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OTORRHINOLARYNGOLOGY

CHRISTIANE RIBEIRO ANIAS, MD

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Ludwig's Angina

Introduction

It is the most commonly encountered neck space infection. It is a rapidly swelling cellulitis of the sublingual and submaxillary spaces, often arising from infection of the tooth roots (molars and pre-molars) that extend below the mylohyoid line of the mandible. Although most abscesses in the spaces are caused by dental infections (80% ), they can also result from foci in the floor of the mouth, the base of the tongue, the lingual tonsils, salivary calculi or from intravenous injection of the internal jugular vein especially in drug abusers.

Clinical Manifestations

The patient is severely ill and toxic, has edema and erytema of the neck under the chin and often of the floor of the mouth. There is intense pain on tongue moviment and the patient may be severe dehydrated owing to inability to take anything by mouth. The mouth is open and the tongue is lifted upwards and backwards, so that it is pushed against the roof of the mouth and the posterior pharyngeal wall, when this occurs, acute respiratory obstruction is likely to occur.

There is difficulty in opening the mouth if the swelling has spread into the pterygoid region. Examination shows a brawny tense swelling of the submaxillary and submental regions with enlargement of all the neighbouring lymph

Diagnostic Studies

The diagnostic is basicaly clinical, CT scan is helpful in defining the extent of the abscess and microbiologic studies isolates include: Streptococci, Bacteroides, Fusobacterium, Staphylococcus aureus most commonly.

Treatment

Fundamentals of treatment are: