Ludwig's Angina
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This document discusses infections of the submandibular space, which is divided into two compartments by the mylohyoid muscle. Dental infections are the most common cause, with roots above or below the mylohyoid muscle leading to sublingual or submaxillary infections, respectively. Symptoms include odynophagia, trismus, and swelling of the submental and submandibular regions. Treatment involves systemic antibiotics, incision and drainage of any abscesses either intraorally or externally, and tracheostomy if the airway is endangered. Complications can arise from spread of infection or airway obstruction.
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Ludwig's angina
Ludwig's angina is an acute, potentially life-threatening infection of the submandibular space that causes severe swelling and difficulty opening the mouth or swallowing. It usually stems from dental infections. Clinical features include bilateral swelling of the submandibular region, elevated tongue, and difficulty speaking or swallowing. Management involves securing the airway through tracheostomy or intubation, administering IV antibiotics, and incising and draining any abscesses through bilateral submandibular and submental incisions. Early diagnosis, antibiotic treatment, and surgical drainage are crucial for successful treatment.
Ludwig's angina
Submandibular space infection, also known as Ludwig's angina, is caused by dental infections in 80% of cases. The submandibular space lies between structures in the floor of the mouth and the superficial cervical fascia. Symptoms include difficulty swallowing, trismus, and swelling of the sublingual space or submaxillary space. Treatment involves systemic antibiotics and incision/drainage of abscesses either intraorally or externally depending on the location of the infection. Complications can include spread of infection to other spaces, airway obstruction, sepsis, or aspiration pneumonia.
Ludwigs angina
Ludwig's angina is a serious neck infection that can compromise the airway. It involves the sublingual and submandibular spaces and spreads through connective tissue planes. The infection is usually polymicrobial, involving bacteria like Streptococcus and Staphylococcus. It commonly originates from an odontogenic infection. Symptoms include neck swelling, difficulty swallowing and breathing. Immediate priorities in treatment are airway protection through intubation or tracheostomy and IV antibiotics.
Ludwig's angina
Ludwig's angina is a severe bacterial infection that involves the submandibular, sublingual, and submental spaces of the neck. It causes swelling in these areas bilaterally and can potentially lead to airway obstruction. The infection is usually caused by both aerobic and anaerobic bacteria spreading from an odontogenic source such as a dental abscess. Treatment involves aggressive antibiotic therapy, incision and drainage of the swollen areas, and airway management to prevent respiratory distress. Without proper treatment, Ludwig's angina can cause complications such as sepsis, mediastinitis, or even death from asphyxiation within 12 to 24 hours.
Causes of trismus
Trismus, also known as lockjaw, is spasms of the muscles of mastication that result in inability to open the mouth. It is often symptomatic of pericoronitis. The most common causes are impacted third molars, wisdom tooth removal, and tonsil removal. Other potential causes include radiation therapy to the face/neck, tetanus, tumors, trauma, and various diseases. Treatment focuses on heat therapy, analgesics, a soft diet, and possibly muscle relaxants.
Ranula
A 15-year-old male presented with a swelling in his neck for 2 months. Clinical examination revealed a fluctuant, transilluminant swelling over the submental and left submandibular region that was not fixed to underlying structures. An MRI scan was performed. The plan was to excise the ranula and sublingual gland through a trans-cervical approach under general anesthesia. Post-operatively, the patient was started on IV antibiotics and analgesics. The neck drain was removed on day 3 and sutures were removed on day 4. Histopathology revealed a mucous retention cyst of the salivary gland.
Caldwell luc surgery
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2. Indications for CWS include chronic maxillary sinusitis, cysts and polyps in the sinus, and benign or malignant tumors. Contraindications are acute infections and performing it in children due to risk of damaging developing teeth.
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Fascial space & infections
This document provides information on fascial spaces of the head and neck region. It begins by defining fascial spaces as clefts or compartments containing connective tissue. It then classifies the spaces based on mode of involvement and clinical significance. Several key fascial spaces are described in detail, including boundaries, contents, etiology, clinical features, and spread of infection. These include the buccal, sublingual, submandibular, pterygomandibular, masseteric, temporal, lateral pharyngeal, and retropharyngeal spaces. The objectives and microbiology of odontogenic infections are also summarized.
