Most cases 85% are thought to originate from an untreated odontogenic infection most commonly the second and third mandibular molars 7, mainly streptococcus spp. Ludwig s angina is also otherwise commonly known as angina. The condition can be so serious that the patients airway is compromised and needs to be immediately admitted to. Ludwigs angina a case report ghazali mat nor, bds mal msc lon lecturer departmentoforalsurgery, faculty ofdentistry, university ofmalaya, 59100kuala lumpur. The commonest cause is dental caries, but it may also be due to sialoadenitis, the infection tracking via the. Ludwig angina is a rapidlyspreading lifethreatening cellulitis of the floor of mouth, involving the submandibular, sublingual, and submental spaces. Ludwigs angina symptoms, causes, pictures, tests and. 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. The aetiology and management ofa case ofludwigsangina are briefly discussed. Ludwigs angina is a rapidly progressive cellulitis of the submandibular space that can have a high mortality if not promptly recognized and treated. Ludwigs angina is simply known as submandibular and sublingual space infection. It is caused by severe dental infection in the oral cavity and is left untreated long enough that it has spread to the surrounding areas and forms a large cellulitis in the sublingual region. 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 defined as a phlegmonous cellulitis, diffuse, rapidly spreading in the soft tissues of the mouth floor, submandibular and sublingual space.
Ludwigs angina is also otherwise commonly known as angina. However, there may be chest pain in ludwigs angina in case the infection has spread into the retrosternal space. Nevertheless, the term should not be confused with angina pectoris wherein the patient suffers from severe chest pain. Bilateral infection of submental, submandibular, and sublingual spaces. Almost half of the patients suffering from ludwigs angina have existing or previous infections of. Ludwig angina is a lifethreatening type of soft tissue cellulitis involving 3 compartments on the floor of the mouth including the submental, sublingual, and submandibular spaces bilaterally. Causes symptoms and treatment aishwarya balakrishnan,m. 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. 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. 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. Ludwigs angina lat angina ludovici is a type of severe cellulitis involving the floor of the mouth.
If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. If the condition is not promptly treated it can lead to serious complications and can be fatal. The mortality rate for ludwigs angina is currently below 8% down from the preantibiotic numbers over 50% 1. Source of infection often polymicrobial, most commonly strep staphylococcus and bacteroides species. In ludwigs angina, there is the feeling of choking, and not the feeling of any pain in the chest or thorax. Largely due to the advent of antibiotics, the condition is uncommon in present day modern societies. Previously this disease was deemed as fatal but later on it. He was finally discharged a week after admission and. 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. Ludwigs angina is a disease which is characterised by the infection in the floor of the oral cavity. Elevation of the tongue, difficulty in eating and swallowing, edema of the. Here we discuss the anesthetic management with fiberoptic intubation of a 45yearold man with ludwigs angina scheduled for emergency drainage.
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. Ludwigs angina is a rare bacterial infection that affects the floor of the mouth. Ludwigs angina pictures, treatment, diagnosis, causes. It causes elevation of the tongue, as the infection is contained by mylohyoid fig. Ludwigs angina is a bilateral infection of the submandibular space that consists of two compartments in the floor of the mouth, the sublingual space and the submylohyoid also known as submaxillary space. Ludwig s angina is defined as a phlegmonous cellulitis, diffuse, rapidly spreading in the soft tissues of the mouth floor, submandibular and sublingual space. In the preantibiotic era, ludwigs angina frequently caused asphyxiation and death. Ludwigs angina is a type of severe cellulitis involving the floor of the mouth. The bacteria streptococcus and staphylococcus are common causes. Summary ludwigs angina is a potentially lethal orofacial cellulitis due to orodental infection. The condition was later named ludwigs angina, a term which persists in medicine to this day. Ludwigs angina is a potentially lifethreatening, rapidly spreading, bilateral cellulitis of the submandibular spaces. Recognized less often today, this rapidly progressive submaxillary cellulitis may still be fatal.
Ludwigs angina is a diffuse cellulitis in the submandibular, sublingual, and submental spaces, characterized by its propensity to spread rapidly to the surrounding tissues. Any difficulties with swallowing, swelling, crepitus, or signs of airway obstruction with recent dental disease should be highly suspicious for ludwigs angina. Ludwigs angina ludwigs angina is a severe form of cervicofascial infection cellulitis which usually arises from the lower second or third molars wisdom teeth. A case associated with haemophilus influenzae bacteremia in an adult is presented. It usually occurs if a tooth infection is left untreated. Ludwigs angina ludwigs angina is a serious, potentially life threatening infection of the neck and. In the preantibiotic era, the mortality rate of the disease exceeded 50%. Ludwig s angina uncountable a serious, potentially lifethreatening infection of the floor of the mouth, usually occurring in adults with concomitant dental infections, and if left untreated, may obstruct the airways, necessitating tracheotomy.
Cellulitis without clear fluctuance abscess should heighten suspicion. 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 obstruction. Ludwigs angina is a potentially lifethreatening cellulitis of the sublingual space, leading to swelling of the tissues in the floor of the mouth. Ludwig s angina free download as powerpoint presentation. An uncommon and potentially lethal neck infection vung d. The majority of patients report dental pain, or a history of recent dental procedures, and neck. 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. Early on the floor of the mouth is raised and there is difficulty swallowing saliva, which may run from the persons mouth. 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. Know the causes, symptoms, treatment, prognosis, epidemiology of ludwigs angina. In most cases ludwig angina results from a dental lesion radicular or periodontogenica. Angina ludovici ludwig s angina is a severe infection of the connective tissue from the floor of the mouth, usually occurring. Patients with deep neck infections present challenging airways for an anesthesiologist.
1277 339 1103 318 1397 781 163 371 1193 1314 1120 886 1109 965 1006 412 311 258 966 1211 270 58 2 591 928 1368 1061 409 453 710 571 898 433 1376