Visual Diagnosis # 5 : Answers

 

 

  Ludwig’s angina is a potentially life-threatening, rapidly progressing, gangrenous infection of the submandibular and sublingual spaces spreading along the fascial planes with dental infections accounting for over 90% of cases. Symptoms include severe neck pain and swelling, fever, malaise and dysphagia.

 

 

 

 

 

The most life-threatening complication of Ludwig’s angina is airway obstruction due to the progressive swelling of the soft tissues and elevation and posterior displacement of the tongue. Stridor suggests an impending airway crisis.

 

 

 

 

 

 

  Initial management focuses on airway management (in the operating room or prophylactically in the emergency department) broad spectrum antibiotics and urgent surgical consultation with an oral maxillofacial surgeon or ENT specialist as up to 65% of patients with Ludwig’s angina develop suppurative complications that require surgical drainage.

 

 

 

 

 

 

 

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