We present a case which needed awake fibreoptic intubation due to severe trismus and a prolonged period intubated in the intensive care unit after incision and drainage of neck spaces and removal of his lower wisdom teeth. Ludwig angina is a rapidlyspreading lifethreatening cellulitis of the floor of mouth, involving the submandibular, sublingual, and submental spaces. Source of infection often polymicrobial, most commonly strep staphylococcus and bacteroides species. Know the causes, symptoms, treatment, prognosis, epidemiology of ludwigs angina. It results from bacteria that are present due to other issues, such as a tooth abscess or. Ludwig angina is a bacterial cellulitis in the floor of the mouth triggered by a tooth infection usually second or third mandibular molar. Ludwigs angina lateral neck xray taken of this patient shows a soft tissue enlargement over the submandibular space with gas formation. The patient in this case did not have clinically significant airway compromise and was treated with antibiot. Causes symptoms and treatment aishwarya balakrishnan,m.
Ludwigs angina pictures, treatment, diagnosis, causes. Ludwigs angina is a lifethreatening infection early diagnosis and immediate treatment is the key for successful management antibiotic therapy should be administered empirically and tailored to culture and sensitivity results prompt and early surgical intervention is required to provide a higher control of the patients health. Ludwig s angina free download as powerpoint presentation. In ludwigs angina, there is the feeling of choking, and not the feeling of any pain in the chest or thorax. However, there may be chest pain in ludwigs angina in case the infection has spread into the retrosternal space. Ludwigs angina is a rapidly progressive cellulitis involving the floor of the mouth and submandibular space that can lead to death via asphyxiation in a matter of hours. He was finally discharged a week after admission and followed up in the. Ludwigs angina ludwigs angina is a severe form of cervicofascial infection cellulitis which usually arises from the lower second or third molars wisdom teeth. Nevertheless, the term should not be confused with angina pectoris wherein the patient suffers from severe chest pain. The aetiology and management ofa case ofludwigsangina are briefly discussed. If the condition is not promptly treated it can lead to serious complications and can be fatal. The case is described of an occurrence of ludwigs angina with advanced stage of the disease with progressive and rapid airway compromise and fatal consequence.
The bacteria streptococcus and staphylococcus are common causes. Physical examination of a patient with ludwig angina reveals a woody, tender floor of mouth and slight dyspnea respiratory rate, 20min. Monitoring in an intensive care unit setting with a pulse oximeter is a safe option. Once an infection is present, it may spread freely through tissue planes because of. The cornerstone of the treatment is securing the airway, providing efficient drainage, appropriate antimicrobials, and improving immunologic status 3. Ludwig s angina is also otherwise commonly known as angina.
Ludwig angina definition of ludwig angina by medical. Ludwigs angina is a potentially lifethreatening bacterial infection that can occur if an infected tooth root, or an abscessed tooth, goes untreated. Ludwigs angina primarily affects the soft tissues of the floor of the mouth and the neck. Ludwigs angina lat angina ludovici is a type of severe cellulitis involving the floor of the mouth. A preceding dental infection, most often involving the second or third mandibular molars, is the most common cause. Ludwigs angina a case report ghazali mat nor, bds mal msc lon lecturer departmentoforalsurgery, faculty ofdentistry, university ofmalaya, 59100kuala lumpur. It often follows a mouth injury or infection, such as a tooth abscess. Ludwigs angina is a dangerous and potentially airway compromising infection of the floor of the mouth and neck and, if not diagnosed and treated correctly, can prove lifethreatening. Cellulitis without clear fluctuance abscess should heighten suspicion. Ludwig angina is primarily a clinical diagnosis, but this case demonstrates findings that may be present on ct to support the diagnosis. Here we discuss the anesthetic management with fiberoptic intubation of a 45yearold man with ludwigs angina scheduled for emergency drainage.
Ludwigs angina is a diffuse cellulitis in the submandibular, sublingual, and submental spaces, characterized by its propensity to spread rapidly to the surrounding tissues. As the condition worsens, the airway may be compromised with hardening of the spaces on both sides of the tongue. In a study that was conducted on 16 different patients suffering from ludwigs angina, odontogenic infection was the commonest aetiologic factor observed in 12 cases 75%, trauma was responsible for. Ludwig angina is a type of bacterial infection that occurs in the floor of the mouth, under the tongue.