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Ludwig's angina
Ludwig's angina is an acute, potentially life-threatening infection of the submandibular space that causes severe swelling and difficulty opening the mouth or swallowing. It usually stems from dental infections. Clinical features include bilateral swelling of the submandibular region, elevated tongue, and difficulty speaking or swallowing. Management involves securing the airway through tracheostomy or intubation, administering IV antibiotics, and incising and draining any abscesses through bilateral submandibular and submental incisions. Early diagnosis, antibiotic treatment, and surgical drainage are crucial for successful treatment.
Ludwig's angina
Submandibular space infection, also known as Ludwig's angina, is caused by dental infections in 80% of cases. The submandibular space lies between structures in the floor of the mouth and the superficial cervical fascia. Symptoms include difficulty swallowing, trismus, and swelling of the sublingual space or submaxillary space. Treatment involves systemic antibiotics and incision/drainage of abscesses either intraorally or externally depending on the location of the infection. Complications can include spread of infection to other spaces, airway obstruction, sepsis, or aspiration pneumonia.
Ludwigs angina
Ludwig's angina is a serious neck infection that can compromise the airway. It involves the sublingual and submandibular spaces and spreads through connective tissue planes. The infection is usually polymicrobial, involving bacteria like Streptococcus and Staphylococcus. It commonly originates from an odontogenic infection. Symptoms include neck swelling, difficulty swallowing and breathing. Immediate priorities in treatment are airway protection through intubation or tracheostomy and IV antibiotics.
Ludwig's angina
Ludwig's angina is a severe bacterial infection that involves the submandibular, sublingual, and submental spaces of the neck. It causes swelling in these areas bilaterally and can potentially lead to airway obstruction. The infection is usually caused by both aerobic and anaerobic bacteria spreading from an odontogenic source such as a dental abscess. Treatment involves aggressive antibiotic therapy, incision and drainage of the swollen areas, and airway management to prevent respiratory distress. Without proper treatment, Ludwig's angina can cause complications such as sepsis, mediastinitis, or even death from asphyxiation within 12 to 24 hours.
Causes of trismus
Trismus, also known as lockjaw, is spasms of the muscles of mastication that result in inability to open the mouth. It is often symptomatic of pericoronitis. The most common causes are impacted third molars, wisdom tooth removal, and tonsil removal. Other potential causes include radiation therapy to the face/neck, tetanus, tumors, trauma, and various diseases. Treatment focuses on heat therapy, analgesics, a soft diet, and possibly muscle relaxants.
Ranula
A 15-year-old male presented with a swelling in his neck for 2 months. Clinical examination revealed a fluctuant, transilluminant swelling over the submental and left submandibular region that was not fixed to underlying structures. An MRI scan was performed. The plan was to excise the ranula and sublingual gland through a trans-cervical approach under general anesthesia. Post-operatively, the patient was started on IV antibiotics and analgesics. The neck drain was removed on day 3 and sutures were removed on day 4. Histopathology revealed a mucous retention cyst of the salivary gland.
Caldwell luc surgery
1. Caldwell Luc surgery (CWS) is over 120 years old and remains an important procedure for ENT surgeons. It involves making a window in the anterior maxillary bone to access and treat diseases of the maxillary sinus.
2. Indications for CWS include chronic maxillary sinusitis, cysts and polyps in the sinus, and benign or malignant tumors. Contraindications are acute infections and performing it in children due to risk of damaging developing teeth.
3. The procedure involves making a U-shaped incision over the canine fossa, removing bone to create a window, excising the sinus lining and lesions, debriding, irrigating, placing a drain, and packing with
Fascial space & infections
This document provides information on fascial spaces of the head and neck region. It begins by defining fascial spaces as clefts or compartments containing connective tissue. It then classifies the spaces based on mode of involvement and clinical significance. Several key fascial spaces are described in detail, including boundaries, contents, etiology, clinical features, and spread of infection. These include the buccal, sublingual, submandibular, pterygomandibular, masseteric, temporal, lateral pharyngeal, and retropharyngeal spaces. The objectives and microbiology of odontogenic infections are also summarized.
