Ludwig's angina

Ludwig’s angina causes, symptoms, management

Ludwig’s angina is a rare skin infection that is caused by bacteria after the tooth abscess. A tooth abscess is an accumulation of pus cells in the center of the tooth. This rare skin infection is a type of cellulitis that occurs at the floor of your mouth underneath the tongue. This infection mostly occurs in adults. It is a bilateral infection of sublingual space and submandibular space. Therefore, it is also known as Submandibular Space Infection.

This condition is treatable if you get prompt treatment. If the condition is worsened, you may get blocked the airway or other serious life-threatening complications. Because it requires rapid intervention for the prevention of Asphyxia and also requires careful monitoring.

Symptoms of Ludwig’s angina

This skin infectious disease often follows a tooth infection, mouth injury, or other infections in the mouth. The patient often developed neck pain, swelling of the tongue, and breathing problems. The overall symptoms of Ludwig’s angina include

  • Neck pain
  • Drooling of saliva
  • Difficulty swallowing
  • Pain or tenderness in the floor of the mouth which is below your tongue
  • Dysarthria or problems with speech
  • Fatigue
  • Swelling of the neck
  • An earache
  • Redness of the neck
  • Weakness
  • Chills
  • Swelling of the tongue that causes your tongue to push back against your palate
  • Fever

As the infection progressed further, it may lead to breathing difficulty or chest pain. It may also cause some life threatening complications such as sepsis. Therefore, when you experienced blocked airway or breathing difficulty, you immediately call your health care provider.

Is Ludwig’s Angina Is Contagious?

Mostly Ludwig’s angina is primarily caused by infection of second and third molar teeth. But once infection develops, it rapidly spreads to the sublingual space. This infection also spreads along the deep cervical fascia that may result in a mediastinal abscess, mediastinitis, jugular vein thrombosis, empyema, innominate artery rupture, pneumothorax, pericardial and pleural effusion, necrotizing fasciitis, subphrenic abscess, and mandibular or cervical osteomyelitis.

Causes of Ludwig’s Angina

The most common cause of Ludwig’s angina is mouth injury, tooth abscess or other bacterial infections whom if follows. The most common bacteria are Streptococcus and Staphylococcus. So the causes of Ludwig’s angina include

  • Poor dental hygiene
  • Mandible fracture
  • Tooth abscess
  • Trauma or lacerations in the mouth
  • Infections of lower second and third molar
  • A recent tooth extraction
  • Submandibular gland infection

Penetrating injury of the floor of the mouth

Following investigations are required to confirm the diagnose (Ludwig’s angina).

1- Dental X-ray

Infections in the roots of teeth following the tooth abscess can be identified with a dental X-ray.

2- CT scan

A CT scan of the neck with contrast is used to identify the neck space infections. If infections of the chest cavity are suspecting, a chest scan is needed to do.

3- Cell Culture

Take the pus samples from the infected person to identify the organism.

Differential Diagnosis

The following possible conditions must be ruled out to confirm Ludwig’s angina because they have some resemblance. These possible diseases include sublingual hematoma formation, angioneurotic edema or lingual carcinoma

Treatment of Ludwig’s Angina

1- Systemic

Antibiotics are given to treat the infection.

2- Incision and drainage

  • Intraoral
  • Externally

If the infection spreads to submaxillary space.

If the infection is still localized to sublingual space. A transverse incision is made from one angle of the mandible to the other angle of the mandible with the vertical opening of the midline musculature of the tongue with the blunt hemostat. Very often it is serous fluid rather than the flank pus that is encountered.

3- Tracheostomy

It is done when airway blockage is endangered.

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