Ludwig's angina

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