ludwigs angina is a life threatening disease

2. LUDWIG’S ANGINA
PRESENTED BY:- DR. NAZMUN NAHAR HAFSA
DR. KAMRUNNAHAR JEBIN
DR. FATEMA-TUZ-ZOHRA DIPA

3. CONTENT
 INTRODUCTION
 HISTORICAL BACKGROUND
 DEFINITION
 AETIOLOGY
 MICROFLORA
 PATHOPHYSILOGY
 CLINICAL FEATURE
 INVESTIGATION
 HISTOPATHOLOGY
 PRINCIPLES OF TREATMENT
 FATE OF LUDWIGS ANGINA

4. INTRODUCTION
Infection of oro-facial and neck region have
been one of the most common diseases in
human beings. Despite great advancement in
healthcare, these infections remain a major
problem. Ludwig’s angina is one of the life
threatening complications among these oro-
facial infections.

6. HISTORICAL BACKGROUND:
 First described in 1836 by Wilhelm Friedreich
Von Ludwig
The word angina derived from the latin word
“angere” means suffocation or chocking
sensation
“Ludwig” comes from the person to whom the
credit goes for its description

7. DEFINITION:
Ludwig’s angina is a massive, firm, brawny
cellulitis or induration and acute, toxic stage ,
involving simultaneously , the submandibular,
sublingual & submental spaces bilaterally.
Cellulitis is a common, potentially serious
bacterial skin infection. Cellulitis appears as a
swollen, red area of skin that feels hot and
tender.

9. AETIOLOGY:
ODONTOGENIC:
1) acute dentoalveolar abscess
2) acute periodontal abscess
3) acute pericoronal abscess
NON-ODONTOGENIC:
1) iatrogenic
2) traumatic injuries to oro-facial regions
3) osteomyelitis
4) submandibular & sublingual sialadenitis

10. MICROFLORA:
Commonly mixed infections involving both
aerobes & anaerobes-
streptococci
staphylococci
E.coli
pseudomonas
bacteroids

11. PATHOPHYSIOLOGY:
This is a spreading type of infection in which
organisms produce hyaluronidase & fibrinolysin
which dissolve hyaluronic acid and fibrin.
Thus the inflammation of soft tissue , not being
confined to one area , spread through the
fascial planes and tissue spaces.

13. CLINICAL FEATURE:
GENERAL:
-patient is toxic & dehydrated
- pyrexia
-anorexia
-chills
-malaise
- dysphagia
-respiratory rate increased

14. CLINICAL FEATURE:
LOCAL:
- firm, brawny swelling
-bilateral
- extends down anterior part of neck
- non-pitting , non-fluctuant
-severe tenderness
-trismus
-mouth remains open due to sublingual tissue
edema leading to raised tongue
-airway obstruction

16. INVESTIGATION:
Panoramic x-ray- to identify possible
odontogenic sources
Cervical, profile and posterior-anterior
radiograph- to observe the volume increasing
in the soft tissues and any deviation of the
trachea
Ultra sound

17. HISTOLOGICAL FEATURES:
A microscopic section though an area of
cellulitis shows a diffuse exudation of
polymorphoneuclear leukocyte and
lymphocyte.
With considerable serous fluid and fibrins
causing separation of connective tissue and
muscle fibres

18. TREATMENT GOALS:
Sufficient airway management
Early & aggressive antibiotic therapy
Incision and drainage
Adequate nutrition and hydration support

19. PRINCIPLES OF TREATMENT:
Airway maintenance
Medical management
Surgical management

20. Airway maintenance
Airway management in Ludwig’s angina can
be challenging
Suggested methods include – tracheostomy ,
fiberoptic laryngoscopy and nasoendotracheal
intubation

21. MEDICAL MANAGEMENT
Intravenous access, fluid resuscitation and
administration of IV antibiotics
Antibiotic therapy should be administered
empirically and according to c/s
regimens:
- penicillin with beta lactamase inhibitor
- cephalosporin
- metronidazole

22. Surgical management
Extraction: extraction of offending tooth, if present
• Incision & Drainage:
- bilateral submandibular incision and if
required a midline sub-mental incision 1cm below the
inferior border of mandible
• - place a drain tube and fix
- remove the tube when the drainage become
minimal
CARE: care should be taken to preserve or avoid
trauma to – facial vessels, lingual nerve and jugular
vein laterally below the angle region

23. Irrigation: copious irrigation of the wound
drains with an antibacterial solution

24. Fate of Ludwig’s angina
If untreated it can be fatal within 12 to 24
hours , death arising from asphyxia
Other cause of death are septicemia , septic
shock, mediastinitis and aspiration
pneumonia.

25. COMPLICATION
Osteomyelitis
Maxillary sinusitis
Localized respiration tract disturbances
Digestive tract disturbances