scholarly journals Fatal Ludwig's Angina: Cases of Lethal Spread of Odontogenic Infection

2018 ◽  
Vol 8 (1) ◽  
pp. 150-169 ◽  
Author(s):  
Catherine R. Miller ◽  
Kendall Von Crowns ◽  
Vickie Willoughby
Keyword(s):  
Pleural Empyema ◽  
Odontogenic Infection ◽  
Odontogenic Infections ◽  
Space Infection ◽  
Dental Abscess ◽  
Submandibular Space ◽  
History Of ◽  
Ludwig’S Angina ◽  
Submandibular Space Infections ◽  
Ludwig's Angina

We report two cases of deaths resulting from complications of odontogenic infections/submandibular space infections. In one case, the decedent had a history of toothache as well as facial and tongue swelling; autopsy revealed inflammation involving the tongue and larynx. In the second case, the decedent had a history of toothache, and at autopsy there was spread of infection to the mediastinum. Ludwig's angina is a form of submandibular space infection, which often is a result of odontogenic infection. The infection can spread into the deep spaces of the neck, producing complications including edema of the tongue and pharynx (causing airway obstruction), descending mediastinitis, pericarditis, necrotizing fasciitis, pleural empyema, and pneumonia. Gross findings at autopsy might reveal a dental abscess or other forms of infection of the head and neck, necrosis of the neck muscles and larynx, and infrequently, infection extending to the chest cavity. Microscopically, there is acute inflammation with necrosis and/or granulation tissue predominantly within the fascia. Without treatment, submandibular space infections can be life threatening and progression to death can be swift. These cases demonstrate the lethal effects of odontogenic infections. Without a clinical history of toothache or dental abscess, one can be alerted to a possible submandibular space infection by identifying isolated necrosis of the neck musculature.

scholarly journals Clinicopathological study and management of infective swellings of neck in pediatric age group patients

2020 ◽  
Vol 6 (12) ◽  
pp. 2178
Author(s):  
Sudhakar Rao M. S. ◽  
Bipinkumar . ◽  
Vijaya T. N.
Keyword(s):  
Age Group ◽  
Institutional Management ◽  
Space Infection ◽  
Submandibular Space ◽  
Pediatric Age Group ◽  
Paediatric Age ◽  
Deep Neck Space Infections ◽  
Red Flag ◽  
Ludwig’S Angina ◽  
Ludwig's Angina

<p><strong>Background:</strong> Neck swellings are common presenting complaint in paediatric age group patients attending ENT department and are cause of concern for both doctors and parents because they are considered as red flag.</p><p><strong>Methods</strong>: This prospective study was conducted among 102 paediatric patients of both genders attending the OPD of department of ENT, Vijayanagar institute of medical sciences, Bellary, Karnataka, between July 2018 to March 2020.</p><p><strong>Results</strong>: Out of 102 patients in our study, majority of them were reactive lymphadenopathy 47 (46%). Out of 41 deep neck space infections, submandibular space is the most commonly involved space 27 (65.8%). Twenty-nine (70.7%) DNSI’s needed institutional management hence got admitted and among them 20 (48.7%) were submandibular space infection and 7 (17%) were Ludwig’s angina which was statistically significant (p=0.001). Among 27 submandibular space infection, 24 (88.8%) had fever, 19 (70.3%) had local pain, 4 (14.8%) had dysphagia which was statistically significant (p&lt;0.05).</p><p><strong>Conclusions:</strong> In the infective neck swellings of paediatric age group the submandibular space infection needs the zenith of active institutional management among both the genders, and the Ludwig’s angina warrants its treatment on institutional admission which is frequent in this age group.</p>

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

F1000Research ◽  
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.

Life-threatening complications of Ludwig’s angina: a series of cases in a developed country

2021 ◽  
Vol 14 (4) ◽  
pp. e240429
Author(s):  
Catarina Mendes Silva ◽  
Joana Paixão ◽  
Pedro Neves Tavares ◽  
João Pedro Baptista
Keyword(s):  
Developed Countries ◽  
Developed Country ◽  
Mortality And Morbidity ◽  
Space Infection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Ludwig’S Angina ◽  
Reduction Of Mortality ◽  
Modern Era ◽  
Ludwig's Angina

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.

