Difference between revisions of "Ludwig's angina"

(See Also)
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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  
**Streptococcus, Staphylococcus, Bacteroides are pathogens
+
**Strep, staphylococcus, bacteroides
*Patients usually 20-60yr, male predominance  
+
*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 third gen cehpalosporin with clindamycin or flagyl
+
**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

  1. PTA
  2. Retropharyngeal Abscess
  3. Pharyngitis

Source

  • Tintinalli
  • ER Atlas