Ludwig angina is an abscess of the floor of the mouth, often the result of a bad tooth infection. The usual findings of an abscess are present, but the special issue here is the threat to the airway. Incision and drainage are done, but intubation and tracheostomy may also be needed.
Bell’s palsy produces sudden paralysis of the facial nerve for no apparent reason. Although not an emergency per se, current practice includes the use of antiviral medications—and as is the case for other situations in which antivirals are used, prompt and early administration is the key to their success. Steroids are also typically prescribed.
Facial nerve injuries sustained in multiple trauma produce paralysis right away. Patients who have normal nerve function at the time of admission and later develop paralysis have swelling that will resolve spontaneously.
Cavernous sinus thrombosis is heralded by the development of diplopia (from paralysis of extrinsic eye muscles), along with facial pain and high fever, in a patient suffering from frontal or ethmoid sinusitis. This is a rare but very serious emergency (30% mortality) that requires hospitalization. Diagnosis is best done with MRI. Treatment is based on early and aggressive IV antibiotic administration, for a minimum of 3 or 4 weeks, with penicillinase-resistant penicillin plus a third- or fourth-generation cephalosporin. While the cavernous sinus itself would not benefit from operative intervention, the responsible paranasal sinuses should be surgically drained.
Epistaxis in children is typically from nosepicking; the bleeding comes from the anterior septum, and phenylephrine spray and local pressure controls the problem. In an 18-year-old the prime suspects are cocaine abuse (with septal perforation) or juvenile nasopharyngeal angiofibroma. Posterior packing may be needed for the former, and surgical resection is mandatory for the latter (the tumor is benign, but it eats away at nearby structures). In the elderly and hypertensive, nosebleeds can be copious and life-threatening. The blood pressure has to be controlled, and posterior packing is usually required. Sometimes surgical ligation of feeding vessels is the only way to control the problem.
Dizziness may be caused by inner ear disease or cerebral disease. When the inner ear is the culprit, the patients describe the room spinning around them. When the problem is in the brain, the patient is unsteady but the room is perceived to be stable. In the first case meclizine, promethazine, or diazepam may help. In the second case, neurologic workup is in order.
Full-fledged Ménière disease includes vertigo, tinnitus, and hearing loss. It is treated primarily with diuretics.