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LUDWIGS ANGINA Ludwigs angina e Ludwig’s angina is a serious, potentially life- threatening infection of the neck and the floor of the mouth e Originally described by Wilhelr j»y Anatomy e The submandibular space comprises part of the space above the hyoid bone. e The total space is divided into the sublingual space superiorly and submandibular space inferiorly e Ludwigs angina begins in the submaxillary space and secondarily involves submental and sublingual space e Typically affected structures, in order of most frequent contamination, are the anterior neck, the pharyngomaxillary space, the retropharynx, and the superior mediastinum. YO SAS 660) & Supramylohyoid portion of submandibular © Inframylohyoid portion ‘ of submandibular space muscle (anterior belly) Etiology Ludwig's angina usually originates from an odontogenic infection, especially from the second or third lower molars. These teet have roots that lie at the level of the mylohyoid muscle, and abscesses here can spread to the submandibular space. Other causes of Ludwig's a Sialadenitis Peritonsillar Abscess Open Mandibular Fracture Infected Thyroglossal Duct C Epiglottitis e Oral Lacerations e Tongue Piercing e Upper Respiratory Infections Infection Abscess inside tooth Nerve roots e Trauma To The Floor Of The Mouth. suberaanciaar gland Possible pathways of spread of infection from the upper and lower jaw molar teeth e Predisposing factors include: Dental Carries Recent Dental Treatment Systemic Illnesses Such As Diabetes Mellitus Malnutrition Alcoholism Compromised Immune System Such As AIDS Organ Transplantation And Trauma Omnmogn w On Oral examination e Board like swelling of floor of mouth e Elevation of the tongue e Nonfluctuant suprahyoid swelling typify the disease process. There is typically a bilateral submandibular edema, e The swelling of the anterior soft tissues of the neck above the hyoid bone sometimes leads to the characteristic “bull’s neck” appearance of affected patients. e Adenopathy and fluctuance are not usually seen in patients with Ludwig's angina Tongue protrusion culminating in rapid and progressive airway obstruction. Table 1. Clinical Pearls Concerning Ludwig's Angina Ludwig's angina is rare and sometimes fatal. Morbidity and mortality primarily result from airway compro- mise from swelling. Etiology usually involves an odontogenic infection. Streptococci and staphylococci are the most common bacte- ria associated with Ludwig's angina. Early recognition, prompt airway control, and antibiotic administration are the keys to optimum outcome. Early consultation with an anesthesiologist and an ear-nose- throat surgeon are strongly encouraged. Diagnosis e There are 4 cardinal signs of Ludwig’s angina: e (1) bilateral involvement of more than a single deep tissue space e (2) gangrene with serosanguinous, putrid infiltration but little or no frank pus e (3) involvement of connective tissue, fasciae, and muscles but not glandular structures and e (4) spread via fascial space continuity rather than by the lymphatic system Management e Protection of the airway takes highest priority in the initial management of affected patients. e Immediate air way mangement is with - cricothyroidotomy or formal tracheostomy e When severe swelling or trismus prevents orotracheal intubation, formal tracheostomy remains the gold standard for securing the airway e Administration of nebulized epinephrine has been suggested as a possible adjunct prior to airway manipulation saree and i Ghaliage 
