Which of the following statements best represents Ludwing’s Angina
Correct Answer: An infection of the cellular tissues around submandibular salivary gland
Description: Ludwig described a clinical entity characterised by a brawny swelling of the submandibular region combined with inflammatory oedema of the mouth. It is these combined cervical and intraoral signs that constitute the characteristic feature of the lesion, as well as the accompanying putrid halitosis. The infection is often caused by a virulent streptococcal infection associated with anaerobic organisms and sometimes with other lesions of the floor of the mouth such as carcinoma. The infection encompasses both sides of the mylohyoid muscle causing oedema and inflammation such that the tongue may be displaced upwards and backwards, giving rise to dysphagia and subsequentlyto painful obstruction of the airway. Unless treated, cellulitis may extend beneath the deep fascial layers of the neck to involve the larynx, causing glottic oedema and airway compromise. Antibiotic therapy should be instituted as soon as possible using intravenous broad-spectrum antibiotics, such as amoxycillin or cefuroxime, combined with metronidazole to combat the anaerobes. In advanced cases when the swelling does not subside rapidly with such treatment, a curved submental incision may be used to drain both submandibular triangles. The mylohyoid muscle may be incised to decompress the floor of the mouth and corrugated drains placed in the wound, which is then lightly sutured. This operation may be conducted under local anaesthetic. Rarely, a tracheostomy may be necessary. Bailey & Love,25th,731
Category:
Surgery
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