Difference between revisions of "Ludwig's angina"

(Treatment)
Line 19: Line 19:
 
*Abx
 
*Abx
 
**Must cover typical oral flora
 
**Must cover typical oral flora
 +
**Usually third gen cehpalosporin with clindamycin or flagyl
 +
*Steroids controversial
  
 
==Disposition==
 
==Disposition==

Revision as of 15:22, 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, 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, however
*Weigh the risks and benefits

Treatment

  • Abx
    • Must cover typical oral flora
    • Usually third gen cehpalosporin with clindamycin or flagyl
  • Steroids controversial

Disposition

  • Admit

Source

Tintinalli