LUDWIG’S ANGINA PRESENTATION CELLULITIS.pptx

Ludwig's Angina

1. LUDWIG’S ANGINA DEPARTMENT OF ENT GSVM MEDICAL COLLEGE DR QAZI

2. *Ludwig angina is life-threatening cellulitis of the soft tissue involving the floor of the mouth and neck. *Ludwig angina involves 3 compartments of the floor of the mouth: sublingual, submental, and submandibular. *The infection is rapidly progressive , leading to potential airway obstruction.

3. CLINICAL ANATOMY: *Submandibular space lies between the mucous membrane of The floor of the mouth and tongue on one side and the superficial layer of deep cervical fascia extending between the hyoid bone and mandible on the other.

4. It is divided into two compartments by the mylohyoid muscle : 1. Sublingual compartment (above the mylohyoid). 2. Submaxillary and submental compartment (below the mylohyoid). The two compartments are continuous around the posterior border of the mylohyoid muscle. Ludwig’s angina is an infection of the submandibular space.

5. AETIOLOGY Dental Infections. *They account for 80% of the cases. *Roots of premolars often lie above the attachment of the mylohyoid and cause sublingual space infection. * In contrast, roots of the molar teeth extend up to or below the mylohyoid line and primarily cause submaxillary space infection . 2. Submandibular Sialadenitis, Injuries of Oral Mucosa and Fractures of the Mandible account for other cases

6. 3.BACTERIOLOGY * Mixed infections involving both aerobes and anaerobes are common. * Alpha-haemolytic Streptococci, Staphylococci and Bacteroides groups are common. *Rarely Haemophilus Influenzae, Escherichia coli, and Pseudomonas are seen

7. CLINICAL FEATURES *There is marked difficulty in swallowing (odynophagia ) with varying degrees of trismus. *When infection is localized to the sublingual space, Structures in the floor of the mouth are swollen and the tongue seems to be pushed up and back. *When the infection spreads to submaxillary space , submental and submandibular regions become swollen and tender, and impart a woody-hard feel.

8. *Usually, there is cellulitis of the tissues rather than frank abscess. * Tongue is progressively pushed upwards and backward threatening the airway. * Laryngeal edema may appear

9. TREATMENT Systemic antibiotics. 2. Incision and drainage of abscess. (a) Intraoral —if the infection is still localized to sublingual space. (b) External —if the infection involves submaxillary space . A transverse incision extending from one angle of Mandible to the other is made with a vertical opening of midline musculature of the tongue with a blunt hemostat. Very often it is serous fluid rather than frank pus that is encountered. 3. Tracheostomy, if the airway is endangered.

10. COMPLICATIONS Spread of infection to parapharyngeal and retropharyngeal spaces and thence to the mediastinum. 2. Airway obstruction due to laryngeal edema, or swelling and pushing back of the tongue. 3. Septicemia. 4. Aspiration pneumonia.

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