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Masticatory space infection
This document discusses infections that can occur in the five masticatory spaces. It describes the boundaries, contents, causes, clinical features, and treatment for infections of the pterygomandibular space, submasseteric space, and the three temporal spaces (superficial, infratemporal, and deep). Infections in these spaces can spread between adjacent spaces and present with symptoms like trismus, swelling, and pain. Treatment involves incision and drainage through intraoral, extraoral, or combined approaches depending on the specific infected space.
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Ludwig's angina is a severe bacterial infection that simultaneously involves the submandibular, sublingual, and submental spaces bilaterally. It was first described in 1836 and can be caused by odontogenic infections or injuries to the oral cavity. Patients experience fever, difficulty swallowing and breathing, and swelling of the floor of the mouth and tongue. Treatment requires securing the airway, long-term antibiotics, extracting any infected teeth, and surgically draining the infected facial spaces. Without prompt treatment, complications can include sepsis, airway obstruction, and even death.
Fracture maxilla
This document provides information on fractures of the maxilla bone. It begins with an introduction to the maxilla's anatomy and location. It then describes the different types of Le Fort fractures classified by Rene Le Fort in 1901, including Le Fort I (low maxillary), Le Fort II (pyramidal), and Le Fort III (craniofacial disjunction) fractures. For each type, it outlines the fracture pattern and key clinical features such as deformities, symptoms, and appropriate management approaches involving open reduction and fixation.
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2) It describes the signs, symptoms, and features of each type of fracture both externally such as swelling and internally such as dental mobility.
3) It discusses methods for evaluating and managing maxillary fractures including reduction techniques, fixation methods, and immobilization.
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For more information, you can book an appointment at
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
Ranula and plunging ranula
A ranula is a cyst that forms in the floor of the mouth caused by a blocked salivary gland duct. It appears as a blue swelling under the tongue. A plunging ranula is a ranula that spreads deeper into the neck. Surgery to remove the cyst and affected salivary gland tissue is usually required to treat a ranula.
Salivary glands diseases
This document provides information on salivary gland diseases presented over multiple sessions. It begins with the objectives and overview of topics to be covered, including applied anatomy of the salivary glands, autonomic innervation and effects on function, inflammatory and obstructive disorders, neoplasms, and investigations. It then describes in detail the anatomy, physiology and investigations of the major salivary glands. Salivary gland diseases are classified as functional, obstructive, non-neoplastic and neoplastic. Specific conditions like sialadenitis, sialolithiasis, mucocele and ranula are explained. Imaging modalities like ultrasound, sialography, CT, MRI and sialendoscopy
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Oral ulcers
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Pleomorphic adenoma
Pleomorphic adenoma is the most common benign tumor of the parotid gland. It consists of both epithelial cells and spindle-shaped mesenchymal cells within an abundant mucoid matrix. On pathology, it displays well-differentiated epithelial cells and spindle/stellate cells in a pleomorphic stroma with mucoid material. The tumor presents as a slow-growing, painless swelling of the parotid gland and is diagnosed by FNAC. The treatment is complete surgical excision via superficial parotidectomy while preserving the facial nerve. Recurrence is possible if there are pseudopods left behind or inadequate margins. Malignant transformation may occur in long-standing tumors.
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(1) The document discusses various odontogenic infections including cellulitis, Ludwig's angina, cavernous sinus thrombosis, and osteomyelitis.
(2) Ludwig's angina is a serious bacterial infection that causes massive swelling of the neck and floor of the mouth. It develops from a dental infection and can compromise the airway.
(3) Treatment for these infections involves drainage of abscesses, high-dose antibiotics, and potentially surgical intervention to maintain the airway if it becomes obstructed.
