Ludwig's angina

Revision as of 15:24, 11 September 2011 by Russellm77 (talk | contribs) (Disposition)

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, usually ICU for airway monitoring
  • Emergent ENT or OMFS consult

Source

Tintinalli