Difference between revisions of "Ludwig's angina"

(Source)
(Diagnosis)
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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
+
**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, however
+
**May lose airway in scanner when pt lies flat
*Weigh the risks and benefits
+
**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