Ludwig's angina: Difference between revisions
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== Diagnosis == | == Diagnosis == | ||
*Mouth pain, drooling, trismus, tongue protrusion,stridor | *Mouth pain, drooling, trismus,brawny edema,tongue protrusion,stridor | ||
*Acute laryngospasm with airway compromise is biggest concern | *Acute laryngospasm with airway compromise is biggest concern | ||
**Suggested by dyspnea or cyanosis | |||
*Clinical diagnosis, but CT with IVC can define abscess | *Clinical diagnosis, but CT with IVC can define abscess | ||
**May lose airway in scanner when pt lies flat | |||
**Weigh the risks and benefits | |||
==Treatment== | ==Treatment== | ||
Revision as of 15:25, 11 September 2011
Background
- Infection of submandibular and sublingual spaces
- 85% of cases arise from an odontogenic source, usually mandibular molars
- Patients usually 20-60 yrs old, male predominance
- Streptococcus, Staphylococcus, and Bacteroides spp. are pathogens
- Intubation may be very difficult
Diagnosis
- Mouth pain, drooling, trismus,brawny edema,tongue protrusion,stridor
- Acute laryngospasm with airway compromise is biggest concern
- Suggested by dyspnea or cyanosis
- Clinical diagnosis, but CT with IVC can define abscess
- May lose airway in scanner when pt lies flat
- Weigh the risks and benefits
Treatment
- Abx
- Must cover typical oral flora
- Usually third gen cehpalosporin with clindamycin or flagyl
- Steroids controversial
Disposition
- Admit, usually ICU for airway monitoring
- Emergent ENT or OMFS consult
Source
Tintinalli ER Atlas