Ludwig’s Angina/

Angina Ludovici
Lutfia Papita Derizky R.
1610911120024
Definition

Potentially life-threatening cellulitis of the floor of the mouth

Named after German physician Wilhelm Friedrich von Ludwig

Synonym
Angina maligna
Morbus strangularis

Angina = strangling
 Etiology
 Polymicrobial : Streptococcus sp, Staphylococcus dp,
Prevotella sp., Porphyromonas sp., Bacteroides

 Route of infection :
 Dental infection (infection of molar and pericoronitis) 
80% of cases
 penetrating injury of the floor of the mouth
 Osteomyelitis
 compound fracture of the jaw
 otitis media
 submandibular gland sialidenitis
 sialolithiasis, and tongue piercing
Predisposing factors
 Dentalcaries
 recent dental treatment like dental extraction
 systemic illness such as diabetes mellitus (DM)
 malnutrition
 Alcoholism
 compromised immune system like AIDS
 organ transplantation
 trauma
 Clinical manifestation
 Bilateral lower facial swelling

 Swelling of infected area and epiglottis  block the airway or prevent

you from swallowing saliva  difficulty of breathing and drooling

 Swelling under the tongue  tongue displacement  airway

obstruction, odynophagia and dysphagia

 Neck pain and swelling  “Bull neck” appearance  bilateral

 Febrile, trismus

 Infection spread to internal ear  hearing impairment (10% of cases)

Bilateral lower face swelling
 Treatment

Primary goal:
 Preserve the oropharyngeal airway.

Secondary goal:
 Antibiotic agent or incision and drainage
 Airway maintenance

 Endotraclear intubation

 Nasal intubation

 Cricothyroidotomy

 Tracheotomy.
Antibiotic agent

 High-dose penicillin G.

 Sometime combined with metronidazole.

 In penicillin-allergic patients, use

clindamycin.
 IV dexamethasone, given for 48 h, has been
beneficial in reducing edema.
Surgical

Decompression
sublingual and submandibular spaces.

Incision and drainage

Debridement
External incision