0:01

This was a patient who had a palpable

0:03

mass in the floor of the mouth that was

0:06

associated with tenderness and fever.

0:09

And again, we'll start up at the top here.

0:12

We've got a little bit of the, uh, posterior

0:15

pharyngeal structures, a little bit of inflammatory

0:17

disease going on in the maxillary antra.

0:21

The parotid glands look pretty good.

0:23

The palatine tonsils are—

0:25

Uh, look pretty good.

0:26

There are some, uh, small areas of narrowing of the

0:29

airway at the level of the palatine tonsils, and you see

0:33

some irregularity to the palatine tonsillar tissue.

0:37

However, more importantly, we see this

0:39

low-density collection, which has a rim

0:42

around it, and it is in proximity to the

0:45

sublingual gland in the floor of the mouth.

0:50

This was an inflammatory process that

0:52

was drained and had purulent material.

0:54

Differential diagnosis here includes cystic

0:57

lesions within the tongue, which include things

1:00

like epidermoids or thyroglossal duct cysts.

1:03

If this was a little bit closer to the midline,

1:06

we might suggest a thyroglossal duct cyst.

1:08

That, as you can see on the sagittal

1:11

scan, usually occurs a little bit

1:14

more towards the foramen cecum region

1:17

and follows a pathway towards the hyoid bone.

1:21

So this is a little bit too far anterior.

1:23

Here you can see the mylohyoid musculature, which marks

1:26

the floor of the mouth, and we have that collection.

1:30

This ended up being, as I said, a contained

1:33

purulent material and was a Ludwig's

1:36

angina abscess in the floor of the mouth.

1:40

Now, most of the time, Ludwig's angina will

1:42

extend through into the submandibular space.

1:46

In this case, we've got a little bit of enlargement

1:48

of the left submandibular gland compared to the

1:50

right, but not much in the way of inflammation.

1:54

We do see also in this individual that there is some

1:57

swelling of the epiglottis and the pre-epiglottic

2:00

fat, which you can also see in this area here.

2:04

This is the epiglottis, the base of the tongue,

2:06

and some edema in the pre-epiglottic fat.

2:10

All this, uh, representing, uh, manifestations of

2:14

an inflammatory process in the floor of the mouth.

Case: Ludwig's Angina

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