Ludwig Angina
Basics
Description
Description
- Named for German physician Wilhelm Friedrich von Ludwig, who 1st described this in 1836 as a rapidly progressive, gangrenous cellulitis and edema of soft tissues of the neck, floor of the mouth
- Gangrene is serosanguineous infiltration with little or no frank pus or primary abscesses
- Contiguous spread may encircle the airway or involve the mediastinum
- Emergent interventions rarely include surgical or aspiration techniques
- Most deaths are due to airway compromise, occlusion, and resultant asphyxia
- Mortality exceeded 50% in preantibiotic era, currently <8%
Etiology
Etiology
- Odontogenic in 90% of adult cases, usually from 2nd, and 3rd mandibular molars
- Less commonly: Mandibular fractures, oral lacerations, contiguous infections, sialadenitis, errant drug injections, tongue piercings
- Polymicrobial: β-hemolytic strep commonly associated with anaerobes such as peptostreptococcus, pigmented bacteroides
- Microbiologic analyses may guide therapy
Factors Increasing Morbidity and Mortality
- Comorbid illness
- Diabetes mellitus – specifically shown to independently increase life-threatening complications above other comorbidities
- Pregnancy
- Large body habitus
- Involvement of more than one neck space
- Anterior visceral space involvement (hyoid bone → superior mediastinal space)
Pediatric Considerations
- Frequently no clear etiology or site of origin
- Ideally, a destination facility will have specialty expertise available (surgery and subspecialties, anesthesia) and be properly equipped to provide emergent intervention
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Citation
Schaider, Jeffrey J., et al., editors. "Ludwig Angina." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307651/all/Ludwig_Angina.
Ludwig Angina. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307651/all/Ludwig_Angina. Accessed December 10, 2024.
Ludwig Angina. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307651/all/Ludwig_Angina
Ludwig Angina [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 10]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307651/all/Ludwig_Angina.
* Article titles in AMA citation format should be in sentence-case
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