Ludwig's angina; sublingual & submandibular cellulitis

Introduction

A rapidly-spreading, life-threatening cellulitis of the sublingual & submandibular spaces.

Etiology

• generally originates from an infected lower molar
• bacterial pathogens
  • streptococci
  • oral anaerobes
• risk factors
  • alcohol use disorder
  • immunocompromised states
    • diabetes mellitus

Clinical manifestations

• fever
• difficulty swallowing (dysphagia)
• drooling
• edema in the sublingual area may push the tongue up & back
• slurred speach, not hoarseness (muffled voice) dysphonia
• mouth pain & neck pain
• submandibular swelling with edema & induration of the mouth floor
• cervical lymphadenopathy

Laboratory

• blood cultures

Radiology

• CT of neck with contrast to determine depth of invasion

Complications

• airway obstruction (major cause of death)

Management

• intravenous antibiotics
  • ampicillin sulbactam (Unasyn)
  • high dose penicillin plus metronidazole
• airway protection
  • endotracheal intubation
  • tracheostomy
• surgical debridement vs surgical drainage of infected tissue compartments if CT of neck confirms abscess

More general terms

• cellulitis
• angina

Additional terms

• ampicillin sulbactam (Unasyn)
• dysphagia (swallowing disorder)
• endotracheal intubation
• metronidazole (Flagyl, MetroGel)
• penicillin
• tracheostomy