Differential Diagnosis for Submandibular Mass Extending to Parapharyngeal and Hypopharyngeal Area

• Single Most Likely Diagnosis
  • Ludwig's Angina: This condition is a severe infection of the submandibular space that can spread to the parapharyngeal and hypopharyngeal areas, causing significant swelling and potentially life-threatening airway obstruction. The presentation matches the description given, making it the most likely diagnosis.
• Other Likely Diagnoses
  • Deep Neck Abscess: An abscess in the deep tissues of the neck can present similarly to Ludwig's Angina, with swelling and potential airway compromise. The location and severity can vary, making it a plausible alternative.
  • Submandibular Gland Tumor: A tumor of the submandibular gland, whether benign or malignant, can cause a mass in the submandibular area that could potentially extend into the parapharyngeal and hypopharyngeal spaces.
  • Lymphadenopathy: Enlarged lymph nodes in the neck, due to infection, inflammation, or malignancy, could present as a mass and potentially extend into the parapharyngeal space.
• Do Not Miss Diagnoses
  • Epiglottitis: Although typically presenting with more acute symptoms of airway obstruction, epiglottitis can sometimes have a more insidious onset and could be masked by the swelling in the submandibular and parapharyngeal areas.
  • Retropharyngeal Abscess: An abscess in the retropharyngeal space can cause significant airway compromise and has a high mortality rate if not promptly treated. Its location could potentially be obscured by swelling in the submandibular area.
  • Carotid Artery Aneurysm or Pseudoaneurysm: A vascular anomaly in the carotid artery could present as a neck mass and, although rare, is critical not to miss due to the risk of rupture or embolism.
• Rare Diagnoses
  • Branchial Cleft Cyst: A congenital anomaly that can present as a mass in the neck, potentially extending into the parapharyngeal space, although it is less likely to cause acute symptoms unless infected.
  • Parapharyngeal Space Tumors (e.g., paraganglioma, schwannoma): These are rare tumors that can occur in the parapharyngeal space and might extend into the submandibular and hypopharyngeal areas, but they typically have a more gradual onset.
  • Metastatic Disease: Metastasis to the lymph nodes or soft tissues in the neck from a distant primary malignancy could present as a mass, but the pattern of spread and associated symptoms would likely differ from a primary neck infection or tumor.