Difference between revisions of "Ludwig's angina"

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Revision as of 04:35, 24 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