Ludwig's angina
Background
- Infection of submandibular and sublingual spaces
- 85% of cases arise from an odontogenic source, usually mandibular molars
- Patients usually 20-60 yrs old, male predominance
- Streptococcus, Staphylococcus, and Bacteroides spp. are pathogens
- Intubation may be very difficult
Diagnosis
- Mouth pain, drooling, trismus,brawny edema,tongue protrusion,stridor
- Acute laryngospasm with airway compromise is biggest concern
- Suggested by dyspnea or cyanosis
- Clinical diagnosis, but CT with IVC can define abscess
- May lose airway in scanner when pt lies flat
- Weigh the risks and benefits
Treatment
- Abx
- Must cover typical oral flora
- Usually third gen cehpalosporin with clindamycin or flagyl
- Steroids controversial
Disposition
- Admit, usually ICU for airway monitoring
- Emergent ENT or OMFS consult
Source
- Tintinalli
- ER Atlas