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Ludwig‘s Angina

Ludwig‘s Angina

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Ludwig‘s Angina

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  1. Ludwig‘s Angina Aneta Dolezal, Nov. 2012

  2. Definition • Aka Angina ludovici, anginamaligna, M. Strangularis • Named after German Wilhelm Friedrich von Ludwig in 1836 • Rapidlyexpandinginflammationofthe submandibular, submental andsublingual smooth connectivetissue • Bloatingcancauseobstructionofupperairways •  potentiallylifethreating !

  3. Symptoms Fever, pain, chills, sorenessalongthechin Pusis not produced, oedemaappearsasresultofextracellularyexudate Tongueisdisplaced on thepalatinawhichforcesthemouth open Further: Neck swelling, dysphagia, breathingdifficultiescanleadtolifethreatingsituation

  4. Causes • Bacterialinfection incl.: Streptococci, staphylococci, gram-neg., anaerobicorganism • Infectionstartsusuallyatthelowermolars (3rd) • Mainlyobserved in patientswithimpairedimmunity such as: immuncomprimised (chemotherapy, cortisoltreatment) malnutrition, diabetes etc. • Also seen in patients after lingualfrenulumpiercingprocedure.

  5. Treatments • Airwaymonitoringismandatory • Nasotrachealtubeforventilation. CAVE: Tracheostomyis not indicated, tokeeptheinfectionfromspreadingfurther • Parenteral antiobiotics: high dose Penicillin G orClindamycin • Incisionanddrainageoftheoedema

  6. Summary • Potentiallylifethreatinginfection • Mostlyseen in immuncomprimisedpatients • Symptonsleadfrompain, bleeding, fevertosevereswellingofthe neck andairwayobstruction. • Airwaymaintenanceiscompulsory • High dosedantiobiotics, surgicalincisionanddrainage

  7. Thankyouforyourattention