Background Ludwig’s angina is a diffuse cellulitis in the sub-mandibular space, which extends to the sublingual space. It is an emergency that often occurs in adults as a complication of oral infections. It is rare in children and is particularly life-threatening due to the smaller size, as well as the characteristics in these spaces in a child. This is the case of Ludwig’s angina in a 2-year-old boy, with rapid onset of signs of respiratory discomfort, no dental or systemic etiology, and great evolution. Case presentation A little boy was brought by his mom to the emergency room for the onset a firm swelling in the sub-mental region along with pain and fever, which appeared 3 days prior to the consultation. He was first examined by a pediatrician who prescribed oral broad-spectrum antibiotics (amoxicillin). The symptoms worsened over 48 h, as the little boy presented respiratory discomfort in supine position. He was admitted in the emergency department. Without dysphagia or respiratory distress. The clinical examination showed swelling in the sub-mental and sub-mandibular region with/without trismus or signs of oral infection. The laboratory investigations showed hyper-leukocytosis with a microcytic hypochromic anemia.CRP = 300; HIV test was negative. The computed tomography (CT scan) showed a diffuse abscess in the sub-mental and sub-mandibular and sub-lingual regions.No mediastinal collection was found. The diagnosis of Ludwig’s angina was established. The patient underwent percutaneous surgical drainage of 15 ml of pus, which alleviated his symptoms, the treatment was carried out through broad-spectrum antibiotics, analgesics, and daily cleaning of the wound and change of surgical dressing. Bacteriological exam found gram-positive cocci in chains. The culture showed a Staphylococcus aureus. The patient presented clinical and biological improvement and was discharged after 7 days. Six months follow-up showed a healthy child, without signs of infection or any other complication. Conclusion Ludwig’s angina in children -however rare- is a potentially life-threatening, rapidly spreading, bilateral swelling of the sub-mandibular. Its management is based on airway control, drainage of the collection and broad-spectrum intravenous antibiotics, as well as surveillance of the biological parameters. Early diagnosis and appropriate management enhances outcome and decreases mortality significantly.

Background Lipomas are ubiquitous tumors. They are mostly present in the trunk as well as the proximal portion of the limbs. However, 15–20% are located in the head and neck regions, and only 4.4% are found in the oral cavity. They normally present as a bulge with signs of compression, without signs of infiltration. Case presentation This is the rare case of a 36-year-old man, who was admitted to ENT consultation for a bulge in the left inferior vestibule of the oral cavity. The bulging was not painful, with no inflammatory signs, no dental mobility, or abnormalities in the vestibular mucosa. No other masses were found in the general clinical exam. The patient underwent a dental panoramic X-ray, which showed a low opacity lesion next to the left inferior vestibular space, without signs of bone invasion. There was no hypoesthesia in the territory of the alveolar nerve was found. The patient underwent a craniofacial MRI which showed a mass which was hypointense on T1 and hyperintense on T2. Fine needle aspiration was not performed. The patient’s pre-operative blood work showed no abnormalities. He underwent surgical excision under general anesthesia. The incision was carried out in the left inferior vestibular space, 1 cm away from the alveolar gingiva; careful dissection of the mucosa allowed the discovery of a large fatty mass, encapsulated, with a nourishing pedicle, without signs of invasion or ulceration in the adjacent structures. Careful dissection and hemostasis were performed, followed with the closure of the mucosa with Vicryl 4.0. The histopathological exam showed mature adipose tissue. The fat contains few small capillaries within thin fibrous strands. A thin fibrous capsule was seen. Clinical follow-up of 2 months showed no complications. The surgical incision healed perfectly, and no bulging was noticed upon palpation. Conclusions This is the rare case of a vestibular lipoma of the oral cavity; the clinical and radiological aspect allowed consideration of several differential diagnoses. The most important take away lesson is related to the very rich variety of differential diagnosis in oral cavity masses. Clinical and radiological aspects allow the clinician to have diagnostic theories. Only histological results allow to establish a definitive diagnosis.