Ludwig's angina
Encyclopedia
Ludwig's angina, otherwise known as angina ludovici, is a serious, potentially life-threatening cellulitis
, or connective tissue infection, of the floor of the mouth, usually occurring in adults with concomitant dental infections. It is named after the German physician, Wilhelm Friedrich von Ludwig who first described this condition in 1836. Other names include "angina Maligna" and "Morbus Strangularis".
Ludwig's angina should not be confused with angina pectoris, which is also otherwise commonly known as "angina". The word "angina" comes from the Greek
word ankhon, meaning "strangling", so in this case, Ludwig's angina refers to the feeling of strangling, not the feeling of chest pain, though there may be chest pain in Ludwig's angina if the infection spreads into the retrosternal space.
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 Ludwig's is 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.
Ludwig's angina is also associated with piercing
s of the lingual frenulum.
s, malaise, fever
, dysphagia
(difficulty swallowing) and, in severe cases, stridor
or difficulty breathing. Swelling of the submandibular and/or sublingual space is imminent.
and/or dental
consultation to incise and drain the collections. A nasotracheal tube is sometimes warranted for ventilation if the tissues of the mouth make insertion of an oral airway difficult or impossible.
In cases where the patency of the airway is compromised, skilled airway management is mandatory. This entails management of the airway according to the American Society of Anesthesiologists' "Difficult Airway Algorithm" and necessitates fiberoptic intubation.
Cellulitis
Cellulitis is a diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters,...
, or connective tissue infection, of the floor of the mouth, usually occurring in adults with concomitant dental infections. It is named after the German physician, Wilhelm Friedrich von Ludwig who first described this condition in 1836. Other names include "angina Maligna" and "Morbus Strangularis".
Ludwig's angina should not be confused with angina pectoris, which is also otherwise commonly known as "angina". The word "angina" comes from the Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
word ankhon, meaning "strangling", so in this case, Ludwig's angina refers to the feeling of strangling, not the feeling of chest pain, though there may be chest pain in Ludwig's angina if the infection spreads into the retrosternal space.
Causes
The cause is usually an infection with Streptococcal bacteria, although other bacteria can cause the condition. Since the advent of antibiotics, Ludwig's angina has become a rare disease.The route of infection in most cases is from infected lower molars
Molar (tooth)
Molars are the rearmost and most complicated kind of tooth in most mammals. In many mammals they grind food; hence the Latin name mola, "millstone"....
or from pericoronitis
Pericoronitis
Pericoronitis is a common problem in young adults with partial tooth impactions. It usually occurs within 17 to 24 years of age as it is when the third molars start erupting. It occurs when the tissue around the wisdom tooth has become inflamed because bacteria have invaded the area. Poor oral...
, which is an infection of the gums surrounding the partially erupted lower (usually third) molars. Although the widespread involvement seen in Ludwig's is 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.
Ludwig's angina is also associated with piercing
Body piercing
Body piercing, a form of body modification, is the practice of puncturing or cutting a part of the human body, creating an opening in which jewelry may be worn. The word piercing can refer to the act or practice of body piercing, or to an opening in the body created by this act or practice...
s of the lingual frenulum.
Symptoms
The symptoms include swelling, pain and raising of the tongue, swelling of the neck and the tissues of the submandibular and sublingual spaceSublingual space
-Anatomical boundaries:The sublingual space is a space between the mylohyoid muscle and the geniohyoid and genioglossal muscles, containing a number of vessels and nerves, such as the lingual artery and nerve, and the hypoglossal and glossopharyngeal nerve, Wharton's duct and some extrinsic tongue...
s, malaise, fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, dysphagia
Dysphagia
Dysphagia is the medical term for the symptom of difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, the term is sometimes used as a condition in its own right. Sufferers are sometimes unaware of their dysphagia....
(difficulty swallowing) and, in severe cases, stridor
Stridor
Stridor is a high pitched wheezing sound resulting from turbulent air flow in the upper airway. Stridor is a physical sign which is produced by narrow or obstructed airway path. It can be inspiratory, expiratory or biphasic . Inspiratory stridor is common...
or difficulty breathing. 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 surgerySurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
and/or dental
Dentistry
Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...
consultation to incise and drain the collections. A nasotracheal tube is sometimes warranted for ventilation if the tissues of the mouth make insertion of an oral airway difficult or impossible.
In cases where the patency of the airway is compromised, skilled airway management is mandatory. This entails management of the airway according to the American Society of Anesthesiologists' "Difficult Airway Algorithm" and necessitates fiberoptic intubation.