Severe Ludwig’s angina caused by an unknown insect bite

2021 ◽  
Vol 14 (8) ◽  
pp. e243566
Author(s):  
Gihad Almadhi ◽  
Mohammed Alkathlan ◽  
Othman Alharbi ◽  
Ahmad Almeman
Keyword(s):  
Intensive Care Unit ◽  
Blood Cultures ◽  
Source Of Infection ◽  
Intravenous Antibiotics ◽  
Facial Swelling ◽  
History Of ◽  
Ludwig’S Angina ◽  
Insect Bites ◽  
Left Parotid Gland ◽  
Ludwig's Angina

Hereby, we report a case of a 75-year-old man who presented with a 3-day history of facial swelling and choking sensation. The only history of note was an insect bite on the left parotid gland area 3 days prior. The patient was later diagnosed with insect-bite-induced Ludwig’s angina. Enterococcus faecalis was detected on blood cultures and was presumed the source of infection. Intravenous antibiotics and corticosteroids were initiated. The patient was intubated and was subsequently made to undergo a tracheostomy insertion to establish a definitive airway. He was admitted to the intensive care unit and when his condition improved, he was transferred to the ward for full recovery. The patient spent a total of 66 days in hospital before being discharged. This case suggests that Ludwig’s angina can be caused by insect bites. However, further similar cases are needed to be documented to explore this theory.

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

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

scholarly journals Successful Management of Ludwig’s Angina due to Dental Implant Displacement: A Rare Case Report

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Lincoln Lara Cardoso ◽  
Giovanni Gasperini ◽  
Leandro Carvalho Cardoso ◽  
Guilherme Romano Scartezini ◽  
Annika Ingrid Maria Soderberg Campos ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Technique ◽  
Dental Implant ◽  
Clinical Case ◽  
Treatment Plan ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Submandibular Space ◽  
Ludwig’S Angina ◽  
Ludwig's Angina

Dental implant surgery is a common procedure in oral and maxillofacial surgery practices. Extensive training, skill, and experience allow this procedure to be performed with an atraumatic approach, but like any surgical technique, it is subject to accidents and complications. This is an unusual clinical case of an accidental displacement of an implant into the submandibular space that progressed to Ludwig’s angina, and it has not yet been described in the literature. This case report describes a clinical case of dental implant displaced into the submandibular space after healing cap removal. After seven days, it progressed to Ludwig’s angina. The removal was performed through extraoral access in the submandibular area by using hemostatic forceps and radioscopic technique. After implant removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical planning to achieve an appropriate treatment plan, which is essential for a favorable prognosis. Therefore, prevention and management of displaced objects requires proper planning and surgical technique.

scholarly journals Ludwig's angina: a case report with a 5-year follow-up

2019 ◽  
Vol 32 (2) ◽  
pp. 70-75
Author(s):  
Dario Re Cecconi ◽  
Roberto Fornara
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Second Molar ◽  
Odontogenic Infections ◽  
Periapical Lesions ◽  
Endodontic Infection ◽  
Systemic Antibiotic Therapy ◽  
Rapid Spread ◽  
Ludwig’S Angina ◽  
Ludwig's Angina

Aim: Ludwig’s angina is a rare aggressive infection, often of dental origin, characterized by a rapid spread of cellulitis in the submandibular and sublingual spaces. Ludwig[42TD$DIF]’s angina is potentially fatal, if it obstructs the airways and if it is not treated with appropriate antibiotic therapy. Summary: The case report describes the diagnosis and the management of a Ludwig[42TD$DIF]’s angina caused by an endodontic infection in a 16 years-old female patient. The infection has been caused by a decay of the second lower right molar. After hospitalization and systemic antibiotic therapy, in accordance with the patient and the parents endodontic and restorative treatments of the tooth were performed. After 3 and 5 years, the radiological examination revealed no periapical lesions around right lower second molar and the presence of lamina dura. Key learning points: This aggressive infection may often be undervalued and this may cause dangerous consequences to the patient[43TD$DIF]’s life. The infection can be prevented by periodic dental care and interventions, which can avoid odontogenic infections. In the case of Ludwig’s angina, early diagnosis is fundamental to save the patient’s life. After the initial antibiotic therapy and once the life of the patient is no longer at risk, an appropriate endodontic therapy can be considered a valid therapy for this disease.

