LUDWIG'S ANGINA

LUDWIG'S ANGINA

Ludwig’s angina is a form of firm, acute, toxic and severe diffuse cellulitis causing board swelling of submandibular, sublingual and submental spaces bilaterally.

It is a disease primarily of dental origin following infection of second and third inferior molars.

This is a condition of acute infection of the floor of the mouth (i.e. cellulitis) involving the cellular tissue and tissues of the neck and submandibular area.

ETIOLOGY:

l.  Infection from mandibular molar teeth

2. Infection within the floor of the mouth

3. Vincent’s angina

4. Periodontal disease

5. Acute tonsillitis

6. Peritonsillar abscess (Quinsy)

7. Pericoronitis

8. Fracture of the mandible

9. Erysipelas

PREDISPOSING FACTORS:

Lowered resistance and poor oral hygiene.

CLINICAL FINDINGS:

l.  Painful, rapid developing board-like swelling in the floor of the mouth.

2. Elevation of tongue.

3. Enlarged painful lymph nodes.

4. Difficulty in swallowing and opening the mouth.

5. High fever, rapid pulse, fast breathing.

6. Headache, malaise and other signs of toxaemia.

7. Swelling of the upper part of the neck.

8. Oedema of glottis causing respiratory obstruction.

9. Infection may spread to pharyngeal spaces, to carotid sheath or to pterygopalatine fossa.

l0. Cavernous thrombosis with subsequent meningitis is sequel to this type of spread of infection.

TREATMENT:

l. Incision and drainage of pus

2. Antibiotic therapy

3. Mouthwashes

4. Liquid diet

5. Emergency tracheostomy, if symptoms of asphyxia are present.