Ludwig's angina: clinical aspects and therapeutic approaches

Authors

DOI:

https://doi.org/10.33448/rsd-v11i15.37767

Keywords:

Airway; Ludwig's angina; Treatment; Diagnosis.

Abstract

Ludwig's angina (AL) is an infection of the submandibular space, first described by Wilhelm Frederick von Ludwig in 1836. The presence of dental caries, oral trauma, immunosuppression and the continuous use of psychoactive substances, such as alcohol and drugs of abuse, are predisposing factors for the emergence of this infection. Given the above, this study aimed to review the literature on Ludwig's angina, highlighting its clinical aspects and therapeutic approaches. For the construction of this article, a bibliographic survey was carried out in the databases SciVerse Scopus, Scientific Electronic Library Online (Scielo), U.S. National Library of Medicine (PUBMED) and ScienceDirect, using the Mendeley reference manager. LA is a rapidly progressing infection of the floor of the mouth, which can rapidly compromise the patient's airways. It occurs most commonly in those with poor dentition or immunosuppression. Patients may have a hardened or woody floor of the mouth with submandibular swelling. Trismus is a late and serious finding. Due to the threat of rapid airway compromise, emergency consultation with anesthesia and otolaryngology is vital, especially if a definitive airway is required. The first-line approach to airway intervention in the ER is flexible intubation endoscopy with preparation for a surgical airway. Broad-spectrum antibiotics, such as ampicillin-sulbactam, and surgical source control are critical in infection control. Emergency physicians must be aware of this emerging diagnosis, requiring rapid recognition and airway protection.

References

Boscolo-Rizzo, P., & Maria Cristina Da Mosto. (2009) “Submandibular Space Infection: A Potentially Lethal Infection.” International Journal of Infectious Diseases 13(3):327–33. https://doi.org/10.1016/j.ijid.2008.07.007.

Bridwell, R. E., Joshua J. Oliver, Sean A. & Griffiths, B. L. (2020) “Sialolithiasis with Abscess: An Uncommon Presentation of a Ludwig’s Angina Mimic.” The American Journal of Emergency Medicine 38(6):1295.e1-1295.e2. doi: https://doi.org/10.1016/j.ajem.2020.01.010.

Bridwell, R., Michael G., Alex K., & Brit L. (2021). “Diagnosis and Management of Ludwig’s Angina: An Evidence-Based Review.” The American Journal of Emergency Medicine 41:1–5. doi: https://doi.org/10.1016/j.ajem.2020.12.030.

Chen, R-F., & Chih-Hao L. (2010). “Ludwig’s Angina Caused by a Migrating Fish Bone.” Tzu Chi Medical Journal 22(4):206–8. doi: https://doi.org/10.1016/S1016-3190(10)60074-2.

Coca Pelaz, A., José L. Llorente P., & Carlos Suárez Nieto. (2010) “Ludwig’s Angina as an Extremely Unusual Complication for Direct Microlaryngoscopy.” American Journal of Otolaryngology 31(2):117–19. doi: https://doi.org/10.1016/j.amjoto.2008.09.013.

Costain, N., & Thomas J. M. (2011) “Ludwig’s Angina.” The American Journal of Medicine 124(2):115–17. doi: https://doi.org/10.1016/j.amjmed.2010.08.004.

Fellini, R. T., Volquind, D., Schnor, O. H., Angeletti, M. G. & Souza, O. E. (2017) “Airway Management in Ludwig’s Angina – a Challenge: Case Report.” Brazilian Journal of Anesthesiology (English Edition) 67(6):637–40. doi: https://doi.org/10.1016/j.bjane.2014.10.010.

Gilbert, L. (2011) “Ludwig’s Angina.” P. 229 in, edited by L. A. Fleisher and M. F. B. T.-E. of A. P. (Third E. Roizen. Philadelphia: W.B. Saunders.

Ho, M-P, Kuang-Chau T, Szu-Lin Y, Cheng-Lin L., & Chia-Hung C. (2006). “A Rare Cause of Ludwig’s Angina by Morganella Morganii.” Journal of Infection 53(4):e191–94. doi: https://doi.org/10.1016/j.jinf.2005.12.026.

