicine departments, intravenous antibiotic treatment was started with vancomycin 1 g every 12 hours, clindamycin 600 mg every 8 hours and meropenem 1 g every 8 hours. Surgical drainage of the submandibular, bilateral sublingual and submentonian spaces was performed, communicating them and proceeding to the placement of a passive penrose-type drain. Given the cervicothoracic extension, the General Surgery team complemented the surgical drainage in the right supraclavicular region, leaving a penrose drain in the same way. Three daily lavages were performed with 1,000 cc of saline solution.
Following the surgical procedure and the therapy implemented, the patient improved clinically, with evidence of a decrease in the increase in volume and the re-establishment of the airway lumen on control CT scans. Two weeks after the surgical drainage, on presenting laboratory values of white blood cells with 6,580 U/mm3, haemoglobin of 12.8 g/dl, haematocrit of 39.6% and clinical improvement of the initial symptoms, discharge from the Oral and Maxillofacial Surgery Unit was decided.

