A 60-year-old male is brought in by ambulance with fevers >40°C, rigors and confusion.

He has been on antibiotics for the preceding 3 days due to a dental infection with associated facial swelling and had a dental extraction earlier the same day.

On examination he looks unwell. Vitals include temperature 41.9°C; GCS 14; BP 110/80, HR 95

Extensive swelling of the right side of the face extending from maxilla to the submental space, very tender to palpate with overlying erythema and subcutaneous crepitus palpable above the ear

He had limited mouth opening to 2 finger breaths, there was no visible discharge within the mouth. He had an expeditious CT scan organised after a bedside nasendoscopy showed no significant airway compromise.


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Dr Leon Lam LITFL Author 2

Dr Leon Lam FRANZCR MBBS BSci(Med). Clinical Radiologist and Senior Staff Specialist at Liverpool Hospital, Sydney

Dr Jenni Davidson LITFL Author

Sydney-based Emergency Physician (MBBS, FACEM) working at Liverpool Hospital. Passionate about education, trainees and travel. Special interests include radiology, orthopaedics and trauma. Creator of the Sydney Emergency XRay interpretation day (SEXI).

Dr Parvathy suresh kochath LITFL Author

Provisional fellow in emergency radiology, Liverpool hospital, Sydney. Other areas of interest include paediatric and cardiac imaging.

Dr Georgina Beech LITFL Author

Emergency Medicine Education Fellow at Liverpool Hospital NSW. MBBS (Hons) Monash University. Interests in indigenous health and medical education. When not in the emergency department, can most likely be found running up some mountain training for the next ultramarathon.

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