Ludwigs angina, is a serious, potentially life-threatening cellulitis, or connective tissue infection, of the floor of the mouth Causes Dental infections account for approximately 80% of cases of Ludwigs angina. Mixed infections, due to both aerobes and anaerobes, are of the cellulitis associated with Ludwigs angina. Typically, these include alpha-hemolytic streptococci, staphylococci and bacteroides groups. The route of infection in most cases is from infected lower molars or from pericoronitis, which is an infection of the gums surrounding the partially erupted lower (usually third) molars. Although the widespread involvement seen in Ludwigs usually develops in immunocompromised persons, it can also develop in otherwise healthy individuals. Thus, it is very important to obtain dental consultation for lower-third molars at the first sign of any pain, bleeding from the gums, sensitivity to heat/cold or swelling at the angle of the jaw. Symptoms and signs True Ludwigs Angina is a cellulitic facial infection. The signs are bilateral (meaning both sides) lower facial swelling around the lower jaw and upper neck. This is because the infection has spread to involve the Submandibular, Sublingual and Submental spaces of the face. Swelling of the Submandibular space, while externally is concerning the true danger lies in the fact that the swelling has also spread inwardly - compromising, or in effect narrowing the airway. Dysphagia (difficulty swallowing), Odynophagia (pain during swallowing) are symptoms that are typically seen and demand immediate attention. The Sublingual and Submental spaces are anterior (beneath the middle and chin areas of the lower jaw) to the Submandibular space. Swelling in these areas can often push the floor of the mouth, including the tongue upwards and backwards - further compromising the airway. Additional symptoms include malaise, fever, dysphagia (difficulty swallowing), odynophagia (pain during swallowing) and, in severe cases, stridor or difficulty breathing. There may also be varying degrees of trismus. Swelling of the submandibular and/or sublingual space is imminent. Treatment Treatment involves appropriate antibiotic medications, monitoring and protection of the airway in severe cases, and, where appropriate, urgent maxillo-facial surgery and/or dental consultation to incise and drain the collections.
Posted on: Mon, 19 Jan 2015 09:53:29 +0000
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