Life-Threatening paediatric odontogenic cellulitis secondary to a partially erupted primary molar

This unusual presentation was of a 15-month-old male who was admitted to Great Ormond Street Hospital for Children (GOSH). He presented with a right unilateral facial and neck swelling of rapid onset over three hours, resulting in airway occlusion and septic shock. Medically, the child was fit and well with no pre-existing medical conditions, having been born at 39 weeks gestation without complications. Vaccinations were reportedly up to date. The patient's father reported that the patient initially displayed changes in behaviour indicative of toothache on the lower right quadrant. After two days, the father noticed a rapidly increasing facial swelling and called for an ambulance which took the patient to a local district general hospital. After admission, the patient's condition deteriorated, his airway was compromised and the patient was intubated before being transferred to GOSH due to the severity of his condition. The swelling was reported initially as in the right parotid region spreading to the submandibular region and then crossing the midline at the time of intubation (Figure 1). At the time of onset of the swelling, the patient's father noticed a green discharge from an apparent ‘hole in the gum’ of the lower right quadrant.