Ludwig's angina
Revision as of 17:29, 21 May 2014 by Sharon.cu.md (talk | contribs)
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
- 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