History

A 41-year-old white female with no significant past medical history presented to the ED complaining of ear pain and difficulty swallowing. The patient stated that the earache began the day prior, and was left-sided. However, when describing the pain she pointed to her lower jaw.

She says that last night she woke up and her jaw felt swollen. She has no history of prior dental problems, or recent dental procedures. No fever, nausea, or vomiting was elicited. The patient took a Benadryl last night which helped her to sleep, but otherwise provided no pain relief. She noticed that her voice sounds distorted today, and she is now having difficulty opening her mouth. She was able to drink some coffee this morning, which is the last time she had anything to eat or drink.

Focused Physical Exam:

VITAL SIGNS: Temperature 98.6, pulse 101, respirations 16, blood pressure 119/72.
GENERAL APPEARANCE: This is a well-developed, well-nourished white female who appears nontoxic.
HEENT: Atraumatic. Pupils are equally round and reactive to light. Extraocular movements appear intact. Nares are clear without drainage. Although the oropharynx is difficult to examine due to pain with mouth opening, there appears to be some increased swelling and erythema in the left peritonsillar area. The uvula is mildly shifted to the right. The patient has definite trismus and is tender to palpation in the left supratonsillar area. Swelling is noted to the soft palate. There is no visible exudate or intraoral lesions. She has no tenderness on palpation of the mandible or neck. External auditory canals are patent, without swelling or erythema and TMs are intact and normal bilaterally.
LYMPHATICS: There is no submandibular or supraclavicular lymphadenopathy.
LUNGS: Clear to auscultation bilaterally. No crackles or wheezes.

Rest of head to toe exam was unremarkable.

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