An Upper Airway Obstruction Emergency

Abstract

Ludwig angina remains a potentially lethal disease, rapidly spreading bilateral cellulitis of the submental, sublingual, and submandibular spaces, which bears the threat for rapid airway obstruction. Since the introduction of antibiotics in 1940s, the mortality was reduced significantly. This resulted in the rare occurrence of the disease, leaving many physicians with limited experience of Ludwig angina. Although the occurrence of Ludwig angina in adults is rare, its presence in the pediatric edentulous population is even more uncommon. Because the unfamiliarity with this disease is now increasing, unnecessary delaying diagnosis or inadequate management may occur and may result in serious complications. This presentation will consist of a historical review, discussion of pathophysiology, followed by clinical presentation, etiology, bacteriology, and management. With early diagnosis, airway observation and management, aggressive intravenous antibiotic therapy, and judicious surgical intervention, the disease should resolve without complications. In addition, the source of infection should be determined and eliminated if possible. A thoughtful, individualized management strategy seems to be the most reasonable approach to the disease.

Retrospective analysis of etiology and comorbid diseases associated with Ludwig's Angina

“…[ 8 ] Finally, patients require stringent control of their fluid management and adequate nutritional support, usually via a nasogastric feeding tube, in their postoperative recovery phase. [ 14 ] This all translates into substantial resource utilization during hospitalization and intensive manpower input and time. [ 15 ]…”

Ludwig’s angina, a rare complication of mandibular fractures

“…Other authors consider that early surgery with extensive drainage of the septic area and necrectomy up to the limit of the clinically healthy tissues is mandatory for a favourable outcome. [19][20][21] Some authors maintain that effective drainage of these severe infections and effective necrectomy can be obtained through a less invasive approach by percutaneous catheterization 21 and later through negative pressure wound therapy. 22,23 Our personal experience with percutaneous catheterization drainage is limited, which does not allow us to objectively assess this method, but we can say that extensive drainage of the affected tissues with the complete removal of necrotic areas has proved to be efficient and is the most recommended type of surgical approach for the treatment of Ludwig's angina and necrotizing fasciitis.…”

A Review of Evidence-Based Recommendations for Pericoronitis Management and a Systematic Review of Antibiotic Prescribing for Pericoronitis among Dentists: Inappropriate Pericoronitis Treatment Is a Critical Factor of Antibiotic Overuse in Dentistry

“…Thus, early diagnosis and treatment are essential. The treatment follows the same principles—pus evacuation, antibiotics, sufficient fluids, and pain medication [ 45 ]. Successful treatment of these complications includes resolving the primary source of infection.…”