Ludwig's angina

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, 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, however
*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