Infection of the submandibular and/or sublingual space typically originates from an infected or recently extracted lower tooth. The result is the severe, lifethreatening infection referred to as Ludwig's angina (see "Oral Infections," above). Infection of the lateral pharyngeal (or parapharyngeal) space is most often a complication of common infections of the oral cavity and upper respiratory tract, including tonsillitis, peritonsillar abscess, pharyngitis, mastoiditis, or periodontal infection. This space, located deep to the lateral wall of the pharynx, contains a number of sensitive structures, including the carotid artery, internal jugular vein, cervical sympathetic chain, and portions of cranial nerves IX. | Chapter 031. Pharyngitis Sinusitis Otitis and Other Upper Respiratory Tract Infections Part 14 Infection of the submandibular and or sublingual space typically originates from an infected or recently extracted lower tooth. The result is the severe lifethreatening infection referred to as Ludwig s angina see Oral Infections above . Infection of the lateral pharyngeal or parapharyngeal space is most often a complication of common infections of the oral cavity and upper respiratory tract including tonsillitis peritonsillar abscess pharyngitis mastoiditis or periodontal infection. This space located deep to the lateral wall of the pharynx contains a number of sensitive structures including the carotid artery internal jugular vein cervical sympathetic chain and portions of cranial nerves IX through XII at its distal end it opens into the posterior mediastinum. Involvement of this space with infection can therefore be rapidly fatal. Examination may reveal some tonsillar displacement trismus and neck rigidity but swelling of the lateral pharyngeal wall can easily be missed. The diagnosis can be confirmed by CT. Treatment consists of airway management operative drainage of fluid collections and at least 10 days of IV therapy with an antibiotic active against streptococci and oral anaerobes . ampicillin sulbactam . A particularly severe form of this infection involving the components of the carotid sheath postanginal septicemia Lemierre s disease is described above see Oral Infections . Infection of the retropharyngeal space can also be extremely dangerous as this space runs posterior to the pharynx from the skull base to the superior mediastinum. Infections in this space are more common among children 5 years old because of the presence of several small retropharyngeal lymph nodes that typically atrophy by the age of 4 years. Infection is usually a consequence of extension from another site of infection most commonly acute pharyngitis. Other sources include otitis media
