Ludwig's Angina

Question 1

What is Ludwig’s angina?

Answer 1

Infection of the space between the floor of the mouth and mylohyoid

Question 2

What type of infection is it most commonly associated with?

Answer 2

Dental infection

Question 3

What symptoms are seen?

Answer 3

Drooling 
Painful mouth 
Protruding tongue
Dysphagia
SOB
Trismus 
Stridor
General malaise 
Fever

Question 4

Does this condition have slow or rapid onset?

Answer 4

Rapid

Question 5

What occurs early on?

Answer 5

Floor of the mouth is raised and there is difficulty swallowing saliva

Question 6

Majority follow a dental infection, but what else can cause it?

Answer 6

Parapharyngeal abscess
Mandibular fracture
Cut or piercing inside mouth
Submandibular stones

Question 7

What investigations are required?

Answer 7

Dental X-ray

CT neck

Question 8

What external signs can be seen?

Answer 8

Bilateral lower facial swelling around mandible and upper neck
Elevation of floor of mouth

Question 9

What could elevation of the floor of the mouth lead to?

Answer 9

Posterior displacement of tongue - compromised airway

Question 10

1/3 of cases of Ludwig’s angina are associated with systemic illness such as…

Answer 10

DM
HIV
Immunocompromised

Question 11

How is it managed?

Answer 11

Secure airway
IV antibiotics
Surgery to drain collection

Question 12

What is the leading cause of death?

Answer 12

Airway compromise

Question 13

If suspect Ludwig’s angina what needs to happen immediately?

Answer 13

Transfer to hospital = ENT emergency

Can cause rapid deterioration within minutes with airway compromise