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Ludwig’s Angina. St Emlyn’s

There’s two reasons why Ludwig’s angina sends a shiver down my spine but probably only one of them will apply to you.

Back in 2003 when I was a third year medical student my consultant was quizzing my fellow students and me on eponymous sydromes.

‘What are the signs and symptoms of Ludwig’s angina?’ he asked me.

After a long, painful, drawn out awkward silence, I blurted out in a hopeful voice,

‘Chest pain?’

He shook his head disappointedly and moved onto one of my brighter colleagues and I could hear the words of another famous doctor (Dr. Ross Geller in The One with Ross and Monica’s cousin) in my head,

‘Yeah you really shouldn’t…

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Articles of Interest

More Than A Sore Throat: Ludwig's Angina

Most cases of Ludwig’s angina are due to dental infections, with the second mandibular molar being the most common site

Acute Management of Ludwig’s Angina and the Emergent Difficult Airway

Patients with Ludwig’s angina have an anatomically and potentially physiologically complex airway that can quickly become compromised.

Ludwig's Angina – An emergency: A case report with literature review

Ludwig's angina is a form of severe diffuse cellulitis that presents an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a state of emergency. Early diagnosis and immediate treatment planning could be a life-saving procedure.

Ludwig's Angina: A Rapid Radiological and Clinical Nightmare

Ludwig's Angina (LA) is a life-threatening emergency disease characterized with mouth floor and submandibular space cellulitis. LA frequently begins from submandibular region first and the tongue is pushed forward. Diabetic patients, immunocompromised conditions such as chronic hepatitis, chronic renal failure, chemotherapy are more prone to this condition.

Ludwig’s Angina in Children

Ludwig’s is much more than the standard swollen submandibular lymphnodes children often get, but obviously, we’d like to detect it before it gets to the point of airway compromise.

A pain in the neck. Ludwig’s Angina

“Ludwig’s” is often loosely applied to deep space neck infections but should be limited to those infections which are: bilateral, involves the submandibular space (including both the sublingual and submylohyoid spaces), originates in the floor of the mouth, and is associated with rapid spread; often with a brawny cellulitis.

Airway management in Ludwig's angina - a challenge: case report

Ludwig's angina (LA) is an infection of the submandibular space, first described by Wilhelm Frederick von Ludwig in 1836. It represents an entity difficult to manage due to the rapid progression and difficulty in maintaining airway patency, a major challenge in medical practice, resulting in asphyxia and death in 8-10% of patients.

Diagnosis: Ludwig's Angina

Fiberoptic-guided nasotracheal intubation is the preferred method if available. The degree of airway obstruction may not permit intubation and a tracheostomy may be required.

Ludwig’s Angina: The Original Angina

The case is important as it illustrates the need to recognize that the early treatment of disease is necessary to avoid disastrous consequences and the importance to liaise with anaesthetic colleagues in order to keep the patient intubated for a period of time in order for the postoperative swelling and oedema to settle.

Resources

emDOCs

Early antibiotics—Coverage for beta-lactamase producing aerobic or anaerobic... PCN G + metronidazole, clindamycin, or unasyn.

Journal of Urgent Care Medicine

This condition is complex for a plethora of reasons, the first being the complicated anatomy involved with the deep neck spaces. This complexity can lead to imprecise localization of the infection. However, in patients presenting with Ludwig’s angina, nearly two-thirds have a dental source of infection involving the second or third mandibular molar teeth.

Life in the Fastlane

Ludwig angina: rapidly progressive gangrenous bilateral cellulitis of the submandibular space with risk of life-threatening airway compromise

StatPearls

Ludwig's angina is life-threatening cellulitis of the soft tissue involving the floor of the mouth and neck. It involves two compartments on the floor of the mouth namely sublingual and submaxillary space. The infection is rapidly progressive leading to potential airway obstruction.

WikEM

Often there is no lymphatic involvement and no abscess formation but infection rapidly spreads bilaterally.