Ludwig's Angina

Ludwigs angina is an overwhelming diffuse, suppurative cellulitis, which simultaneously involves the submandibular, sublingual and submental spaces.

Predisposing factors:-

Diabetes Mellitus.

HIV Infection

Oral Transplants

Aplastic Anemia

Causative Microorganisms:-

Hemolytic streptococci.

Staphylococci.

Bacteroides.

Primary source of Infection:-

Periapical, pericoronal or periodontal infection.

Gunshot injury.

Stab wound on floor of mouth.

Osteomyelitis.

Infection of orofacial soft tissue.

Peritonsillar or parapharyngeal abcess.

Submandibular sialadenitis.

Pathogenesis:-

Sublmandibular, sublingual and submental space are involved simultaneously.

Although it occurs one after another the spread of infection is so rapid that it seems that it involves all the spaces together. 

Infection from mandibular second and third molar teeth often perforates the lingual cortical plate (bucal cortical plate is much harder so it is not usually perforated).

Clinical Features:-

Produces a rapdly spreading, large, diffuse and board like aggressive swelling.
This swelling involves the upper part of the neck and floor of the mouth bilaterally.
The swelling causes elevation of the tongue.
Open mouthed appearance.
Enlarged tongue may protrude outside the mouth = WOODY TONGUE.
Swollen area is firm, painful non fluctuant and non pitting.
Dificulty in speaking, swallowing and mouth opening.
High fever, chill rapid pulse, dysphagia, sore throat, drooling and increased respiratory rate.
If untreated cellulitis may spread further and cause a massive swelling in neck and above the hyoid bone, this condition is known as BULL NECK.
 Further there may be development of EDEMA GLOTTIS. (which is a serious condition and may result in death).

COMPLICATIONS:-

Cavernous sinus thrombosis.

Meningitis.

Brain abcess.

Suppurative encephalitis.

(clinical feature of the disease are often very specific)

Diagnosis:-

Leukocytosis.

Bacterial culture.

Treatment:-

High dose of antibiotics.
Drainage by incision at the anterior part of the neck.
Emergency tracheostomy may be required in cases of airway obstruction.