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Ludwig's angina; sublingual & submandibular cellulitis
A rapidly-spreading, life-threatening cellulitis of the sublingual & submandibular spaces.
Etiology:
1) generally originates from an infected lower molar
2) bacterial pathogens
a) streptococci
b) oral anaerobes
Clinical manifestations:
1) fever
2) difficulty swallowing (dysphagia)
3) drooling
4) edema in the sublingual area may push the tongue up & back
5) slurred speach, not hoarseness
Radiology:
- CT of neck to determine depth of invasion [3]
Complications:
- airway obstruction
Management:
1) intravenous antibiotics
a) ampicillin sulbactam (Unasyn)
b) high dose penicillin plus metronidazole
2) airway protection
a) endotracheal intubation
b) tracheostomy
3) surgical debridement vs surgical drainage of infected tissue compartments if CT of neck confirms abscess
Related
ampicillin sulbactam (Unasyn)
dysphagia (swallowing disorder)
endotracheal intubation
metronidazole (Flagyl, MetroGel)
penicillin
tracheostomy
General
cellulitis
angina
References
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 182, 185
- Bridwell R, Gottlieb M, Koyfman A, Long B.
Diagnosis and management of Ludwig's angina: An evidence-based review.
Am J Emerg Med. 2021 Mar;41:1-5.
PMID: 33383265 Review.
- NEJM Knowledge+