From the Guidelines
Ludwig's angina is a medical emergency that requires immediate attention with broad-spectrum intravenous antibiotics and potential surgical drainage to prevent airway obstruction and sepsis. The condition is a rapidly spreading oral cellulitis that can be a complication of tongue piercing, as reported in a study on adolescent and young adult tattooing, piercing, and scarification 1. This study highlights the importance of maintaining an adequate airway and administering systemic antibiotic agents in the treatment of Ludwig's angina.
Key Considerations
- Ludwig's angina can cause significant swelling that can obstruct the airway, leading to respiratory distress and potentially life-threatening complications.
- Prompt administration of broad-spectrum intravenous antibiotics, such as penicillin G or clindamycin, is essential in the treatment of Ludwig's angina.
- Surgical drainage may be necessary to remove purulent material and prevent further complications.
- Airway management is critical, and patients may require intubation or tracheostomy if respiratory distress develops.
Risk Factors and Prevention
- Poor dental hygiene and recent dental procedures can increase the risk of developing Ludwig's angina.
- Diabetes and immunocompromised states can also increase the risk of developing this condition.
- Regular dental check-ups and good oral hygiene practices can help prevent the development of Ludwig's angina.
- Patients with a history of tongue piercing or other oral piercings should be aware of the potential risks and seek medical attention immediately if they experience any symptoms of Ludwig's angina.
From the Research
Definition and Overview of Ludwig's Angina
- Ludwig's angina is a dangerous surgical condition that can cause severe airway compromise and death 2.
- It is a rapidly spreading infection that involves the floor of the mouth, occurring more commonly in those with poor dentition or immunosuppression 3.
- The condition is characterized by a woody or indurated floor of the mouth with submandibular swelling, and trismus is a late finding 3.
Diagnosis of Ludwig's Angina
- Computed tomography of the neck soft tissue with contrast is preferred for diagnosis if the patient is able to safely leave the ED and can tolerate lying supine 3.
- Point-of-care ultrasound can be a useful adjunct, particularly in those who cannot tolerate lying supine 3.
- A review of the literature highlights the importance of early recognition of the clinical process for effective treatment 4.
Management of Ludwig's Angina
- The management of Ludwig's angina requires a trained team combining medical skills in surgery, antibiotic therapy, and resuscitation 5.
- Broad spectrum antibiotics and surgical source control are keys in treating the infection 3.
- Securing the airway is crucial, with options including awake fiberoptic intubation under topical anesthesia, flexible nasotracheal intubation, and elective awake cricothyrotomy and tracheostomy 6.
- Conservative airway management may be suitable for a select subset of patients, but close observation is necessary due to the risk of rapid airway compromise 2.
Airway Management
- Emergent consultation to anesthesia and otolaryngology may be helpful if a definitive airway is required 3.
- Flexible intubating endoscopy with preparation for a surgical airway is the first line approach for airway intervention in the ED 3.
- Video-assisted laryngoscopy may allow the clinician additional flexibility in nonsurgical airway management 6.
- Patients with Ludwig's angina should be admitted to the intensive care unit for close airway observation 3.