ByJini P.

Abraham

Ludwig’s Angina

Definition Infection of the submandibular space Submandibular space lies between the

mucous membrane of floor of mouth and tongue on one side and superficial layer of deep cervical fascia extending between the hyoid bone and mandible on the other.

It is divided into 2 compartments – Sublingual compartment Submaxillary and submental compartment

Etiology Dental infections – Accounts for 80%

cases. Roots of premolars cause sublingual space infection while roots of molar teeth causes submaxillary space infection.

Submandibular sialadenitis Injuries to oral mucosa Fractures of the mandible

Bacteriology Mixed infections Common – Alpha hemolytic Streptococci Staphylococci H. influenzae, E. coli and Pseudomonas

Clinical Features Marked difficulty in swallowing (odynophagia) Trismus Infection localized to sublingual space –

structures in floor of the mouth are swollen and tongue seems to be pushed back

Infection spreads to submaxillary space - submental and submandibular regions become swollen and tender and gives a woody feel

Laryngeal edema may occur

Treatment Systemic

antibiotics Incision and

drainage of the abscess Intraoral –

Infection is localized to sublingual space

External – Infection involves submaxillary space

Tracheostomy, if airway is endangered

Complications Spread of infection to parapharyngeal and

retropharyngeal spaces and hence to the mediastinum

Airway obstruction due to laryngeal edema Septicaemia Aspiration pneumonia

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