Ludwig's angina

Revision as of 21:36, 25 August 2014 by Kxl328 (talk | contribs) (Diagnosis)

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
  1. Begins in floor of mouth
  2. Aggressive "woody" or braqny cellulitis in submandibular space
  3. No lymphatic involvement
  4. Generally no abscess formation
  5. 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

  1. PTA
  2. Retropharyngeal Abscess
  3. Pharyngitis

Source

  • Tintinalli
  • ER Atlas
  • Rosen's