Abscesses of the second and third mandibular molars may perforate the mandible and spread into the submandibular and submental spaces. Ludwig's angina is manifested by swelling of the floor of the mouth and elevation and posterior displacement of the tongue. A rapidly spreading gangrenous cellulitis produces a brawny edema of the suprahyoid region of the neck. The infection begins unilaterally but quickly spreads to include the entire neck. The most common presenting symptoms are oral, neck, and dental pain. In addition, there is neck swelling, odynophagia, dysphagia, dysphonia, trismus; and tongue swelling. Airway patency is the main concern. In many of these patients, it is impossible to introduce an endotracheal tube and therefore, tracheotomy under local anesthesia is the only way to ventilate them.
Submental space abscess, secondary to dental disease