Ludwigs angina definition of ludwigs angina by medical. Ludwigs angina is simply known as submandibular and sublingual space infection. This condition is complex for a plethora of reasons, the first being the complicated anatomy involved with the deep neck spaces. Ludwig s angina is a rare, serious skin infection that develops on the floor of the mouth and the neck. Bilateral infection of submental, submandibular, and sublingual spaces. Elevation of the tongue, difficulty in eating and swallowing, edema of the. Ludwigs angina is actually a progressive cellulitis of the connective tissues of the floor of the mouth and neck that begins in the submandibular space dental disease is the most. Ludwigs angina is a form of severe diffuse cellulitis that presents an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a state of emergency. Awake fiberoptic intubation under topical anesthesia may. He was treated with oral penicillin and an opiate analgesic and advised to have the affected teeth pulled. Early diagnosis and immediate treatment planning could be a lifesaving procedure. It causes elevation of the tongue, as the infection is contained by mylohyoid fig. Almost half of the patients suffering from ludwigs angina have existing or previous infections of the teeth and gums.
Ludwigs angina is a disease which is characterised by the infection in the floor of the oral cavity. Ludwigs angina is a rare but serious infection of the space below the jaw and the floor of the mouth, under the tongue, usually caused by bacteria normally found in the mouth. Ludwig s angina is a lifethreatening disease, but can be treated using appropriate therapy. Ludwigs angina, which is considered to be a form of cellulitis, or severe diffuse irritation or inflammation of the sublingual space or the submandibular space, can be lifethreatening. Patients with deep neck infections present challenging airways for an anesthesiologist. Ludwigs angina in olden days was invariably fatal condition but now, with advent of effective medicines and surgical techniques the mortality rate has considerably reduced. Ludwigs angina is a rare bacterial infection that affects the floor of the mouth. Most of the mortalities in the earlier years are associated with poor diagnosis and lack of antibiotics to treat the disease. In the preantibiotic era, the mortality rate of the disease exceeded 50%. It often develops after an infection of the roots of the teeth such as tooth abscess or a mouth injury this condition is uncommon in children. Most cases 85% are thought to originate from an untreated odontogenic infection most commonly the second and third mandibular molars 7, mainly streptococcus spp.
Early on the floor of the mouth is raised and there is difficulty swallowing saliva, which may run from the persons mouth. Early recognition and treatment for ludwigs angina are of paramount importance due to the myriad of complications that can occur in association with ludwigs angina. A 58yearold healthy man was evaluated for a toothache of 2 days duration. Ludwigs angina is a form of severe diffuse cellulitis that presents an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a. Ludwigs angina is a potentially lifethreatening, rapidly spreading, bilateral cellulitis of the submandibular spaces. Ludwigs angina can take hold beneath the tongue on the floor of the mouth also known as the sublingual or submandibular space if root canal treatment is delayed or if dental health care. It usually occurs if a tooth infection is left untreated. Ludwigs angina symptoms, causes, pictures, tests and. Ludwigs angina complicated by fatal cervicofascial and. Ludwig s angina is a form of severe diffuse cellulitis that presents an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a. Today, advanced diagnostic procedures and antibiotics had made ludwig s angina as a rare disease. Ludwigs angina is an infection of the deep tissues of the skin and muscle of the floor of the mouth and underneath the tongue. The maintenance of the airways must be a priority in the treatment of the patient, since the main cause of death at a first moment is the asphyxia due to.
Previously this disease was deemed as fatal but later on it. Deep fascial space infections cause gross inflammatory exudates a fluid with a high content of protein and cellular debris which has escaped from blood vessels and has been deposited in tissues or on tissue surfaces, usually as a. The skin area of the chin and neck may become warm and tender and may also cause fever, chills, swollen lymph nodes, and blisters. This patient has ludwigs angina, and you should begin immediate management steps for this potentially lifethreatening infection by ensuring an adequate airway and treating the infection. Keeping the air passage clear is the most important part of treating ludwigs angina. With progressive swelling of the soft tissues and elevation and posterior displacement of the tongue, the most life. Summary ludwigs angina is a potentially lethal orofacial cellulitis due to orodental infection.
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