Ludwig's angina: Difference between revisions
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*Bilateral infection of submandibular and sublingual spaces | *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 | ||
** | **Strep, staphylococcus, bacteroides | ||
*Patients usually 20-60yr | *Patients usually 20-60yr; male predominance | ||
*Intubation may be very difficult | *Intubation may be very difficult | ||
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*CT face with contrast | *CT face with contrast | ||
**Only obtain if diagnosis is question | **Only obtain if diagnosis is question | ||
**Pt may lose airway in scanner lies flat | **Pt may lose airway in scanner if lies flat | ||
==Treatment== | ==Treatment== | ||
*Airway management | |||
*Emergent ENT consult for I&D | *Emergent ENT consult for I&D | ||
*Abx | *Abx | ||
**Must cover typical oral flora | **Must cover typical oral flora | ||
**Usually | **Usually 3rd generation cehpalosporin + (clindamycin or metronidazole) | ||
*Awake intubation | *Awake intubation | ||
Revision as of 22:39, 27 February 2012
Background
- Bilateral infection of submandibular and sublingual spaces
- 85% of cases arise from an odontogenic source, usually mandibular molars
- Strep, staphylococcus, bacteroides
- 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 if lies flat
Treatment
- Airway management
- Emergent ENT consult for I&D
- Abx
- Must cover typical oral flora
- Usually 3rd generation cehpalosporin + (clindamycin or metronidazole)
- Awake intubation
Disposition
- Admit, usually ICU for airway monitoring
See Also
Source
- Tintinalli
- ER Atlas