Rapidly spreading cellulitis involving submandibular, sublingual and submental spaces bilaterally

• Most common bacteria:
  • Staphylococcus
  • Streptococcus
  • Peptostreptococcus
  • Fusobacterium
  • Bacteroides
  • Actinomyces

• Arise from:
  • Periapical infection
  • Periodontal infection
  • Tonsilitis
  • Jaw fracture
  • Salivary gland infection/sialadenitis
  • Infected neoplasm

• Pathology:
  • Anaerobic bacteria spread from infected tooth – severe form of cellulitis – involves submandibular and sublingual spaces – spreads to lateral pharyngeal and pterygoid spaces to mediastinum

• Clinical presentation:
  • Upward and outward orientation of tongue
  • Edema, limited mouth opening
  • Firm diffuse swelling in affected areas
  • Swelling tense, tender and firm
  • Overlying skin taut and shiny
  • Fever, pain, malaise
  • Regional lymph nodes tender
  • Respiratory distress
  • Dysphagia
  • Stridor
  • Cyanosis

• Investigations:
  • Radiology
  • CT scan
  • FBC – anemia, infection
  • Blood gases – pH, acidosis, alkalosis
  • RBS – Treat diabetes alongside

• Management:
  • Airway – Intubation, tracheostomy, cricothyroidotomy
  • Address cause
  • Surgical debridement – pus, exudate, inflammation
  • Antibiotics
  • Antipyretics
  • Rehydrate
  • Medical support (diabetes, hypertension, acute renal failure)

• Fatal outcomes:
  • Edema of upper respiratory tract
  • Mediastinitis
  • Septicemia