Ludwig’s Angina

Epidemiology

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Etiology

  • Oral Trauma
  • Submaxillary/Sublingual Sialadenitis (see Sialadenitis)
  • Dental Abscess of Mandibular Teeth

Anatomy

  • Submandibular space is bounded inferiorly by the superficial layer of the deep cervical fascia extending from the hyoid to the mandible, laterally by the body of the mandible, and superiorly by the mucosa of the floor of mouth
  • Submandibular space infections may spread to the parapharyngeal and retropharyngeal spaces

Physiology

  • Deep Neck Infection of Submandibular Space (see Deep Neck Infection): inflammation and cellulitis of the submandibular space, usually originating in the submaxillary space and spreading to the sublingual space via the fascial planes (not via the lymphatics)
    • Induration of floor of mouth (which does not necessarily require a focal abscess) -> tongue is forced upward and backward, resulting in airway obstruction

Clinical

  • Drooling
  • Trismus
  • Pain in Floor of Mouth
  • Dysphagia (see Dysphagia])
  • Submandibular Mass
  • Acute Upper Airway Obstruction (see Obstructive Lung Disease)
    • Acute Respiratory Failure (see Acute Hypoventilation): due to high-grade upper airway obstruction with excessive work of breathing

Treatment

  • Tracheostomy: required for airway management (as airway obstruction can be life-threatening)
  • Antibiotics

Prognosis

  • Mortality in Pre-Antibiotic Era: 50%
  • Current Mortality Rate: <5%

References

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