Angina Ludwig

dr Putra Hendra SpPD

UNIBA
 Ludwig Angina
Acute infection of mouth floor with sublingual
space infection & submental, submandibular
space infection
Etiology
80% Teeth infection,
20% mouth floor infection
Anaerobe bacteria & staphylococcus
 Sign & Symptom
Fever, back tongue pushing
Spread infection, painful cellulites
laryngeal edema & breathing problem
spread to other spaces
Crepitation
Trismus
Treatment:
Antibiotic care of airway surgical treatment
Infection in multi-space

Ludwig’s
angina
 Physical exam
 Toxicity
 Brawny bilateral boardlike edema
 Submandibular, submental, sublingual
 Trismus
 Tongue elevation
 No fluctuance
 Etiology
 Streptococcus
 Staphylococcus
 Mixed aerobic/anaerobic infection
 B. Fragilis
 ß-lactamase resistance (<= 40%)
 Diagnosis
 Clinical
 CT scan
 Treatment
 Airway control - EARLY
 Fiberoptic
 Deterioration may be rapid
 Cricothyrotomy or tracheostomy may be necessary
 Surgical consultation mandatory
 Oral maxillofacial surgeon or ENT
 Definitive surgical drainage and debridement
 ICU
 Antibiotics
 Extended spectrum penicillins
 Ampicillin/Sulbactam (Unasyn)
 Ticarcillin/Clauvulate (Timentin)
 Piperacillin/Tazobactam (Zosyn)

 Clindamycin + Cipro (PCN allergy)

 Flagyl (B. Fragilis)
 Steroids
 Reduce edema
 “Used routinely when airway compromise
suspected” (Larawin et al.)
 Dexamethasone 10-20 mg IV
 Then 4-6 mg Q6 for 8 doses (Busch)
 Surgical intervention
 Decompression
sublingual and submandibular spaces.

 Incision and drainage

 Debridement
 Complication
 Deep neck infection
 Mediastinitis
 Sepsis

 Pneumonia
 Empyema

 Asphyxia
 Pneumothorax