a i A previously healthy 33-year-old man, with a history of type 1 diabetes mellitus, underwent left lower molar extraction. Two days later, he presented to the emergency department with swelling in the left submandibular area and was subsequently treated with meperidine, codeine, and penicillin G. Two days later, after an unsuccessful resolution, he returned with bilateral submandibular swelling and difficulty swallowing and breathing. Vital signs were as follows: heart rate 140 beats/min, respiratory rate 28 beats/min, blood pressure 220/120 mm Hg, and temperature 39°C. After admission, he was taken to the operating room for an emergency tracheostomy and a drainage procedure. Antibiotic therapy was continued with penicillin G and clindamycin, and he made an uneventful recovery.