PMC3420434_01
Sagittal CT image of patient preoperatively. Note the classic "sniffing" position of patient to maximize air entry in the presence of an upper airway obstruction. White arrows point to significant gas formation in anterior cervical space.
CRIM.OTOLARYNGOLOGY2012-931350.001.jpg
PMC3420434_01_CRIM.OTOLARYNGOLOGY2012-931350.001.jpg
fig1
A CT scan was obtained which revealed significant gas in anterior cervical space suggestive of infection (Figures 1 and 2).
Axial CT image of patient preoperatively at level of hyoid. Note again presence of gas in anterior cervical space and stranding of fat suggestive of acute infection.
CRIM.OTOLARYNGOLOGY2012-931350.002.jpg
PMC3420434_01_CRIM.OTOLARYNGOLOGY2012-931350.002.jpg
fig2
A CT scan was obtained which revealed significant gas in anterior cervical space suggestive of infection (Figures 1 and 2).
Postoperative CT scan at level of the hyoid. Note: the extensive loss of soft tissue in the anterior neck compartment (arrow).
CRIM.OTOLARYNGOLOGY2012-931350.003.jpg
PMC3420434_01_CRIM.OTOLARYNGOLOGY2012-931350.003.jpg
fig3
Postoperative CT scans demonstrate clear loss of anterior neck soft tissue (Figure 3). 
Intraoperative image taken after repeat debridement. Note: exposed submandibular gland on right side (single arrow) and exposed hyoid bone (double arrow).
CRIM.OTOLARYNGOLOGY2012-931350.004.jpg
PMC3420434_01_CRIM.OTOLARYNGOLOGY2012-931350.004.jpg
fig4
Further debridements were necessary to completely remove the necrotic tissue (Figure 4) and the impacted mandibular molar responsible for the infection was subsequently extracted by oral surgery.