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The document discusses various salivary gland disorders including infections, inflammatory conditions, cysts, tumors and other pathologies. It provides details on:
- Acute and chronic bacterial sialadenitis, most commonly caused by retrograde infection from the mouth. Acute infections more often affect the parotid gland.
- Viral infections like mumps can cause acute non-suppurative sialadenitis. Mumps is spread through droplets and involves the parotid glands.
- Sjögren's syndrome is an autoimmune condition characterized by lymphocytic destruction of exocrine glands causing dry mouth and eyes. Diagnosis involves labial biopsy.
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Oroantral Communication and Fistula
This document discusses oroantral communications and fistulas. It defines them as abnormal connections between the oral and maxillary sinus cavities. Causes include tooth extraction, tumors, cysts, and trauma. Signs and symptoms may include unpleasant taste/odor, fluid/food reflux into the nose, and air leakage. Examination involves inspection, suctioning the socket, and radiographs. Management includes immediate closure attempts and antibiotics to prevent sinusitis. Surgical techniques like buccal and palatal flaps are used for larger defects or fistulas based on factors like location, size, and presence of infection.
Ranula
Mucoceles are benign cysts caused by mucus extravasation or retention from minor salivary glands. When located in the floor of the mouth, they are called ranulas. Ranulas present as smooth, blue, dome-shaped swellings that can enlarge and elevate the tongue. Treatment involves complete surgical excision of the cyst wall and sublingual gland to prevent recurrence, while preserving nearby nerves like the lingual nerve. Plunging ranulas extend behind the mylohyoid muscle into the neck.
Masticatory space infection
This document discusses infections that can occur in the five masticatory spaces. It describes the boundaries, contents, causes, clinical features, and treatment for infections of the pterygomandibular space, submasseteric space, and the three temporal spaces (superficial, infratemporal, and deep). Infections in these spaces can spread between adjacent spaces and present with symptoms like trismus, swelling, and pain. Treatment involves incision and drainage through intraoral, extraoral, or combined approaches depending on the specific infected space.
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Ludwig's angina is a severe bacterial infection that simultaneously involves the submandibular, sublingual, and submental spaces bilaterally. It was first described in 1836 and can be caused by odontogenic infections or injuries to the oral cavity. Patients experience fever, difficulty swallowing and breathing, and swelling of the floor of the mouth and tongue. Treatment requires securing the airway, long-term antibiotics, extracting any infected teeth, and surgically draining the infected facial spaces. Without prompt treatment, complications can include sepsis, airway obstruction, and even death.
Fracture maxilla
This document provides information on fractures of the maxilla bone. It begins with an introduction to the maxilla's anatomy and location. It then describes the different types of Le Fort fractures classified by Rene Le Fort in 1901, including Le Fort I (low maxillary), Le Fort II (pyramidal), and Le Fort III (craniofacial disjunction) fractures. For each type, it outlines the fracture pattern and key clinical features such as deformities, symptoms, and appropriate management approaches involving open reduction and fixation.
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Ludwig’s angina is a life-threatening infection with associated compromised airway and is an emergency in OMFS. Airway management is the primary concern in this situation
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This document discusses maxillary fractures, including:
1) It classifies maxillary fractures according to Le Fort's classification system into Le Fort I, II, and III fractures based on the fracture pattern and location.
2) It describes the signs, symptoms, and features of each type of fracture both externally such as swelling and internally such as dental mobility.
3) It discusses methods for evaluating and managing maxillary fractures including reduction techniques, fixation methods, and immobilization.
