LUDWIGS ANGINA.pptx

Applied Anatomy
Etiology of Ludwig’s Angina
Clinical Picture of Ludwig’s Angina
Differential Diagnosis
Complications of Ludwig’s Angina
Management of Ludwig’s Angina

If Ludwig's angina is diagnosed, the patient should be intubated immediately. Imaging has no role in the immediate assessment of the patient - the decision to intubate is made solely on clinical parameters, as sending a patient with an impending airway to the CT scanner will delay treatment and may be lethal.
Once the airway is secured, a CT scan of the neck with intravenous (IV) contrast can then be used to evaluate the severity of the infection and assess for any abscess.
In addition, CT scans and MRI can be used to identify mediastinal fluid cumulus and corroborate the airway edema.
Neck and chest x-rays may demonstrate gas in the tissues in the case of infections caused by anaerobic microflora.
Lastly, metastatic abscesses and pus may be seen with ultrasonography.
Blood cultures should be obtained to determine if there is a hematogenous spread of the infection.

1. LUDWIG’S ANGINA DR AWAIS IRSHAD Fazaia Ruth Pfau Medical College Department of ENT 1

2. Learning Objectives Applied Anatomy Etiology of Ludwig’s Angina Clinical Picture of Ludwig’s Angina Differential Diagnosis Complications of Ludwig’s Angina Management of Ludwig’s Angina Fazaia Ruth Pfau Medical College Department of ENT 2

3. Fazaia Ruth Pfau Medical College Department of ENT 3 Submandibular space Divided into two compartments Sublingual compartment Submaxillary & Submental compartment Ludwig’s angina is infection of submandibular space. Applied Anatomy

4. Fazaia Ruth Pfau Medical College Department of ENT 4 Dental Infections Submandibular sialadenitis Inuries of oral mucosa Fractures of mandible Bacteriology Streptococcus Staphylococcus Bacterioides H. influenzae ., E.coli, Pseudomonas Etiology

5. Fazaia Ruth Pfau Medical College Department of ENT 5 M assive, firmy & brawny cellulitis or induration involving spaces bilaterally: Submandibular Sublingual Submental Trismus Marked difficulty in swelling (Odynophagia) When infection is localized to sublingual space, structures in the floor of mouth are swollen & tongue seems to be pushed up and back. When infection spreads to submaxillary space, submental and submandibular regions become swollen and tender. Tongue is progressively pushed upwards and backwards threatening airway. Laryngeal edema may appear. Clinical Picture

6. Fazaia Ruth Pfau Medical College Department of ENT 6 Tooth Pain Tachypenia & tachycardia & fever Patients may exhibit dysphonia.

7. Fazaia Ruth Pfau Medical College Department of ENT 7 Cellulitis Lingual carcinoma Lymphadenitis Salivary gland abcess Sublingual hematoma Peritonsillar abcess Differential Diagnosis

8. Fazaia Ruth Pfau Medical College Department of ENT 8 History Examination Investigations Treatment Management of Ludwig’s Angina

9. Fazaia Ruth Pfau Medical College Department of ENT 9 Onset Pain Tooth Extraction Tooth Infection Neck Pain Difficulty in speaking Hoarseness of voice Trismus Tongue swelling Stiff neck Stridor History

10. Fazaia Ruth Pfau Medical College Department of ENT 10 Fever Submental & Submandiular swelling Tenderness Swelling of floor of mouth Elevation of tongue Tenderness of involved teeth Induration of submental neck Edema of upper neck The patient will not typically have lymphadenopathy. Examination

11. Fazaia Ruth Pfau Medical College Department of ENT 11 If Ludwig's angina is diagnosed, the patient should be intubated immediately . Imaging has no role in the immediate assessment of the patient - the decision to intubate is made solely on clinical parameters, as sending a patient with an impending airway to the CT scanner will delay treatment and may be lethal . Once the airway is secured, a CT scan of the neck with intravenous (IV) contrast can then be used to evaluate the severity of the infection and assess for any abscess . In addition, CT scans and MRI can be used to identify mediastinal fluid cumulus and corroborate the airway edema . Neck and chest x-rays may demonstrate gas in the tissues in the case of infections caused by anaerobic microflora . Lastly, metastatic abscesses and pus may be seen with ultrasonography . Blood cultures should be obtained to determine if there is a hematogenous spread of the infection. Investigations

12. Treatment The treatment of Ludwig's angina is aimed principally at protecting the airways - the most common cause of death is asphyxiation from airway obstruction - controlling the infection with antibiotic therapy , and in some cases of well-established infections surgical draining. Incision and drainage of abscess. Intraoral Extra-oral Tracheostomy, if airway is endangered. Fazaia Ruth Pfau Medical College Department of ENT 12

13. Fazaia Ruth Pfau Medical College Department of ENT 13 Spread of infection to parapharyngeal and retropharyngeal spaces & then to mediastinum. Airway obstruction due to laryngeal edema. Septicemia. Aspiration pneumonia. Complications

14. Fazaia Ruth Pfau Medical College Department of ENT 14 A 48 years old female presented to the ER with complaints of progressive, diffuse neck swelling over the submental area and high grade fever for the past 4 to 5 days. As an ENT doctor: What specific questions you would ask in history to aid and elicit the diagnosis? Give differential diagnosis. Give management plan of most probable diagnosis. Differentiate between neck swellings of various causes. What impending emergencies do you need to e aware of and how to manage them? Write the labs and prescription for above issue. CBL 16

15. Fazaia Ruth Pfau Medical College Department of ENT 15