by Lilia Weiss, MD, Jeff Finkelstein, MD, and Alan Storrow, MD
HISTORY OF PRESENT ILLNESS:
A 41 year old woman presents to the emergency department with complaints of fever, neck pain, and neck swelling for five days. She had a wisdom tooth extraction one week ago and was placed on penicillin for an oral infection four days ago. She denies trouble breathing but has difficulty speaking, handling secretions, and opening her mouth. She is otherwise healthy.
PHYSICAL EXAMINATION:
This obese woman appears to be in mild distress. She is sitting upright and drooling into a cup. Her vital signs are: temperature 39.00C (oral), pulse 105 beats/min., blood pressure 156/89 torr, and respiratory rate of 20/min.
The head and neck exam is significant for diffuse brawny edema over both sides of the jaw and neck. The skin over this area is firm, erythematous, tender and warm (figure 1). There is no fluctuance or crepitance. The patient is unable to open her mouth more than one centimeter. The tongue and oropharynx could not be visualized. There is no stridor. The rest of her physical examination is unremarkable.
LABORATORY:
The complete blood count reveals a leukocytosis with a left shift (WBC-18,200x103/mm3).
From Academic Emergency Medicine
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