35. Phlegmon of the floor of the mouth. Angina von Ludvic. Topographic and surgical anatomy, etiology, clinical features, diagnosis, differential diagnosis

Question 1

Ludwig’s Angina and its anatomical locations

Answer 1

• Severe, rapidly progressing cellulitis=>
• Involves the submandibular, sublingual, and submental spaces bilaterally

Question 2

Common etiological factors leading to Ludwig’s Angina

Answer 2

• Odontogenic Infections=>
• Acute dentoalveolar abscess (most common in mandibular 2nd and 3rd molars).
• Acute periodontal abscess.
• Acute pericoronal abscess (associated with erupting mandibular third molars).
• Infected mandibular cyst
  Iatrogenic Factors=> contaminated needles
  Traumatic Injuries=>
  Mandibular fractures
• **Osteomyelitis
  **
• Sialadenitis

Question 3

Clinical features of Ludwig’s Angina

Answer 3

• Severe dysphagia (difficulty swallowing), dysphonia (difficulty speaking), dyspnea (difficulty breathing), and trismus (lockjaw).
• Drooling
• Severe and painful indurated board-like hardness=>
• Submandibular and submental spaces
• Painful indurated edema=> floor of the mouth and tongue

Question 4

Ludwig’s Angina diagnosis

Answer 4

• Clinical Examination=> inflammation and edema of the floor of the mouth.
• Radiologic Studies: Ultrasonography (US), orthopantomogram (OPG), and computed tomography (CT)

Question 5

Treatment protocol for Ludwig’s Angina

Answer 5

• Surgical intervention
• Drainage of the infected spaces=>
• Rubber drains => least three days until clinical symptoms resolve
• Antibiotics

Question 6

Complications from untreated Ludwig’s Angina

Answer 6

• Fatality within 12 to 24 hours => asphyxia
• Spread of infection to other spaces
• Septicemia/septic shock