Ludwig's Angina - Review of Seven Cases

DOI:

Mazumder SM K A1 , Daulatuzzaman2 , Khan E H3

Abstract

Ludwig's angina is a rare deep soft tissue infection that occurs on the floor of the mouth underneath the Tongue. This bacterial infection often occurs after a tooth abscess. Which is a collection of pus in the center of a tooth. It can also follow other mouth infection or injuries.

Ludwig's angina is also known as angina Ludwig's ,angina malign or morbus strangularis because of the inflammation it causes in the floor of the mouth Causing a strangulating feeling like angina pectoris or chort pains.

Ludwig's angina is best described by Karl fried rich Wilhelm von Ludwig in 1836, as a rapidly and frequently fatal progressive gangrenous cellulitis and edema of the soft tissues of the neck and floor of the mouth1-5. The diqnse extends by continuity rather than lymphatic spread6. Airway compromise has been recognized as the leading cause of death_ Mortality exceeded 50% but since the introduction of antibiotics in 1940's, improved oral and dental hygiene and aggressive surgical approach, the mortality rate was reduced significantlynl. This resulted in the rare occurrence of the disease leaving many physicians with increasingly limited experience of Ludwig's angina. In most cases the primary cause of Ludwig's angina is odontogenic infection 12,13. Other etiologies include peritonsillar

and para-pharyngeal abscesses, oral lacerations/piercing. lymphangiomas, mandibular fractures or submandibular sialoadenitis14-18. Predisposing factors include: dental carries, recent dental treatment, systemic illness such as diabetes mellitus, malnutrition, alcoholism, compromised immune system such as AIDS and organ transplantation trauma19-23. In children, it can occur de novo, without any apparent cause 25. Early recognition of the disease is of paramount importance. Painful neck swelling, tooth pain, dysphagia, dyspnoea, fever, and malaise are the most common complaints. Neck swelling and a protruding or elevated tongue are seen in the vast majority of cases. Stridor, trismus, cyanosis and tongue displacement suggest an impending airway crisis26. Edema and induration of the anterior neck, often with cellulitis, may be present in advanced USW27,28.

Review of cases: Seven cases of Ludwig's Angina were diagnosed and treated who had edema of the floor of the mouth and the tongue along with submandibular swelling and inability to open the mouth_ All the patients have dental infectionincislon and drainage given to all of the patients through the sub mental region and submandibular region immediately after admission under local anesthesia The edema and trismus subsided gradually.

Keywords:


  1. Professor and Head, Department of ENT

    Holy Family Red Crescent Medical College, Dhaka

  2. Professor, Department of ENT

    Holy Family Red Crescent Medical College, Dhaka

  3. Registrar, Department of ENT

    Holy Family Red Crescent Medical College, Dhaka


Volume 29, Number 2 July 2018
Page: 34-38