Ludwigs angina by Dr.K.AmrithaAnilkumar
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Ludwig's angina is a rapidly progressive bacterial infection of the sublingual and submandibular spaces that can lead to airway obstruction. It is usually caused by a dental infection that spreads. Symptoms include painful swelling of the floor of the mouth and neck, difficulty speaking and swallowing, fever, and potential respiratory distress. Without treatment, it can spread and cause complications like mediastinitis or laryngeal edema. Diagnosis involves imaging tests and bloodwork. Treatment requires intravenous antibiotics and may require a tracheostomy if the airway is compromised. With appropriate treatment, mortality is less than 5%.
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Ludwigs angina by Dr.K.AmrithaAnilkumar
- 1. en love da Homoeopathy LUDWIG’S ANGINA
- 3. LUDWIG’SANGINA DEFINITION • Rapidlyprogressive polymicrobial cellulitis of the sublingual & submandibular spaces involving the floor of the mouth& suprahyoidarea on both sidesof the neck LUDWIG’s ANGINA
- 4. CAUSE • Commonest causeis the dental infection of 2nd or 3rd molarteeth precipitatedby tooth extraction • submandibular sialadenitis • Trauma • Peritonsillar abscess • Upper respiratorytract infection, • Interventions by endotracheal intubation PREDISPOSINGFACTORS • Diabetes Mellitus • Chemotherapy • Oral cancer, • OH, • Neutropenia COMMONESTORGANISM • Streptococcus viridians • Staphylococcus aureus • & anerobes • Gramnegative organsims are also involved
- 5. EXTENSION • Cellulitis may extend into the pharyngo-maxillary space, • Retro-pharynx • Superior mediastinum CLINICALFEATURES • Diffuse painful swelling with woodybrawnyindurationof the mouth&anterior neck • Swelling is non- fluctuant but with redness &tenderness • Bilateral submandibular oedema withmarked tenderness on palpationat suprahyoid area withbull’s neck appearance Bull Neck Appearance
- 6. • Toxic features like • Tachypnoea, • Tachycardia • Fever is common • Difficulty in speech, • Earache • Drooling of saliva & putrid halitosis • Involvement of connective tissues, muscles and fascial spaces but not glandular structures • odemaof tongue withpushing against palate(elevation) upwards and backwards causing airwayobstruction • Dysphagia & odynophagia • Stridor • Respiratorydistress • Cyanosis may developdue to oedema of tongue & larynx
- 7. SPREAD • Spreadvia fascial planes in continuitynot by lymphatics • no lymh node enlargement INVESTIGATIONS • CT scan/ MRI – • To identify airway block, • fluid collection • presence of gas • Ultrasoundneck • Total count, Blood sugar • Chest X-Ray • Blood gas analysis(In severe cases) is done DIFFERENTIAL DIAGNOSIS • Angioneuroticoedema • SublingualHaematoma • Sialadenitis • Lymphadenitis Silaladenitis
- 8. COMPLICATION • Laryngeal oedema • due to spread of inflammationto glottis submucosa via stylohyoidtunnel. • may require an emergency tracheostomyto maintainthe respiration • Mediastinitis • due to spread of infectioninto mediastinum MEDIASTINITIS LARYNGEAL OEDEMA
- 9. • aspirationpneumonia • Septicemia • Spreadof infectioninto the para pharyngeal space ↓ Thrombosis of the internal jugular vein ↓ may extend above intosigmoid sinus ↓ fatal & Mortality is less than5% TREATMENT • Antibiotics – intravenously can be given • If the patient is in the respiratory distress – tracheostomyis the life- saving procedure REFERENCE 1. SRB's Manual of Surgery by SriramBhat M 2. A Manual on Clinical Surgeryby Das 3. A Concise textbookof Surgeryby Das
- 10. A Special Thanks To A Very Special Doctor