Ludwig's Angina

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  • potentially life-threatening
  • rapidly expanding, diffuse inflammation of the submandibular and sublingual spaces 
  • occurs most often in young adults with dental infections.
  • initially described in 1836 by German physician Wilhelm Frederick von Ludwig
    • five patients with marked swelling of the neck that progressed rapidly to involve the tissues covering the muscles between the larynx and the floor of the mouth
    •  His first patient was Queen Catherine of Württemberg.
  • Angina is from anchone, the Greek word for strangulation, and was taken to connote throat pain and infection. At that time, the condition was almost always fatal.

Causative bacteria

  • streptococci, 
  • staphylococci, 
  • gram-negative and 
  • anaerobic organisms. 

Symptoms

  • severe neck pain and swelling
  • fever
  • malaise
  • dysphagia

Examination 

  • may reveal carious molar teeth, 
  • neck rigidity
  • drooling. 
  • Airway compromise
    • stridor,
    • dyspnea, 
    • decreased air movement  
    • cyanosis 

Treatment

  • protection of the airway
  • parenteral antibiotics 
    • e.g., high-dose penicillin G or clindamycin
    •  with or without metronidazole
  •  immediate surgical consultation and possible operative drainage.
 

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