Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets (hemodynamic, neurologic, respiratory) and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Assess airway repeatedly; prepare for awake fiberoptic intubation or surgical airway if deteriorating.
- Start broad‑spectrum IV antibiotics and obtain CT with contrast.
- Consult ENT/oral surgery; proceed to incision and drainage when collection present or clinical deterioration.
- Admit for close monitoring; transition to oral antibiotics when improved; dental source control.
Clinical Synopsis & Reasoning
Rapidly progressive cellulitis of the submandibular space with tongue elevation and trismus. Prioritize a secure airway (often awake fiberoptic), start broad‑spectrum IV antibiotics covering oral anaerobes and streptococci, and obtain early surgical drainage when abscess/collection suspected.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| Airway exam (frequent) | Safety | Drooling, muffled voice, stridor | Early ENT/anesthesia |
| CT neck with contrast | Extent/collection | Submandibular/lingual space involvement | Guide drainage |
| Blood and culture from source | Pathogens | Polymicrobial (oral flora) | Tailor therapy |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Ampicillin‑sulbactam 3 g IV q6h or Piperacillin‑tazobactam 4.5 g q6h | β‑lactam/β‑lactamase inhibitor | Hours | Empiric coverage | Adjust for MRSA risk (add vancomycin) |
| Clindamycin 600–900 mg IV q8h (alternative) | Lincosamide | Hours | Penicillin‑allergic patients | C. difficile risk |
| Dexamethasone (selected) | Anti‑inflammatory | Hours | Reduce edema in severe airway compromise | Evidence limited |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- Head and Neck Infection reviews; ENT best practices — Link