Swellings of the jaw
This document summarizes different types of jaw swellings and their characteristics. It begins by classifying jaw swellings based on their origin, such as from tooth germs, mucoperiosteum, or being osseous, inflammatory, or malignant. Specific types of swellings arising from these origins are then described in more detail such as epulis, odontogenic tumors, fibrous dysplasia, Paget's disease, and osteomyelitis. Clinical features, radiographic findings, histological characteristics, and treatment approaches are provided for many of these conditions. In particular, ameloblastoma, a benign odontogenic tumor, is discussed in depth covering its pathogenesis, clinical presentation, classification, management,
Ankyloglossia a congenital oral anomaly
https://userupload.net/h9ig9byum706
Ankyloglossia, also known as tongue-tie, is a congenital oral anomaly that may decrease mobility of the tongue tip and is caused by an unusually short, thick lingual frenulum, a membrane connecting the underside of the tongue to the floor of the mouth. Ankyloglossia or tongue-tie is the result of a short, tight, lingual frenulum causing difficulty in speech articulation due to limitation in tongue movement. Ankyloglossia is a congenital condition in which a neonate is born with an abnormally short, thickened, or tight lingual frenulum that restricts mobility of the tongue. Ankyloglossia may be associated with other craniofacial abnormalities, but is also often an isolated anomaly.
Dental Abscess
A dental abscess (also termed a dentoalveolar abscess, tooth abscess or root abscess), is a localized collection of pus associated with a tooth.
For more information, you can book an appointment at
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
Ranula and plunging ranula
A ranula is a cyst that forms in the floor of the mouth caused by a blocked salivary gland duct. It appears as a blue swelling under the tongue. A plunging ranula is a ranula that spreads deeper into the neck. Surgery to remove the cyst and affected salivary gland tissue is usually required to treat a ranula.
Salivary glands diseases
This document provides information on salivary gland diseases presented over multiple sessions. It begins with the objectives and overview of topics to be covered, including applied anatomy of the salivary glands, autonomic innervation and effects on function, inflammatory and obstructive disorders, neoplasms, and investigations. It then describes in detail the anatomy, physiology and investigations of the major salivary glands. Salivary gland diseases are classified as functional, obstructive, non-neoplastic and neoplastic. Specific conditions like sialadenitis, sialolithiasis, mucocele and ranula are explained. Imaging modalities like ultrasound, sialography, CT, MRI and sialendoscopy
Dentigerous cyst
This document discusses dentigerous cysts. It defines a dentigerous cyst as a cyst that forms around the crown of an unerupted tooth due to fluid accumulation between the reduced enamel epithelium and enamel surface. Dentigerous cysts most commonly occur in males in the first three decades of life in the mandibular third molar and maxillary canine regions. Clinical features include swelling and expansion of bone that may cause facial asymmetry. Treatment options include enucleation, marsupialization, or a combination of the two to remove the cyst lining while preserving adjacent structures.
Oral ulcers
This document discusses oral ulceration, providing a differential diagnosis of primary and secondary ulcers. It notes that oral ulcers can be an initial presentation of systemic conditions and discusses various potential causes including infections, malignancies, drugs, trauma and dermatological conditions. Recurrent aphthous stomatitis is one of the most common causes and presents as painful ulcers that typically heal spontaneously within two weeks. Persistent or painless ulcers should be further evaluated, as they could indicate oral cancer.
Pleomorphic adenoma
Pleomorphic adenoma is the most common benign tumor of the parotid gland. It consists of both epithelial cells and spindle-shaped mesenchymal cells within an abundant mucoid matrix. On pathology, it displays well-differentiated epithelial cells and spindle/stellate cells in a pleomorphic stroma with mucoid material. The tumor presents as a slow-growing, painless swelling of the parotid gland and is diagnosed by FNAC. The treatment is complete surgical excision via superficial parotidectomy while preserving the facial nerve. Recurrence is possible if there are pseudopods left behind or inadequate margins. Malignant transformation may occur in long-standing tumors.
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Hi. This is Dr. Amit T. Suryawanshi. Oral & Maxillofacial surgeon from Pune, India. I am here on slideshare.com to share some of my own presentations presented at various levels in the field of OMFS. Hope this would somehow be helpful to you making your presentations. All the best & your replies are welcomed!
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Spaces of head and neck and infections /certified fixed orthodontic courses b...
