Ludwig's angina: a clinical review

Abstract

Ludwig's angina is caused by a rapidly expanding cellulitis of the floor of the mouth and is characterized by a brawny induration of the floor and suprahyoid region (bilaterally), with an elevation of the tongue potentially obstructing the airway. In the pre-antibiotic era, Ludwig's angina was frequently fatal; however, antibiotics and aggressive surgical intervention have significantly reduced mortality. We reviewed nine patients with Ludwig's angina between July 1996 and June 2002, all of whom presented with fever, neck swelling, bilateral submandibular swelling and elevation of the tongue. In eight patients (89%) a dental infection appeared to be the underlying cause. High-dosage intravenous antibiotics directed towards the suspected causative microorganisms were given to all of the patients: two were treated successfully with conservative medical management, while seven underwent surgical drainage (a tracheotomy was necessary in one patient). Routine aerobic cultures were done on samples of drained material and the predominant microorganisms were Streptococcus species in two patients; there were none in the other five. Two patients had post-operative complications, but all recovered.

Management of 112 Hospitalized Patients with Spreading Odontogenic Infections: Correlation with DMFT and Oral Health Impact Profile 14 Indexes

“…Fewer patients referred to problems such as functional limitation, physical disability, or handicap. (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) years in the present study population; Fig. 1).…”

Management of severe acute dental infections

“…Expert opinion and case series suggest that management requires admission to hospital for intravenous antibiotics together with airway management and surgical drainage of all infected tissue planes under general anaesthesia and close observation and management of underlying diseases. [25][26][27] Sepsis should be managed according to the international guidelines produced by the Society of Critical Care Medicine. 28 29 Parenteral antibiotic prescribing is based on broad spectrum β lactams, metronidazole, and gentamicin.…”

Sudden death by laryngeal polyp: a case report and review of the literature

“…Patients present with fever, neck pain and swelling, dysphagia, and respiratory distress. Modern medical management has greatly decreased the morbidity and mortality associated with Ludwig's angina; however, there are still cases of adults presenting with respiratory distress [47] with progression to airway obstruction and death [48,49]. Finally, acute epiglottitis is an uncommon disease still seen in adults.…”