Ludwig’s angina is characterized by all the following except:
Correct Answer: Aphthous ulcers in the pharynx
Description: Ludwig's Angina is a rapidly spreading cellulitis of the floor of the mouth which involves submandibular space secondary to dental infection. Submandibular space is divided into sublingual space (above the mylohyoid) and submaxillary space (below the mylohyoid muscle) Bacteriology: Mixed infections involving both aerobes and anaerobes are common like, alpha haemolytic streptococci, staphylococci bacteriodes and E. coll. H. influenzae is a rare cause. Clinical features: In Ludwig's angina, there is usually cellulitis of the tissue rather than frank abscess. Marked difficulty in swallowing (odynophagia). Varying degrees of trisumus. On involvement of sublingual space, floor of the mouth is swollen, edematous and tongue seems to be pushed up and back. On involvement of the submaxillary space, the submental and submandibular regions become swollen and tender and impa woody-hard feel.Tongue is progressively pushed upward and backward threatening the airway. Laryngeal edema may appear, if it spreads to parapharyngeal or retropharyngeal space. Treatment: Systemic antibiotics I and D should be postponed as long as possible because pus is seldom found. Tracheostomy is required if airway is endangered. If incision and drainage for Ludwig's angina is done under GA-there are increased chances of aspiration and shock as tongue is pushed up and back in Ludwig angina.
Category:
ENT
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