A 38-Year-Old Man Comes to the Emergency Department for Evaluation

A 38-year-old man comes to the emergency department for evaluation of jaw swelling and pain.  Two weeks ago, the patient cracked a molar in his right lower jaw after biting on an unpopped popcorn kernel and underwent tooth extraction.  Yesterday, he developed a fever and the right side of his jaw began to swell.  The pain has been worsening in that area, and the patient is having trouble swallowing.  Temperature is 38.2 C (100.8 F) , blood pressure is 130/82 mm Hg, pulse is 112/min, and respirations are 22/min.  Oxygen saturation is 99% on room air.  On examination, the patient appears ill and is drooling.  His tongue appears elevated and is displaced posteriorly.  The floor of the patient's mouth feels firm.  His neck is erythematous, warm, and feels woody.  This patient is at greatest risk for which of the following immediate complications?

A) Acute necrotizing mediastinitis
B) Airway obstruction
C) Carotid artery rupture
D) Cavernous sinus thrombosis
E) Facial nerve palsy
F) Spinal epidural abscess

Correct Answer:

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