Kavarodi, A. M. (2011) “Necrotizing Fasciitis in Association with Ludwig’s Angina – A Case Report.” The Saudi Dental Journal 23(3):157–60. doi: https://doi.org/10.1016/j.sdentj.2011.03.003.

Lin, Harrison W., Allison O’Neill, Reza Rahbar, & Margaret L. Skinner. 2009. “Ludwig’s Angina Following Frenuloplasty in an Adolescent.” International Journal of Pediatric Otorhinolaryngology 73(9):1313–15. doi: https://doi.org/10.1016/j.ijporl.2009.05.022.

Osaghae, I. P., Adetokunbo Rafel Adebola, Ibiyinka Olusola Amole, Ademola Abayomi Olaitan, Yussuf Ajibola Salami, Olasunkanmi Kuye, & Ashraf Ayoub. (2022). “Ludwig’s Angina in Nigeria: The Disease of the Poor and Health Inequality!” The Surgeon 20(4):e129–33. doi: https://doi.org/10.1016/j.surge.2021.05.007.

Re Cecconi, D., & Roberto Fornara. (2018) “Ludwig’s Angina: A Case Report with a 5-Year Follow-Up.” Giornale Italiano Di Endodonzia 32(2):70–75. doi: https://doi.org/10.1016/j.gien.2018.06.001.

Silva, P. C. A., et al. (2022). “rara associação de angina de ludwig e leishmaniose visceral: rápida intervenção e desfecho clínico favorável.” The Brazilian Journal of Infectious Diseases 26:102476. doi: https://doi.org/10.1016/j.bjid.2022.102476.

Vallée, M., Benjamin Gaborit, Jérémy Meyer, Olivier Malard, David Boutoille, François Raffi, Florent Espitalier, & Nathalie Asseray. (2020) “Ludwig’s Angina: A Diagnostic and Surgical Priority.” International Journal of Infectious Diseases 93:160–62. doi: https://doi.org/10.1016/j.ijid.2020.01.028.

Vieira, Francisco, Shawn M. Allen, Rose Mary S. Stocks, & Jerome W. Thompson. (2008). “Deep Neck Infection.” Otolaryngologic Clinics of North America 41(3):459–83. doi: https://doi.org/10.1016/j.otc.2008.01.002.

Vincent, S. D., & G. E. Lilly. (1992) “Clinical, Historic, and Therapeutic Features of Aphthous Stomatitis. Literature Review and Open Clinical Trial Employing Steroids.” Oral Surgery, Oral Medicine, and Oral Pathology 74(1):79–86. doi: 10.1016/0030-4220(92)90219-g.

Yalamanchili, S., & Wayne B. L. (2015) “A Curious Case of Cold Ludwig’s Angina.” The Journal of Emergency Medicine 49(4):e121–22. doi: https://doi.org/10.1016/j.jemermed.2015.04.025.

Yang, Rong-Hsin, Shu-Huei Shen, Wing-Yin Li, and Yum-Kung Chu. (2015). “Bisphosphonate-Related Osteonecrosis of the Jaw Complicated by Ludwig’s Angina.” Journal of the Chinese Medical Association 78(1):76–79. doi: https://doi.org/10.1016/j.jcma.2013.08.013.

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Published

24/11/2022

How to Cite

BOMFIM, R. M. .; TIBURCIO, K. D. .; CELESTINO, . J. dos S. .; DINIZ, T. G. .; MACHADO, E. Évilyn de A. .; OLIVEIRA, K. M. de .; ROSA, H. F. .; ARAUJO, A. B.; FERNANDES, W. E. V. da S. .; SILVA, A. M. S. . Ludwig’s angina: clinical aspects and therapeutic approaches. Research, Society and Development, [S. l.], v. 11, n. 15, p. e504111537767, 2022. DOI: 10.33448/rsd-v11i15.37767. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/37767. Acesso em: 18 apr. 2024.

Issue

Vol. 11 No. 15

Section

Health Sciences

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Copyright (c) 2022 Rafael Meneses Bomfim; Kimberly Damazio Tiburcio; Jamesson dos Santos Celestino; Talita Gomes Diniz; Eduarda Évilyn de Andrade Machado; Karen Mamede de Oliveira; Hiago Ferreira Rosa; Andreza Barbosa Araujo; Wandy Elisabeth Vieira da Silva Fernandes; Andressa Mayumi Sakagami Silva

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