Carralero (L.) Angina de Ludwig en un niño de seis años. Arch. de med. y cirug. de l. niños, Madrid, , v, – Eyssautier. Phlegmon et adénophlegmon. Ludwigs angina. 1. LUDWIGS ANGINA; 2. Ludwigs angina Ludwig’s angina is a serious, potentially life- threatening infection of the neck and. Ludwig’s angina is a type of severe cellulitis involving the floor of the mouth. Early on the floor .. Sao Paulo Medical Journal = Revista Paulista De Medicina.

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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 ludwiig. Early diagnosis and immediate treatment planning could be a life-saving procedure. Here we report a case of wide spread odontogenic infection extending to the neck with elevation of the floor of the mouth obstructing the airway which resulted nips breathlessness and stridor for which the patient was directed to maintain his airway by elective tracheostomy and subsequent drainage of the potentially involved spaces.

Late stages of the disease should be addressed immediately and given special importance towards the maintenance of airway followed by surgical decompression under antibiotic coverage.

The appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection remains the standard protocol of treatment in advanced cases of Ludwig’s angina.

Ludwig’s angina was coined after the German physician, Wilhelm Friedrich von Ludwig who first described this condition in as a rapidly and frequently fatal progressive gangrenous cellulitis and edema of the soft tissues of the neck and floor of the mouth. In Ludwig’s angina, the submandibular space is the primary site of infection. The majority of cases of Ludwig’s angina are odontogenic in etiology, primarily resulting from infections of the second and third molars.

The roots of these teeth penetrate the mylohyoid ridge such that any abscess, or dental infection, has direct access to the submaxillary space. Once infection develops, it spreads contiguously to the sublingual space. Infection can also spread contiguously to involve the pharyngomaxillary and retropharyngeal spaces, thereby encircling the airway.

A year-old gentleman reported to the Department of Oral and Maxillofacial Surgery with a chief complaint of inability to open the mouth, pain, and swelling in relation to the lower jaw and neck since a day. On physical examination, he had respiratory distress and was toxic in appearance and his vital signs were monitored immediately. His temperature was Mouth opening was limited to 1. Extra-oral swelling was indurated, nonfluctuant with bilateral involvement of the submandibular and sublingual glands [ Figure 1 ].


An immediate diagnosis of Ludwig’s angina was made, and the patient was posted for surgical decompression under general anesthesia. However, elective tracheostomy was planned for airway maintenance with the help of an otolaryngologist. The blood report was normal except for raise in ESR, eosinophilia. Elective tracheostomy was done under local anesthesia, airway secured and general anesthesia was provided.

Separate stab incisions was made in relation to the submandibular space bilaterally and submental space. A sinus anguna was introduced to open up the tissue spaces and pus sngina drained. The wound was irrigated with normal saline, and a separate tube drain was placed and secured to the skin with silk sutures [ Figure 2 ].

Intravenous administration of cefotaxime 1 g Bd, gentamycin 80 mg Bd, metrogyl mg, Tid were given for 5 days with a tapering dose of decadran 8—4 mg Bd for first two postoperative days.

Postoperative irrigation was done through the drain which was removed after 36 h along with the infected tooth. Tracheostomy tube care was taken in the postoperative period, and the skin was strapped on the fifth postoperative day after the removal of the tracheostomy tube.

Patient recovery was satisfactory. Preoperative appearance with bilateral involvement of the submandibular, sublingual, and the submental spaces showing brawny induration of the swelling. Ludwig’s angina and deep neck infections are dangerous because of angnia normal tendency to cause edema, distortion, and obstruction of airway and may arise as a consequence of airway management mishaps.

In the early stages of the disease, patients may be managed with observation and intravenous antibiotics.

Advanced infections require the airway to be secured with surgical drainage. This is complicated by pain, trismus, airway edema, and tongue displacement creating a compromised airway.

Intravenous penicillin G, clindamycin or metronidazole are the antibiotics recommended for use prior to obtaining culture and antibiogram results. D authors also recommend the association of gentamycin.

If patients present with swelling, pain, elevation of the tongue, malaise, fever, neck swelling, and dysphagia, the submandibular area can be indurated, sometimes with palpable crepitus.

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Ludwig’s angina – Wikipedia

Inability to swallow saliva and stridor raise concern because of imminent airway compromise. The most feared complication is airway obstruction due to elevation and posterior displacement of the nlos. Airway compromise is always synonymous with the term Ludwig’s angina, and it is the leading cause of death. Therefore, airway management is the primary therapeutic concern.

National Center for Biotechnology InformationU. J Nat Sci Biol Med. Ramesh CandamourtySuresh VenkatachalamM. Ramesh Babu1 and G. Author information Copyright and License information Disclaimer. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.

This article has been cited by other articles in PMC. Abstract Ludwig’s angina is a form of severe diffuse cellulitis that presents an acute ludwiy and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a state of emergency. Ludwig’s angina, odontogenic infection, surgical decompression, tracheostomy. Open in a separate window. Postoperative view showing the tube drains and tracheostomy tube in luewig.

Footnotes Source of Support: Saifeldeen Anhina, Evans R.

Report of a case and review of the literature. Spitalnic SJ, Sucov A. Case report and review.

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

Ludwig’s angina resulting from the infection of an oral malignancy. J Oral Maxillofac Surg. J Tenn Dent Assoc. A review of odontogenic infections. J La State Med Soc. Lduwig angina in the pediatric population: Int J Pediatr Otorhinolaryngol. Changing trends in deep neck abscess. A retrospective study of patients. Clin Otolaryngol Allied Sci. Management of Ludwig’s angina with small neck incisions: Otolaryngol Head Neck Surg.

A review of current airway management. Arch Otolaryngol Head Neck Surg.

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

Airway management in Ludwig’s angina. Parhiscar A, Har-El G. A retrospective study of cases. Ann Otol Rhinol Laryngol.

Infection of the neck spaces: A present day complication. Deep neck abscesses — changing trends. Busch RF, Shah D. Support Center Support Center.

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