Ludwig's Angina Flashcards
What is Ludwig’s angina?
A type of severe cellulitis involving the floor of the mouth
What cause Ludwig’s angina?
Usually a polymicrobial infection involving the flora of the mouth
What are some common causative organisms of Ludwig’s angina?
- Staphylococcus
- Streptococcus
- Peptostreptococcus
What is the most common underlying cause of infection (not organisms) in Ludwig’s angina?
Spread of infection follows a dental infection
What percentage of cases of Ludwig’s angina are preceded by a dental infection?
75-90%
What are some other underlying causes of Ludwig’s angina?
- Oral ulcerations
- Infections of oral malignancy
- Mandible fractures
- Bilateral sialolithiasis-related submandibular gland infection
- Penetrating injuries of mouth floor
What are risk factors for Ludwig’s angina?
- DM
- Malnutrition
- Compromised immune system
- Organ transplantation
How does Ludwig’s angina progress?
Has an acute onset and spreads rapidly
What are the symptoms of Ludwig’s angina?
- Painful neck swelling
- Tooth pain
- Dysphagia
- Shortness of breath
- Fever
- General malaise
What are the potential signs of Ludwig’s angina?
- Bilateral lower facial swelling around mandible and neck
- Elevation of floor of the mouth
- Posterior displacement of the tongue
What can be seen in Ludwig’s angina if airway crisis is impending?
- Stridor
- Cyanosis
- Trismus
What investigations may be useful in Ludwig’s angina?
- Dental x-ray
- CT with contrast
- Chest scan
- Culture of pus
Why can dental x-ray be useful in Ludwig’s angina?
Can identify infections originating in the roots of the teeth
Why can CT neck with contrast be useful in Ludwig’s angina?
Can identify deep neck space infections
Why may a chest scan be needed in Ludwig’s angina?
If suspecting spread to chest cavity
What can a pus culture in Ludwig’s angina determine?
Causative organism
What are the differentials for Ludwig’s angina?
- Angioneurotic oedema
- Lingual carcinoma
- Sublingual haematoma
What are the main principles of Ludwig’s angina management?
- Sufficient airway management
- Early and aggressive antibiotic therapy
- Incision and drainage if failure of medical management or abscess formation
- Adequate nutrition and hydration support
What is the leading cause of death in Ludwig’s angina?
Airway compromise
How is airway managed most basically in Ludwig’s angina?
Sit upright with supplemental oxygen
What can airway management in Ludwig’s angina range from?
Conservative to intubation or tracheostomy
How should antibiotic therapy be started in Ludwig’s angina?
Empirical antibiotics against aerobic and anaerobic organisms commonly seen in Ludwig’s angina
What empirical antibiotics are often used in Ludwig’s angina?
- Meropenem or
- Cefuroxime
In comibination with:
- Clindamycin or
- Metronidazole
When should empirical antibiotics be switched to more specific treatment?
When culture and sensitivity results are obtained
For how long and by what routes should antibiotics be given in Ludwig’s angina?
- Parenteral until afebrile for at least 48 hours
- Oral for 2 weeks after
When can surgical incision and drainage of Ludwig’s angina be indicated?
- Airway compromise
- Septicaemia
- Deteriorating condition
- DM
- Palpable or radiographic evidence of abscess formation
Why is nutritional and hydration support important in Ludwig’s angina?
Pain and swelling can cause difficulties eating and swallowing and reduce oral intake
What are the potential complications of Ludwig’s angina?
- Airway compromise
- Sepsis and septicaemia
