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Double tongue signs in a case of submandibular space infection
  1. Takashi Watari1,
  2. Yasuharu Tokuda2
  1. 1Post Graduate Clinical Training Center, Shimane University Hospital, Izumo, Japan
  2. 2Division of General Internal Medicine, Tsukuba University, Mito, Japan
  1. Correspondence to Professor Yasuharu Tokuda, yasuharu.tokuda{at}

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Double tongue signs are a unique physical finding which involve an elevation of floor of the oropharynx caused by a bilateral infection of the submandibular space (a well-known example is Ludwig’s angina) (figure 1A).1 2 In this case, an 80-year-old woman with a 10-year history of diabetes mellitus was referred to our emergency department. She presented with swelling from the submandibular region to the neck surface, with a 3-day history of continuous fever, weakness and fatigue. Physical …

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