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D.AARTHI
THIRD YEAR BDS
 DEFINTION
WILHELM FREDRICK VAN LUDWIG -
cellulitis of fast evolution involving the
region of the submandibular gland which is
disseminated through anatomic contiguity
without tendency towards abscess formation.
-SHAFFER’S
GRADINSKY
 It was a deep neck infection.
 Occurs bilaterally more than one space
 Production of gangrenous serosanguinous
infiltration with or without pus
 Involvement of connective tissue and muscle
but not glandular structure
 Spread by continuity not via lymphatics.
 MICROFLORA
streptococcus sanguis
 ODONTOGENIC
Acute dentoalveolar abscess
acute periodontal abscess
acute pericoronal abscess
 NON ODONTOGENIC
Iatrogenic
traumatic injuries to orofacial region[ mandible fracture ,
frenuplasty]
osteomyelitis
submandibular and sublingual sialadenitis .
 Poor oral hygiene, tooth pain
 Tachypnea,tachycardia,fever
 Dysphagia,drooling,trismus,and fetid breath.
 Stridor,hoarseness,cyanosis.
 Patients may exihibt dysphonia.
1. Board like swelling of floor of mouth
2. Elevation of tongue
3. Nonflutuant suprahyoid swelling tipify the
disease progress. There is typically a
bilateral submandibular edema.
4. BULL’S NECK appearance.
5. As diseases progress – edema of glottis
occur
6. Causes serious risk of suffocation
Angioneuretic edema
Cellulitis
Lingual carcinoma
Lymphadenitis
Peritonsilar abscess
Salivary gland abscess
Sub lingual hematoma
 Panoramic
Laborotary test
x-ray

ultrasound ultrasonography
CT Scan
 Sufficient AIRWAY MANAGEMENT
 Antibiotic therapy
 Incision and drainage
 Adequate nutrition and hydration
therapy
 Trachaeostomy
 Cricotyhroidectomy
 Fiber optic nasotracheal intubation

• ANTIBIOTIC THERAPHY
 Penicillin with beta lactamase inhibitor.
 2nd,3rd,4th generation cephalosporin and
METRONIDAZOLE
Text box type here

 Bilateral submandibular incisions as well as

midline submental incision
 PRINCIPLES [TOPAZIAN &GOLDBERG]
 Ludwig’s angina is life threatening infection.
 Early diagnosis and Immediate treatment is
the key for successful management.