History: Named after German physician, Wilhelm Frederick von Ludwig, who first described this condition in 1836.
Overview:
• Submandibular Space Cellulitis
• Bilateral
• Aggressive, fast spreading
• 70% of Ludwig’s angina is dental in origin
• Real risk of airway compromise: This can result in rapid airway decompensation.
Physical Exam (useful things to document the presence of absence of in the chart):
• Floor of the mouth: is described as: “woody,” which means firm, indurated, taut
• Tongue: displaced superiorly and posteriorly
• This result in: Slow suffocation, drooling, sniffing position, muffled voice, stridor
• Labs
• Vbg, cbc 7, blood cultures
• Imaging
• CT face and neck with IV contrast
• Be very cautious if you are sending them to CT without airway secured
• Consults
• ENT, anesthesia
Treatment
• ABCs…A! Airway obstruction in 33%
• sit upright
• Secure/verify integrity of airway
• Awake fiberoptic nasal intubation
• Mentally prepare yourself for a surgical airway. This is the time to have the materials set up at the bedside.
• Abx: polymicrobial
Oral anaerobes and aerobes
PCN G + flagyl
Unasyn
Clinda
Immunocompromised? Cefepime +flagyl
• Steroids
Dexamethasone 8-12 mg IV
• Dispo
ICU
3-4 day process, gets worse before better
Complications
• Mortality usually associated with airway compromise
• with appropriate treatment, 8% mortality
• Spread of infection: IJ thrombophlebitis, intracranial infection, mediastinitis
Brush up!
Sources: LIFL https://lifeinthefastlane.com/ccc/ludwigs-angina/
Uptodate Lugwig’s angina
Tintinelli’s Lugwig’s angina