Ludwig's angina: Difference between revisions
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== Diagnosis == | == Diagnosis == | ||
*Classical definition | |||
**Infection of sublingual AND submylohyoid/submaxillary spaces | |||
#Begins in floor of mouth | |||
#Aggressive "woody" or braqny cellulitis in submandibular space | |||
#No lymphatic involvement | |||
#Generally no abscess formation | |||
#Bilateral infection | |||
*CT face with contrast | *CT face with contrast | ||
**Only obtain if diagnosis is question | **Only obtain if diagnosis is question |
Revision as of 21:36, 25 August 2014
Background
- Bilateral infection of submental, submandibular, and sublingual spaces
- Cellulitis without clear fluctuance/abscess
- 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
- Consider awake endoscopic NP or OP intubation
- Anesthesia or ENT back-up if possible
Clinical Features
- Dysphagia
- Odynophagia
- Trismus
- Edema of upper midline neck and floor of mouth
- Late signs
- Stridor, drooling, cyanosis
Diagnosis
- Classical definition
- Infection of sublingual AND submylohyoid/submaxillary spaces
- Begins in floor of mouth
- Aggressive "woody" or braqny cellulitis in submandibular space
- No lymphatic involvement
- Generally no abscess formation
- Bilateral infection
- 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
Source
- Tintinalli
- ER Atlas
- Rosen's