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
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El documento describe la angina de Ludwig, una infección aguda y potencialmente mortal de los tejidos blandos del cuello y suelo de la boca. Generalmente es de origen dental y requiere tratamiento antibiótico rápido y posiblemente cirugía. Puede comprometer la vía aérea y extenderse a otras áreas, por lo que requiere diagnóstico y manejo tempranos para prevenir complicaciones graves.
spread of oral infections
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This document discusses various types of neck abscesses including parotid, submandibular, retropharyngeal, and parapharyngeal abscesses. It describes the anatomy of the neck spaces involved, common causes of infection, symptoms, examination findings, and treatment approaches which typically involve intravenous antibiotics along with surgical drainage if an abscess has formed. Complications can include airway obstruction, sepsis, or spread of infection to deeper neck spaces or mediastinum.
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References
- JR Hupp, E Ellis, MR Tucker. Contemporary oral and maxillofacial surgery. 7th ed. Missouri: Mosby Elsevier; 2008
- Deepak Kademani, Paul Tiwana. Atlas of Oral and Maxillofacial Surgery. Illustrated. Elsevier Health Sciences; 2015
- Louis H. Berman, Kenneth M. Hargreaves. Cohen's Pathways of the Pulp Expert Consult. 11th ed. Elsevier Health Sciences; 2015
- Fragiskos D. Fragiskos. Oral Surgery illustrated. Springer Science & Business Media; 2007
- A. Omar Abubaker, Din Lam. Oral and Maxillofacial Surgery Secrets. 3ed. Elsevier Health Sciences; 2015
- J Fagan, J Morkel. Surgical drainage of neck abscesses. The Open Access Atlas of Otolaryngology. 2017
- Moon-Gi Choi. Modified drainage of submasseteric space abscess. J Korean Assoc Oral Maxillofac Surg. 2017
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Odontogenic infections are caused by endogenous oral bacteria and range from mild to severe. They typically involve multiple bacteria including streptococci, staphylococci, and anaerobes. Infections progress through inoculation, cellulitis, and abscess stages. They can spread directly through tissue or via lymph nodes and blood vessels. Severe cases involve fascial space infections in areas like the buccal, submandibular, or infratemporal spaces. Prompt treatment involves tooth extraction or root canal therapy along with antibiotics.
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- 2. Infection of the Submandibular space
- 3. Between mucous membrane of the floor of mouth and tongue on one side and superficial layer of deep cervical fascia (extending between the hyoid bone and mandible) on the other. 2 compartments (divided by the Mylohyoid muscle): 1. Sublingual Compartment above the Mylohyoid. 2. Submaxillary and Submental Compartment below the Mylohyoid. Compartments are continuous around the posterior border of Mylohyoid muscle.
- 4. Dental infections: 80% cases Roots of premolars often lie above the attachment of mylohyoid and cause sublingual space infection. Roots of molar teeth extend up to or below the mylohyoid line and cause submaxillary space infection.
- 5. Submandibular sialadenitis Injuries of oral mucosa Fractures of the mandible
- 6. Commonly mixed infections involving both aerobes and anaerobes Commonly Alpha-hemolytic Streptococci, Staphylococci and bacteroides group Rarely Haemophilus influenzae, Escherichia coli and Pseudomonas
- 7. Odynophagia with varying degrees of trismus. In localized sublingual infection: Structures in the floor of mouth are swollen and tongue seems to be pushed up and back. In submaxillary space involvement: Submental and submandibular regions become swollen and tender, and impart woody-hard feel. Usually there is cellulitis rather than frank abscess. Tongue is pushed upwards and backwards threatening the airway. Laryngeal oedema.
- 9. 1. Systemic antibiotics 2. Incision and drainage of abscess. Intraoral—if infection is still localized to sublingual space. External– if infection involves submaxillary space. A transverse incision extending from one angle of mandible to the other is made with vertical opening of midline musculature of tongue with a blunt haemostat. Very often it is serous fluid rather than frank pus that is encountered. 3. Tracheostomy, if airway is endangered.
- 10. Spread of infection to parapharyngeal and retropharyngeal spaces and thence to mediastinum. Airway obstruction due to laryngeal oedema, or swelling and pushing back of the tongue. Septicaemia. Aspiration pneumonia.
- 12. Thank You