Descending necrotizing mediastinitis from Ludwig’s angina: a life-threatening condition

Ludwig’s angina is a deep neck space infection defined as a rapidly progressive bilateral cellulitis of the submandibular space. In spite of being an uncommon entity in developed countries and the reduction of mortality and morbidity due to modern era of antibiotics, improved imaging and airway management, it is still an important and potentially life-threatening condition. The authors present 3 cases of Ludwig’s angina that occurred in a developed country, and that required admission in intensive care unit and extensive surgical and medical treatment.

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Case Report: Poor oral hygiene leading to an emergency condition: A case report of Ludwig’s angina

F1000Research ◽

10.12688/f1000research.74692.1 ◽

2021 ◽

Vol 10 ◽

pp. 1219

Author(s):

Prashant Pant ◽

Oshan Shrestha ◽

Pawan Budhathoki ◽

Nebula Devkota ◽

Prabin Kumar Giri ◽

...

Keyword(s):

Case Report ◽

Oral Hygiene ◽

Common Source ◽

Poor Oral Hygiene ◽

Presenting Symptoms ◽

Dental Procedures ◽

Life Threatening ◽

History Of ◽

Ludwig’S Angina ◽

Ludwig's Angina

Ludwig’s angina (LA) is a rapidly spreading and potentially life-threatening infection having an odontogenic infection as the most common source. It involves the floor of the mouth and neck. Modernization in medical care has made this entity rare and of low mortality at the present but it is still feared as a lethal entity due to rapidly progressive airway obstruction that follows. Here we report a case of a 15-year-old male who suffered from LA. Presenting symptoms and findings of the examination helped in the clinical diagnosis. Immediate intubation, use of broad-spectrum antibiotics, and treatment of complications aided the patient’s recovery. LA should be considered for differential diagnosis in the case of neck swelling especially in those having a history of poor oral hygiene and recent dental procedures. Management of LA and its complications should always involve doctors from multiple disciplines.

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A Case of Ludwig’s Angina: Life Threatening Deep Neck Infection Presenting with Unusual Symptoms of Chest Pain

British Journal of Medicine and Medical Research ◽

10.9734/bjmmr/2014/7365 ◽

2014 ◽

Vol 4 (7) ◽

pp. 1552-1557

Author(s):

Nicholas Wong

Keyword(s):

Chest Pain ◽

Deep Neck Infection ◽

Neck Infection ◽

Life Threatening ◽

Ludwig’S Angina ◽

Unusual Symptoms ◽

Ludwig's Angina

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Airway Management in a Patient with Ludwig's Angina

10.2310/anes.18411 ◽

2020 ◽

Author(s):

Sara B. Robertson

Keyword(s):

Airway Management ◽

Pediatric Patients ◽

Signs And Symptoms ◽

Thoracic Pain ◽

Neck Infection ◽

Airway Collapse ◽

Life Threatening ◽

Neck Anatomy ◽

Ludwig’S Angina ◽

Ludwig's Angina

Ludwig’s angina (LA) is a rare but life-threatening deep space neck infection that affects several combined potential spaces in the neck, namely the submental and submandibular spaces. Patients often present with signs and symptoms such as dysphonia, odynophagia, neck and thoracic pain, otalgia, sialorrhea, and cough. In later stages, the patient may present with dysphagia, trismus, cyanosis, dyspnea, and stridor which all may signal an impending airway collapse. This comprehensive review will set out to describe the definition, anatomy, and epidemiology of Ludwig’s angina, how it manifests, and how to diagnose and treat the infection that can be often difficult to recognize. Clinical features of the disease are discussed as well as different strategies for anesthesia and airway management. Two special situations in which Ludwig’s angina can occur—pregnancy and pediatric patients—are also covered. This review contains 5 tables, and 30 references. Keywords: Ludwig’s angina, management of the airway in Ludwig’s angina, conservative treatment in Ludwig’s angina, surgical management in Ludwig’s angina, antibiotic treatment for Ludwig’s angina, Ludwig’s angina in pediatrics, Ludwig’s angina in pregnancy, neck anatomy in Ludwig’s angina

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Awareness Of Ludwig’s Angina Among Dental Practitioners

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl3.3319 ◽

2020 ◽

Vol 11 (SPL3) ◽

pp. 996-999

Author(s):

Reshma Thirunavakarasu ◽

Dhanraj Ganapathy ◽

Subhashree Rohinikumar

Keyword(s):

