Difference between revisions of "Ludwig's angina"

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== Background  ==
 
== Background  ==
 
+
*Bilateral infection of submandibular and sublingual spaces
*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  
*Patients usually 20-60 yrs old, male predominance
+
**Streptococcus, Staphylococcus, Bacteroides are pathogens  
*Streptococcus, Staphylococcus, and Bacteroides spp. are pathogens  
+
*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
*Mouth pain, drooling, trismus,brawny edema,tongue protrusion,stridor
+
**Only obtain if diagnosis is question
*Acute laryngospasm with airway compromise is biggest concern
+
**Pt may lose airway in scanner lies flat
**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==
 
==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
*Steroids controversial
+
*Awake intubation
  
 
==Disposition==
 
==Disposition==
 
*Admit, usually ICU for airway monitoring
 
*Admit, usually ICU for airway monitoring
*Emergent ENT or OMFS consult
 
  
 
==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