Ludwig’s Angina

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Ludwig’s Angina is a rare and often fatal soft-tissue infection (a form of cellulitis) of the neck and floor of the mouth, which is known for aggressively progressing and compromising the airways. It is a surgical emergency.

Causes

  • Untreated tooth infection
  • Trauma or laceration in the mouth
  • A recent tooth extraction
  • Oral ulcerations
  • Infections of oral malignancy

Signs and symptoms

  • Swelling of the neck
  • Tongue swelling that causes tongue to push against your plate
  • Difficulty swallowing or drooling
  • Difficulty breathing
  • Neck pain

Complications

  • Blockage of the airway
  • Sepsis
  • Septic shock

Investigations

  • Physical examination
  • MRI
  • CT scan

Treatment objectives

  • Secure the airways
  • Treat infection

Non-pharmacological treatment

  • Surgical Intervention

Pharmacological treatment

Co-Amoxiclav IV

Adult:

1.2g every 8 hours

Child:

Neonates and Premature Infants 25mg/kg every 12 hours

Infants up to 3 months: 25mg/kg every 8 hours

3 months – 12 years: 25mg/kg every 8 hours increased to every 6 hours in more severe infections

AND

Gentamicin IV

Adult:

3-5mg/kg daily in divided doses every 8 hours

Child:

Up to 2 weeks: 3mg/kg every 12 hours

2 weeks to 12 years: 2mg/kg every 8 hours.

Referral

  • Refer to the Oral and Maxillofacial Surgeon

Prevention

  • Treat all dental infections promptly