Ludwig's angina is a potentially life-threatening, rapidly expanding, diffuse inflammation of the submandibular and sublingual spaces. It often originates from an odontogenic infection. Despite a significant drop in the mortality rate from Ludwig's angina since the preantibiotic era, this condition remains a therapeutic emergency because of its inherent life-threatening complication of airway obstruction. Airway protection and aggressive antimicrobial therapy, institute early, have improved outcomes. However, with established infection, control of local sepsis with adequate surgical drainage is essential.
The objectives of this study was to review the clinical profile of Ludwig's angina, to determine the demographic profile, to assess the predisposing condition, evaluate it's management and to determine the outcome and complications.
STUDY DESIGN: Retrospective study
Department of Otorhinolaryngology (ENT-HNS), Jose R. Reyes Memorial Medical Center;
Year 2000 to 2004
42 cases diagnosed to have Ludwig's angina
Using the medical record registry were reviewed to determine the age and sex distribution, the predisposing factors, the length of hospital stay, diagnostics done, management done, complications, and condition of patient once discharged.
There were 42 patients, 64% child and 42% adults. 29 patients (69%) males and 13 patients (31%) females.
The cause of Ludwig's angina in all cases was odontogenic and the most common tooth involved was the lower first molar (31%). Submandibular swelling (81%) was always the reason for consultation. Eighty-eight percent (88%) were managed with incision and drainage under local anesthesia. A combination of penicillin G and metronidazole were the most common IV antibiotics given. Only two patients (5%) experienced complications. One patient developed mediastinitis and the other patient had retropharyngeal abscess. Majority of the patients (62%) were discharged improved.
Majority of the patients belong to the pediatric age group. Diagnoses were established based on history and symptomatology. Predisposing factors were all dental infection. Almost all patients were successfully treated with incision and drainage. There were cases of complications such as mediastinitis and retropharyngeal abscess that were treated with aggressive tracheostomy, IV antibiotics and incision drainage. 62% of the patients were discharged improved with an average of 5 days hospital stay.