Head and neck: Ludwig angina: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anatomy · Head and neck: Ludwig angina

Sample item

A 52-year-old diabetic man with a decayed mandibular third molar has bilateral submandibular swelling, an elevated tongue, trismus and noisy breathing. Which anatomical fact explains why the infection reached the submandibular space?

AThe roots of the second and third molars lie below the mylohyoid lineBThe roots of the molars lie above the mylohyoid lineCThe buccinator attaches below the roots of the molarsDThe masseter covers the lateral surface of the molar roots

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. The roots of the second and third molars lie below the mylohyoid line

The mylohyoid muscle attaches to the mylohyoid line of the mandible. The apices of the second and third molars lie below this line, so a periapical abscess usually breaks through the lingual plate into the submandibular space. Bilateral spread over the sublingual, submandibular and submental spaces (Ludwig angina) raises the floor of the mouth and the tongue and threatens the airway.

Option by option

A. The roots of the second and third molars lie below the mylohyoid line (correct)
Correct. Infection from these roots drains below the mylohyoid into the submandibular space.
B. The roots of the molars lie above the mylohyoid line
Roots above the line would drain into the sublingual space, as occurs with the premolars and first molar.
C. The buccinator attaches below the roots of the molars
The buccinator attachment determines buccal versus vestibular spread, not submandibular spread.
D. The masseter covers the lateral surface of the molar roots
Masseter covers the lateral surface and relates to a masseteric space abscess.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is A, The roots of the second and third molars lie below the mylohyoid line. The mylohyoid muscle attaches to the mylohyoid line of the mandible.

Why is "The roots of the molars lie above the mylohyoid line" not the answer?

Roots above the line would drain into the sublingual space, as occurs with the premolars and first molar.

Why is "The buccinator attaches below the roots of the molars" not the answer?

The buccinator attachment determines buccal versus vestibular spread, not submandibular spread.

Why is "The masseter covers the lateral surface of the molar roots" not the answer?

Masseter covers the lateral surface and relates to a masseteric space abscess.

What concept does this question test?

It tests Head and neck: Ludwig angina in Anatomy. The apices of the second and third molars lie below this line, so a periapical abscess usually breaks through the lingual plate into the submandibular space. Bilateral spread over the sublingual, submandibular and submental spaces (Ludwig angina) raises the floor of the mouth and the tongue and threatens the airway.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Head and neck: Ludwig angina?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.