scholarly journals Paciente acometido por Angina de Ludwig com grave progressão reabilitado com próteses dentárias: relato de caso

2019 ◽  
Vol 8 (3) ◽  
Author(s):  
Adriana Caroline Leite ◽  
Daniele Maria dos Santos Goes ◽  
Ricardo Shibayama ◽  
Glaykon Alex Vitti Stabile ◽  
Marcelo Medeiros Battistetti ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Diabetic Patients ◽  
Deep Neck Infection ◽  
Odontogenic Infections ◽  
Neck Infection ◽  
Retrospective Audit ◽  
Ludwig’S Angina ◽  
Deep Neck Infections ◽  
Head Neck ◽  
Ludwig's Angina

O objetivo deste trabalho é relatar e discutir um caso clínico de um paciente acometido por Angina de Ludwig que evoluiu gravemente para mediastinite. O paciente compareceu inicialmente ao Pronto Socorro do Hospital Universitário da Universidade Estadual de Londrina e após diagnóstico de Angina de Ludwig foi internado e tratado de forma emergencial. O tratamento foi multiprofisssional e constituiu-se em abordagem cirúrgica para descompressão dos tecidos, administração de antimicrobianos e remoção da causa da infecção. Mesmo após a primeira abordagem cirúrgica, o paciente evoluiu gravemente e houve a necessidade de reabordagem da região cervical e torácica. O paciente necessitou de um mês de internação hospitalar até que o quadro infeccioso fosse estabilizado. Após o incidente, o paciente se apresentava com baixa autoestima e com sua relação interpessoal afetada. Desta forma, foi encaminhado para a Clínica Odontológica Universitária da Universidade Estadual de Londrina onde foi reabilitado com prótese total superior e prótese parcial removível inferior a fim de devolver grande parte da função mastigatória, estética e, consequentemente, qualidade de vida.Descritores: Angina de Ludwig; Infecção; Prótese Dentária; Saúde Bucal.ReferênciasJiménez Y, Bagán JV, Murillo J, Poveda R. Odontogenic infections. Complications. Systemic manifestations. Med Oral Patol Oral Cir Bucal. 2004;9(Suppl):139-43.Lugo AFG, Ravago MGC, Martinez RAG, Peltrini RJZ. Ludwig’s angina: A report of two cases. Rev Esp Cir Oral Maxilofac. 2014;36(4):177-81.Umeda M, Minamikawa T, Komatsubara H, Shibuya Y, Yokoo S, Komori T. Necrotizing fasciitis caused by dental infection: a retrospective analysis of 9 cases and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(3):283-90.Bakir S, Tanriverdi MH, Gün R, Yorgancilar AE, Yildirim M, Tekbas G et al. Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol. 2012;33(1):56-63.Brook I. Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg. 2004;62(12):1545-50.Caccamese JF Jr, Coletti DP. Deep neck infections: Clinical considerations in aggressive disease. Oral Maxillofac Surg Clin North Am. 2008;20(3):367–80.Chen MK, Wen YS, Chang CC, Lee HS, Huang MT, Hsiao HC. Deep neck infections in diabetic patients. Am J Otolaryngol. 2000;21(3):169-73Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin North Am. 2008;41(3):459-83.Zarb GA, Bolender CL. Tratamento protético para os pacientes edêntulos – Próteses totais convencionais e implantossuportadas. 13. ed. Santos: São Paulo; 2013.Rodrigues JC. Tabu do corpo. Rio de Janeiro: Fiocruz; 2006.Narby B, Kronström M, Söderfeldt B, Palmqvist S. Changes in attitudes toward desire for implant treatment: a longitudinal study of a middle-aged and older Swedish population. Int J Prosthodont. 2008;21(6):481-85.Walton JN, MacEntee MI. Choosing or refusing oral implants: a prospective study of edentulous volunteers for a clinical trial. Int J Prosthodont. 2005;18(6):483-8.Sakarya EU, Kulduk E, Gündoğan O, Soy FK, Dündar R, Kılavuz AE, Özbay C, Eren E, İmre A. Clinical features of deep neck infection: analysis of 77 patients. Kulak Burun Bogaz Ihtis Derg. 2015;25(2):102-8.Botha A, Jacobs F, Postma C. Retrospective analysis of etiology and comorbid diseases associated with Ludwig’s Angina. Ann Maxillofac Surg. 2015;5(2):168-73.Suehara AB, Goncalves AJ, Alcadipani FAMC, Kawabata NK, Menezes MB. Deep neck infection: analysis of 80 cases. Braz J Otorhinolaryngol. 2008;74(2):253-59.Lee JK, Kim HD, Lim SC. Predisposing factors of complicated deep neck infection: an analysis of 158 cases. Yonsei Med J. 2007;48(1):55-62.Igoumenakis D, Gkinis G, Kostakis G, Mezitis M, Rallis G. Severe odontogenic infections: causes of spread and their management. Surg Infect (Larchmt). 2014;15(1):64-8.Rao DD, Desai A, Kulkarni RD, Gopalkrishnan K, Rao CB. Comparison of maxillofacial space infection in diabetic and nondiabetic patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(4):e7-12.Akinbami BO, Akadiri O, Gbujie DC. Spread of odontogenic ifnfections in Port Harcourt, Nigeria. J Oral Maxillofac Surg. 2010;68(1):2472-77.Flynn TR, Shanti RM, Hayes C. Severe odontogenic infections, Part 2: Prospective outcomes study. J Oral Maxillofac Surg. 2006;64(7):1104-13.Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS. Deep neck infection: analysis of 185 cases. Head Neck. 2004;26(10):854-60.Hsu RF, Wu PY, Ho CK. Transcervical drainage for descending necrotizing mediastinitis may be sufficient. Otolaryngol Head Neck Surg. 2011;145(5):742-47.Varghese L, Mathews SS, Antony Jude Prakash J, Rupa V. Deep head and neck infections: outcome following empirical therapy with early generation antibiotics. Trop Doct. 2018;48(3):179-82.Liau I, Han J, Bayetto K, May B, Goss A, Sambrook P et al. Antibiotic resistance in severe odontogenic infections of the South Australian population – a 9- year retrospective audit. Aust Dent J. 2018;63(2):187-92.

