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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
Airway protection
Antibiotic therapy
Surgical drainage

www.indiandentalacademy.com
Airway protection
Observation
Intubation
Direct laryngoscopy: possible risk of rupture
and aspiration
Flexible fiberoptic ...
LUDWIG’S ANGINA = PERILOUS AIRWAY
Parhiscar and Har-El
Review of 210 patients with deep neck abscess
Overall, 20.5%require...
Antibiotic Therapy
Polymicrobial infections
Aerobic Strep, anaerobes

Ampicillin/sulbactam with metronidazole
Beta-Lactam ...
Surgical Drainage
External
EXPOSURE, EXPOSURE, EXPOSURE
Levitt: anterior vs. posterior
approach
Submandibular incision
Sub...
Image-guided Aspiration
Patient selection
Smaller abscesses, limited extension, uniloculated
Poe, et al: CT guided aspirat...
Internal Jugular Vein Thrombosis
Lemierre’s syndrome
F/C, prostration, swelling and pain along SCM
Bacteremia, septic e...
Carotid Artery Rupture

Mortality of 20-40%
Sentinel bleeds from ear, nose, mouth
Majority from internal carotid, less fro...
Mediastinitis

Mortality of 40%
Increasing dyspnea, chest pain
CXR = widened mediastinum
Treatment
EARLY RECOGNITION AND I...
Recurrent Deep Neck Space Infection
THINK CONGENITAL ABNORMALITY
Imaging should help make the diagnosis
Nusbaum, et al: 12...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Treatment for ludwigs /certified fixed orthodontic courses by Indian dental academy

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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.

Indian dental academy provides dental crown &

Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit

www.indiandentalacademy.com ,or call
0091-9248678078

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Treatment for ludwigs /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Airway protection Antibiotic therapy Surgical drainage www.indiandentalacademy.com
  3. 3. Airway protection Observation Intubation Direct laryngoscopy: possible risk of rupture and aspiration Flexible fiberoptic Tracheostomy Ideally = planned, awake, local anesthesia Abscess may overlie trachea Distorted anatomy and tissue planes www.indiandentalacademy.com
  4. 4. LUDWIG’S ANGINA = PERILOUS AIRWAY Parhiscar and Har-El Review of 210 patients with deep neck abscess Overall, 20.5%requiredtracheotomy Ludwig’s angina, 75%required Tracheostomy Attempted intubation in 20 patients Failed in 11 patients, necessitating “slash” tracheostomy www.indiandentalacademy.com
  5. 5. Antibiotic Therapy Polymicrobial infections Aerobic Strep, anaerobes Ampicillin/sulbactam with metronidazole Beta-Lactam resistance in 17-47% of isolates Alternatives Third generation cephalosporins clindamycin Culture and sensitivity www.indiandentalacademy.com
  6. 6. Surgical Drainage External EXPOSURE, EXPOSURE, EXPOSURE Levitt: anterior vs. posterior approach Submandibular incision Submental incision T-incision www.indiandentalacademy.com
  7. 7. Image-guided Aspiration Patient selection Smaller abscesses, limited extension, uniloculated Poe, et al: CT guided aspiration Early specimen collection, reduced expense, avoidance of neck scar Yeow, et al: Ultrasound guided aspiration 8/10 patients successfully treated with needle aspiration 5/5 patients successful treated with pigtail catheter insertion www.indiandentalacademy.com
  8. 8. Internal Jugular Vein Thrombosis Lemierre’s syndrome F/C, prostration, swelling and pain along SCM Bacteremia, septic embolization, Dural sinus thrombosis IV drug abusers Treatment IV antibiotic therapy Anticoagulation? Ligation and excision www.indiandentalacademy.com
  9. 9. Carotid Artery Rupture Mortality of 20-40% Sentinel bleeds from ear, nose, mouth Majority from internal carotid, less from external carotid, and fewest from common carotid Treatment Proximal and distal control Ligation Patching or grafting ? www.indiandentalacademy.com
  10. 10. Mediastinitis Mortality of 40% Increasing dyspnea, chest pain CXR = widened mediastinum Treatment EARLY RECOGNITION AND INTERVENTION Aggressive IV antibiotic therapy Surgical drainage Transcervical approach Chest tube vs. thoracotomy www.indiandentalacademy.com
  11. 11. Recurrent Deep Neck Space Infection THINK CONGENITAL ABNORMALITY Imaging should help make the diagnosis Nusbaum, et al: 12 cases of recurrent deep neck infection Most Common: second branchial cleft cyst Others: first, third, fourth branchial cleft cysts, lymphangiomas, thyroglossal duct cysts, cervical thymic cyst www.indiandentalacademy.com
  12. 12. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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