LUDWIG’S ANGINA

I’m still a medical emergency though! πŸ˜‚

STUDY NOTES βš•οΈ

It refers to the cellulitis of the submandibular and submental regions combined with inflammatory oedema.

Causes:

πŸ” Streptococcal organisms are responsible for the infection around the submandibular region.

πŸ” Anaerobes also play a major role.

Clinical Features:

πŸ‘©β€βš•οΈ Elderly patients who present with a diffuse swelling in the submandibular and submental regions (brawny oedema).

πŸ‘¨β€βš•οΈ Oedema of the floor of the mouth is seen which causes elevation of the tongue that in turn results in difficulty in swallowing.

πŸ‘©β€βš•οΈ High grade fever with toxicity.

πŸ‘¨β€βš•οΈ Putrid halitosis is also characteristic of Ludwig’s angina.

Treatment:

πŸ’Š Rest and hospitalization

πŸ’Š Appropriate antibiotics should be given.

πŸ’Š Intravenous fluids to correct dehydration and Ryle’s tube feeding.

πŸ’Š If conservative management is not responsive in the patient, then surgery is preferred.

Surgery:

βœ‚οΈ 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.

βœ‚οΈ The submandibular gland is mobilised, mylohyoid muscle is divided, and the pus is drained.

βœ‚οΈ Even if there’s no pus, the oedematous fluid comes out which in itself will improve the patient condition greatly.

βœ‚οΈ The wound is closed by loose sutures, after cleansing the cavity with antiseptics and a drainage tube is inserted.

Complications:

⚠️ 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)


~Sunantha✍️

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