Most cases of Ludwig’s angina are due to dental infections, with the second mandibular molar being the most common site
Patients with Ludwig’s angina have an anatomically and potentially physiologically complex airway that can quickly become compromised.
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 (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 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.
“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.
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.
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.
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.
Ludwig’s angina is a clinical diagnosis and does not require advanced imaging. Do not delay the patient going to the OR or getting transferred to a hospital with a surgeon for a CT. Remember that the patient has to be comfortable lying flat to get a CT.
Airway management is the main priority and biggest challenge in patients with Ludwig’s angina.
Early antibiotics—Coverage for beta-lactamase producing aerobic or anaerobic...
PCN G + metronidazole, clindamycin, or unasyn.
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.
Ludwig angina: rapidly progressive gangrenous bilateral cellulitis of the submandibular space with risk of life-threatening airway compromise
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.
Often there is no lymphatic involvement and no abscess formation but infection rapidly spreads bilaterally.