Incorrect. Dysphagia is a concern, but inability to swallow is not life threatening as it takes several days for dehydration and several weeks for serious malnutrition to set in. 

Possible. The retromandibular venous plexus could become infected and this plexus can subsequently lead to the cavernous sinus. This pathway has a potential for meningitis. While a concern, it is not the most likely pathway of spread for a submandibular infection.

Incorrect. Pain is always a concern, but is not in and of itself a life threatening condition. Pain can also be managed with appropriate medications.

Possible. The presence of significant submandibular cellulitis could lead to necrosis of subcutaneous tissue (called Ludwig's angina). While a concern, it is an uncommon life threatening aspect of an untreated cellulitis condition.

Possible. The infratemporal area houses the retromandibular venous plexus. Infection into this plexus could subsequently lead to the cavernous sinus. This pathway has a potential for meningitis. While a concern, it is not the most likely pathway of spread for a submandibular infection

Correct! Lower molar abscess with submandibular cellulitis has a significant risk of spread to the retropharyngeal space. The retropharyngeal space is contiguous inferiorly to the posterior mediastinum and is a serious concern for infection.

The presence of inspiratory stridor suggests pharyngeal and possibly laryngeal involvement in this patient's infection, which raises the concern for retropharyngeal spread over other possible serious complications.

This patient should be admitted with intravenous antibiotics, airway protection (intubation if needed), and operative drainage of the pharyngeal abscess.

The fascia compartments of the neck consist of connective tissue sheets that enclose and support a variety of structures. Deep to the superficial fascia and platysma, the deep cervical fascia encircles the neck and splits to encase the SCM and the trapezius muscles and attaches to the ligamentum nuchae posteriorly. The prevertebral fascia surrounds the cervical vertebral column and the pre- and paravertebral musculature of the neck. The pretracheal fascia surrounds the larynx, trachea, esophagus, thyroid, and parathyroid glands and splits to enclose the infrahyoid (strap) muscles of the neck. The carotid sheath surrounds the vascular (and vagus) elements of the neck. The buccopharyngeal fascia runs parallel to the medial aspect of the carotid sheath spanning from one side to the other (attaching into the pretracheal fascia) Between the prevertebral and buccopharyngeal fascia lies the retropharyngeal space (“danger space”). This space is a pathway for spread of infection to the mediastinum with numerous potential complications from a major thoracic infection.

Incorrect. While submandibular infection can spread around the trachea, pharynx/esophagus/ or carotid these regions are less likely to allow rapid infection spread into other regions and thus are of lower overall clinical concern.