Ludwig's angina: Difference between revisions
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== Background == | == Background == | ||
*Bilateral infection of submandibular and sublingual spaces | |||
* | |||
*85% of cases arise from an odontogenic source, usually mandibular molars | *85% of cases arise from an odontogenic source, usually mandibular molars | ||
* | **Streptococcus, Staphylococcus, Bacteroides are pathogens | ||
*Streptococcus, Staphylococcus, | *Patients usually 20-60yr, male predominance | ||
*Intubation may be very difficult | *Intubation may be very difficult | ||
== Clinical Features == | |||
*Dysphagia | |||
*Odynophagia | |||
*Trismus | |||
*Edema of upper midline neck and floor of mouth | |||
*Late signs | |||
**Stridor, drooling, cyanosis | |||
== Diagnosis == | == Diagnosis == | ||
*CT face with contrast | |||
* | **Only obtain if diagnosis is question | ||
**Pt may lose airway in scanner lies flat | |||
** | |||
** | |||
==Treatment== | ==Treatment== | ||
*Emergent ENT consult for I&D | |||
*Abx | *Abx | ||
**Must cover typical oral flora | **Must cover typical oral flora | ||
**Usually third gen cehpalosporin with clindamycin or flagyl | **Usually third gen cehpalosporin with clindamycin or flagyl | ||
* | *Awake intubation | ||
==Disposition== | ==Disposition== | ||
*Admit, usually ICU for airway monitoring | *Admit, usually ICU for airway monitoring | ||
==Source== | ==Source== | ||
Revision as of 12:50, 21 November 2011
Background
- Bilateral infection of submandibular and sublingual spaces
- 85% of cases arise from an odontogenic source, usually mandibular molars
- Streptococcus, Staphylococcus, Bacteroides are pathogens
- Patients usually 20-60yr, male predominance
- Intubation may be very difficult
Clinical Features
- Dysphagia
- Odynophagia
- Trismus
- Edema of upper midline neck and floor of mouth
- Late signs
- Stridor, drooling, cyanosis
Diagnosis
- CT face with contrast
- Only obtain if diagnosis is question
- Pt may lose airway in scanner lies flat
Treatment
- Emergent ENT consult for I&D
- Abx
- Must cover typical oral flora
- Usually third gen cehpalosporin with clindamycin or flagyl
- Awake intubation
Disposition
- Admit, usually ICU for airway monitoring
Source
- Tintinalli
- ER Atlas