Ludwig's Angina

Ludwig's angina from ENT by Malik Jauhar
Mail: [email protected]

1. Ludwig’s angina Malik Jauhar Pre-Final MBBS Dept. of ENT, ASCOMS

2. Ludwig’s Angina I nfection of the Submandibular space

3. Submandibular Space B etween mucous membrane of the floor of mouth and tongue on one side and superficial layer of deep cervical fascia (extending between the hyoid bone and mandible) on the other. 2 compartments (divided by the Mylohyoid muscle): Sublingual Compartment above the Mylohyoid . Submaxillary and Submental Compartment below the Mylohyoid . C ompartments are continuous around the posterior border of Mylohyoid muscle.

4. Aetiology Dental infections: 80% cases Roots of premolars often lie above the attachment of mylohyoid and cause sublingual space infection. R oots of molar teeth extend up to or below the mylohyoid line and cause submaxillary space infection.

5. Aetiology Submandibular sialadenitis I njuries of oral mucosa F ractures of the mandible

6. Bacteriology Commonly mixed infections involving both aerobes and anaerobes Commonly Alpha-hemolytic Streptococci , Staphylococci and bacteroides group Rarely Haemophilus influenzae , Escherichia coli and Pseudomonas

7. Clinical Features Odynophagia with varying degrees of trismus . In localized sublingual infection: Structures in the floor of mouth are swollen and tongue seems to be pushed up and back. In submaxillary space involvement: Submental and submandibular regions become swollen and tender, and impart woody-hard feel. Usually there is cellulitis rather than frank abscess. Tongue is pushed upwards and backwards threatening the airway. Laryngeal oedema.

8. Treatment Systemic antibiotics Incision and drainage of abscess. Intraoral —if infection is still localized to sublingual space. External – if infection involves submaxillary space . A transverse incision extending from one angle of mandible to the other is made with vertical opening of midline musculature of tongue with a blunt haemostat. Very often it is serous fluid rather than frank pus that is encountered. Tracheostomy, if airway is endangered.

9. Complications Spread of infection to parapharyngeal and retropharyngeal spaces and thence to mediastinum. Airway obstruction due to laryngeal oedema, or swelling and pushing back of the tongue. Septicaemia. Aspiration pneumonia.

10. Thank You