STUDY NOTES ⚕️
It refers to the cellulitis of the submandibular and submental regions combined with inflammatory oedema.
🔍 Streptococcal organisms are responsible for the infection around the submandibular region.
🔍 Anaerobes also play a major role.
👩⚕️ Elderly patients who present with a diffuse swelling in the submandibular and submental regions (brawny oedema).
👨⚕️ Oedema of the floor of the mouth is seen which causes elevation of the tongue that in turn results in difficulty in swallowing.
👩⚕️ High grade fever with toxicity.
👨⚕️ Putrid halitosis is also characteristic of Ludwig’s angina.
💊 Rest and hospitalization
💊 Appropriate antibiotics should be given.
💊 Intravenous fluids to correct dehydration and Ryle’s tube feeding.
💊 If conservative management is not responsive in the patient, then surgery is preferred.
✂️ Under General Anaesthesia, a 5-6 cm curved incision is made below the mandible in the submandibular region and over the most prominent part of the swelling.
✂️ The submandibular gland is mobilised, mylohyoid muscle is divided, and the pus is drained.
✂️ Even if there’s no pus, the oedematous fluid comes out which in itself will improve the patient condition greatly.
✂️ The wound is closed by loose sutures, after cleansing the cavity with antiseptics and a drainage tube is inserted.
⚠️ Mediastinitis and Septicaemia.
⚠️ Oedema of the glottis which is caused due to the spread of the cellulitis via a tunnel connecting stylohyoid muscle and submucosa of the glottis.
SOURCE: Manipal Manual of Surgery (3rd edition)