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A - MSRA ENT > Ludwig's Angina > Flashcards

Ludwig's Angina Flashcards

1
Q

What is Ludwig’s angina?

A

A type of severe cellulitis involving the floor of the mouth

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2
Q

What cause Ludwig’s angina?

A

Usually a polymicrobial infection involving the flora of the mouth

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3
Q

What are some common causative organisms of Ludwig’s angina?

A
  • Staphylococcus
  • Streptococcus
  • Peptostreptococcus
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4
Q

What is the most common underlying cause of infection (not organisms) in Ludwig’s angina?

A

Spread of infection follows a dental infection

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5
Q

What percentage of cases of Ludwig’s angina are preceded by a dental infection?

A

75-90%

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6
Q

What are some other underlying causes of Ludwig’s angina?

A
  • Oral ulcerations
  • Infections of oral malignancy
  • Mandible fractures
  • Bilateral sialolithiasis-related submandibular gland infection
  • Penetrating injuries of mouth floor
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7
Q

What are risk factors for Ludwig’s angina?

A
  • DM
  • Malnutrition
  • Compromised immune system
  • Organ transplantation
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8
Q

How does Ludwig’s angina progress?

A

Has an acute onset and spreads rapidly

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9
Q

What are the symptoms of Ludwig’s angina?

A
  • Painful neck swelling
  • Tooth pain
  • Dysphagia
  • Shortness of breath
  • Fever
  • General malaise
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10
Q

What are the potential signs of Ludwig’s angina?

A
  • Bilateral lower facial swelling around mandible and neck
  • Elevation of floor of the mouth
  • Posterior displacement of the tongue
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11
Q

What can be seen in Ludwig’s angina if airway crisis is impending?

A
  • Stridor
  • Cyanosis
  • Trismus
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12
Q

What investigations may be useful in Ludwig’s angina?

A
  • Dental x-ray
  • CT with contrast
  • Chest scan
  • Culture of pus
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13
Q

Why can dental x-ray be useful in Ludwig’s angina?

A

Can identify infections originating in the roots of the teeth

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14
Q

Why can CT neck with contrast be useful in Ludwig’s angina?

A

Can identify deep neck space infections

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15
Q

Why may a chest scan be needed in Ludwig’s angina?

A

If suspecting spread to chest cavity

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16
Q

What can a pus culture in Ludwig’s angina determine?

A

Causative organism

17
Q

What are the differentials for Ludwig’s angina?

A
  • Angioneurotic oedema
  • Lingual carcinoma
  • Sublingual haematoma
18
Q

What are the main principles of Ludwig’s angina management?

A
  • Sufficient airway management
  • Early and aggressive antibiotic therapy
  • Incision and drainage if failure of medical management or abscess formation
  • Adequate nutrition and hydration support
19
Q

What is the leading cause of death in Ludwig’s angina?

A

Airway compromise

20
Q

How is airway managed most basically in Ludwig’s angina?

A

Sit upright with supplemental oxygen

21
Q

What can airway management in Ludwig’s angina range from?

A

Conservative to intubation or tracheostomy

22
Q

How should antibiotic therapy be started in Ludwig’s angina?

A

Empirical antibiotics against aerobic and anaerobic organisms commonly seen in Ludwig’s angina

23
Q

What empirical antibiotics are often used in Ludwig’s angina?

A
  • Meropenem or
  • Cefuroxime

In comibination with:

  • Clindamycin or
  • Metronidazole
24
Q

When should empirical antibiotics be switched to more specific treatment?

A

When culture and sensitivity results are obtained

25
Q

For how long and by what routes should antibiotics be given in Ludwig’s angina?

A
  • Parenteral until afebrile for at least 48 hours

- Oral for 2 weeks after

26
Q

When can surgical incision and drainage of Ludwig’s angina be indicated?

A
  • Airway compromise
  • Septicaemia
  • Deteriorating condition
  • DM
  • Palpable or radiographic evidence of abscess formation
27
Q

Why is nutritional and hydration support important in Ludwig’s angina?

A

Pain and swelling can cause difficulties eating and swallowing and reduce oral intake

28
Q

What are the potential complications of Ludwig’s angina?

A
  • Airway compromise

- Sepsis and septicaemia

A - MSRA ENT (22 decks)

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