scholarly journals Knowledge and Practice towards Management of Space Infections among Dental Practitioners

2020 ◽  
Vol 11 (SPL3) ◽  
pp. 967-971
Author(s):  
Ahmed Hilal Sheriff ◽  
Dhanraj Ganapathy ◽  
Subhashree Rohinikumar
Keyword(s):  
Odontogenic Infection ◽  
Incision And Drainage ◽  
Odontogenic Infections ◽  
Space Infection ◽  
Periodontal Infection ◽  
First Choice ◽  
Dental Practitioners ◽  
Knowledge And Practice ◽  
Essential Knowledge ◽  
Supporting Structures

An odontogenic infection is an alveolar, jaw, or facial infection that is caused by a tooth or its supporting structures and is one of the most common infections. Dental caries, heavy restorations or unsuccessful endodontic treatment, pericoronitis and periodontal infection are by far the most likely reasons for odontogenic infections. Infections are typically clustered around teeth and may stay concentrated to the region where it began, and may propagate to neighbouring or distant locations. The questionnaire included questions regarding essential knowledge and understanding of the Management of odontogenic space infections. Responses were obtained, and the data were analyzed. 72% of the respondents have said streptococcus viridans is the most common microorganisms in odontogenic infection, 57% said they would give antibiotics, incision and drainage for canine space infection, 63% said they would give antibiotics, incision and drainage for submandibular infection space infection, 57% said their first choice of antibiotic in managing space infection is Amoxicillin, and 53% said clindamycin is the choice of antibiotics in patients allergic to Amoxicillin. Most of the dental practitioners in this study did not have complete knowledge regarding the new generations of cephalosporins rather; they were aware of the 3rd and 4th generation cephalosporins. More education and understanding will improve the effectiveness of use and solve the difficulties faced in dentistry.

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