❖ Ludwigs angina : #UME_MuscloSkeletal A bilateral infection of the submandibular space that consists of two compartments in the floor of the mouth, the sublingual space and the submylohyoid (also known as submaxillary) space. It was first described by the German physician, Wilhelm Frederick von Ludwig in 1836. This infection most commonly arises from an infected second or third mandibular molar tooth. It is an aggressive, rapidly spreading cellulitis without lymphadenopathy with potential for airway obstruction and requires careful monitoring and rapid intervention for prevention of asphyxia and aspiration pneumonia. Treatment : 1.Maintenance of airway patency. 2.Surgical incision and drainage. 3.Antibiotics active against oral flora. Maintaining airway patency is of the HIGHEST priority. Because swelling makes oral endotracheal intubation difficult, fiberoptic nasotracheal intubation done with topical anesthesia in the operating room or ICU with the patient awake is preferable. Some patients require a tracheotomy. Patients without immediate need for intubation require intense observation and may benefit temporarily from a nasal trumpet. Incision and drainage with placement of drains deep into the mylohyoid muscles relieve the pressure. Antibiotics should be chosen to cover both oral anaerobes and aerobes (eg, clindamycin , ampicillin /sulbactam , high-dose penicillin). #USmleMadeEasy
Posted on: Sun, 16 Nov 2014 06:48:16 +0000
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