Neck Region ◽

Multiple Choice Questions ◽

Head And Neck Region ◽

Causative Factors ◽

Dental Practitioners ◽

Life Threatening ◽

Ludwig’S Angina ◽

Level Of Knowledge ◽

Management Techniques ◽

Ludwig's Angina

Ludwig's angina is life-threatening cellulitis. It is primarily seen involving the submandibular space followed by secondary involvement of the submental space. This disease has an aggressive character and spreads rapidly causing a compromised airway with little warning. The aim of the study is to determine the level of knowledge and awareness of dental practitioners regarding Ludwig's angina and its management techniques. A total of 10 multiple choice questions were formed and distributed to 100 dental practitoners with more than five years of experience. All ten questions assessed the knowledge of dental practitioners regarding Ludwig's angina and awareness of the various management techniques. After all the participants have given their response, their responses were noted and tabulated. All the respondents were aware of the cause and causative factors of Ludwigs, angina.78% said it is cellulitis. Broad-spectrum antibiotics are the choice in 78% of the respondents.80% are aware this condition involves multiple space infections and 64%said they can diagnose this condition based on clinical features. The awareness of management techniques of Ludwig's angina was high among dental practitioners. The importance regarding knowledge of various disease which mainly affects the head and neck region is crucial for dental practitioners. Thus it is essential for the dental practitioners to have knowledge of the conditions and be aware of the management of these conditions.

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Ludwig’s Angina: An Update of Clinical Features and Management

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v7i1-2.53959 ◽

2019 ◽

Vol 7 (1-2) ◽

pp. 51-56

Author(s):

Syed Hasan Imam Al Masum ◽

Ali Jacob Arsalan

Keyword(s):

Airway Obstruction ◽

Clinical Features ◽

Early Recognition ◽

Case Fatality ◽

Submandibular Region ◽

Acute Airway Obstruction ◽

Life Threatening ◽

History Of ◽

Ludwig’S Angina ◽

Ludwig's Angina

Background & objective: Ludwig’s angina (LA) is a potentially life-threatening, rapidly spreading, bilateral cellulitis of the submandibular spaces in children. In the preantibiotic era, the airway obstruction was almost inevitable and case fatality rate was as high as 60%. With the introduction of antibiotics in 1940s the LA has become an uncommon disease. As such, many physicians have limited experience of it. But its early recognition and aggressive management still carries utmost importance to avoid life-threatening acute airway obstruction. Therefore, the present study was undertaken to update the physicians with clinical features and management of Ludwig’s angina. Methods: The present descriptive study was conducted in Bangladesh Institute of Child Health & Dhaka Shisu Hospital, Sher-e-Bangla Nagar, Dhaka between January 2012 to December 2016. Having obtained approval from the Institutional Review Board of the Institute, we retrospectively analyzed the clinical course and management of Ludwig’s angina. During the period a total of 27 patients’ record were found available. Data were collected on demographic and clinical characteristics, causes and predisposing factors, investigations, complications developed and outcome of LA. Penicillin with or without additional anaerobic coverage with clindamycin or metronidazole were used as key patient management strategy. Steroid was given for faster recovery of the patients having airway compromise. Patients who did not recover with conservative treatment underwent surgical treatment with incision and drainage. Result: In the present study children with Ludwig’s angina presented with bilateral swelling of the neck and submandibular region accompanied by pain and induration in the affected region. Systemic symptoms, such as, fever and malaise were also frequently present. Two-thirds (66%) of the children had dehydration and almost half (48%) had toxic look. Over one-third (37%) of the children exhibited, restricted backward and upward elevation of tongue and over half with trismus. Of the systemic signs, high temperature, tachycardia, and tachypnoea were common presentation. One-third of the children exhibited signs of airway obstruction. Fifty percent of the children had the history of toothache (lower molar) one or two weeks prior to the development of Ludwig’s angina, 40% had history of mumps and 3.7% had history of trauma to the mandible. Over one-quarter developed pneumonia with mediastinitis. Airway obstruction, manifested as unable to swallow saliva, dyspnoea, stridor and cyanosis, was exhibited by over 55% of the children and received intravenous steroid for faster recovery from the condition. More than three-quarters (77.7%) of the patients responded to Penicillin with or without clindamycin or metronidazole and those who did not respond to it (22.3%) underwent operative treatment. Conclusion: Despite modern medical and surgical interventions have improved the outcomes of Ludwig’s angina to a great extent, it still remains a potentially lethal disease in the pediatric population. Early recognition of the disease with identification of airway obstruction and prompt intravenous antibiotic therapy could resolve the disease without any complications or need for surgical intervention. Ibrahim Card Med J 2017; 7 (1&2): 51-56

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Ludwig’s Angina Complicated by Descending Necrotizing Mediastinitis and Superimposed Candida mediastinitis: Case Report and Literature Review

Journal of Dental and Maxillofacial Surgery ◽

10.18314/jdms.v1i1.1157 ◽

2018 ◽

Vol 1 (1) ◽

pp. 33-36

Author(s):

Nilesh Tejura ◽

Rajendra Kapila ◽

Lisa Dever

Keyword(s):

Candida Albicans ◽

Case Report ◽

Literature Review ◽

Subsequent Development ◽

Candida Krusei ◽

Descending Necrotizing Mediastinitis ◽

Unique Case ◽

Floor Of The Mouth ◽

Ludwig’S Angina ◽

Ludwig's Angina

Ludwig’s angina is a rapidly spreading infection of the floor of the mouth and neck. A rare and dreaded complication of Ludwig’s angina is extension of the infection to the mediastinum. We describe a unique case of Ludwig’s angina presenting with descending necrotizing mediastinitis, with the subsequent development of Candida albicans and Candida krusei mediastinitis.

