This is a 52-year-old male patient with medical history of controlled hypertension and chronic kidney disease stage V of 6 years of evolution in hemodialysis 3 times a week begins with dysphagia, JoseGO's jawbone area and upper limb volume.
The physical examination revealed sclera iccas, an increase in severe volume with predominance of bilateral submental and submandibular regions and limited mouth opening of approximately 15 mm.
Intraoral examination revealed partial maxillomandibular edentulism, generalized chronic periodontal disease with grade IV mobility of 3.1 and 4.1, presence of local irritants, halitosis, bilateral increase in volume glomus floor space.
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In conjunction with the departments of Infectious Diseases and Internal Medicine, an empirical treatment with crystalline sodium penicillin of 4,000,000 IU every 6 h is initiated intravenously and aztreonam of 1 g intravenously with daily order.
Computed tomography showed an isodense image in the parapharyngeal space consistent with increased volume, showing decreased lumen of the airways of the cervical region and Ludwig's diagnosis of angina.
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In 10 days of treatment the evolution was torpid.
A reassessment by infectious diseases was performed, which indicated intravenous vancomycin 1 g, a drug that causes significant clinical improvement to the patient.
After a systemic stabilization of the patient, an extraction of 3.1 and 4.1 is performed and a surgical drainage of the sublingual, submandibular and submental spaces is performed. This is achieved through a daily submandibular drainage submandibular saline solution.
The patient receiving antibiotic therapy after surgical drainage and changing the antibiotic therapy showed a decrease in volume increase and stabilization of respiratory rate.
At discharge, all these records reveal a white series of 8,600 U/mm3, a medical history of neutrophils (78%), hemoglobin 9.5 g/dl, hematocrit 32.7% and creatinine 6.8 mg/dl