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Comparative study of the outcome of surgical decompression in Ludwig’s angina by conventional skin incision versus multiple interrupted skin incisions

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20204631 ◽

2020 ◽

Vol 6 (11) ◽

pp. 2054

Author(s):

Kulkarni Manik Rao ◽

Navneeth T. P. ◽

Vivek S. ◽

Sonu S. Rathod

Keyword(s):

Hospital Stay ◽

Skin Incision ◽

Conventional Group ◽

Female Ratio ◽

Life Threatening ◽

Common Etiology ◽

Ludwig’S Angina ◽

The Mean ◽

Male To Female ◽

Ludwig's Angina

Background: Ludwig’s angina is a potentially life threatening infection characterized by a rapidly progressing, bilateral gangrenous cellulitis of all the three primary mandibular spaces namely submental, submandibular and sublingual. If left untreated the cellulitis can progress swiftly to produce obstruction of airway and death. Despite that, no specific guidelines exist and management is greatly dependent on clinical judgement and experience.Methods: Forty cases of patients with Ludwig’s angina, attending the department of otorhinolaryngology were included in this study and were randomly allocated into conventional incision (CI) and multiple incisions (MI) groups. Following informed written consent, either conventional incision or multiple small incisions were used for drainage and the outcomes analysed. Results: The mean age of patients was 28.4 years and majority of the patients belonged to 20-40 years age group. Male to female ratio was 2.3:1.The most common etiology was odontogenic. The outcome of both the conventional group and multiple small incisions group were comparable. The mean hospital stay of the conventional group was 10.25 days and multiple incisions group was 5.31 days which was statistically significant.Conclusions: Multiple small incisions for the drainage of Ludwig’s angina is a safe and less invasive alternative method, with the advantages being shorter hospital stay and better cosmesis without an increase in complications.

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Emergency management of Ludwig’s angina: a case report

Journal of Dentomaxillofacial Science ◽

10.15562/jdmfs.v2i3.517 ◽

2017 ◽

Vol 2 (3) ◽

pp. 201

Author(s):

Nur H. Alimin ◽

Endang Syamsuddin

Keyword(s):

Source Control ◽

Airway Patency ◽

Source Of Infection ◽

Hospital Emergency Room ◽

Life Threatening ◽

Infection Source ◽

Mandibular Region ◽

Ludwig’S Angina ◽

Spread Of Infection ◽

Ludwig's Angina

Objective: Ludwig’s angina is a severe diffuse cellulitis in mandibular region that commonly caused by odontogenic infection. Due to its acute on onset, spread rapidly, involving the submandibular, sublingual region bilaterally and submental region, this condition consider as an emergency because it can cause airway obstruction.Methods: A 40 years old male patient came to Dr. Hasan Sadikin hospital emergency room with pain and swelling at lower jaw, drooling, hard to breath and limitation in opening his mouth. He was diagnosed with sepsis and Ludwig’s angina. Tracheostomy was performed to secure the airway, continued with teeth extraction, incision and drainage to eliminate the source of infection. Combination of intravenous antimicrobial was administered.Results: An advanced case of Ludwig’s angina and its management was reported. The patient showed a good response to the treatment and the condition was improved.Conclusion: Ludwig’s angina is a rare emergency condition which potentially life-threatening. Patient showed a significant recovery due to immediate and rapid management in securing airway patency and infection source control to prevent the spread of infection and further complications.

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Ludwig's angina: a multidisciplinary concern

British Journal of Nursing ◽

10.12968/bjon.2019.28.9.547 ◽

2019 ◽

Vol 28 (9) ◽

pp. 547-551

Author(s):

Emma Parker ◽

Gerri Mortimore

Keyword(s):

Emergency Department ◽

Dental Treatment ◽

Out Of Hours ◽

Poor Access ◽

Increased Risk ◽

Life Threatening ◽

Education And Awareness ◽

Ludwig’S Angina ◽

Local Emergency Department ◽

Ludwig's Angina

Although relatively uncommon, Ludwig's angina is a potentially life-threatening infection of the floor of the mouth and neck. There is a danger of airway obstruction by swelling in the area and displacement of the tongue, and patients are at risk of deterioration. There are many factors thought to place patients at an increased risk of developing the condition. These include recent dental treatment, dental caries or generally poor dentition, chronic disease such as diabetes, alcoholism and malnutrition, and patients with compromised immune systems (eg AIDS, organ transplantation). This article examines the aetiology of Ludwig's angina and considers the presentation, diagnosis and treatment of a patient who presented to an out-of-hours streaming area of a local emergency department, with an emphasis on the importance of a multidisciplinary approach. It also considers the need for ongoing education and awareness of health professionals to ensure the successful diagnosis, management and treatment of this condition, particularly in the context of patients with poor access to dental care presenting first to the emergency department.

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