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VOLUME 10 , ISSUE 2 ( May-August, 2018 ) > List of Articles

ORIGINAL ARTICLE

Ludwig\'s Angina: A Study on Etiology and Factors affecting the Prognosis and Management

R Anil Kumar, Nikhil M John, Satish H Subbegowda

Keywords : Airway management, Ludwig\'s angina, Surgical decompression

Citation Information : Kumar RA, John NM, Subbegowda SH. Ludwig\'s Angina: A Study on Etiology and Factors affecting the Prognosis and Management. Int J Otorhinolaryngol Clin 2018; 10 (2):47-51.

DOI: 10.5005/jp-journals-10003-1289

License: CC BY-NC 3.0

Published Online: 00-08-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objectives: To evaluate the various etiological factors contributing to the development of Ludwig\'s angina, factors affecting the prognosis, and various modalities that will help in the management of this potentially dangerous condition and further complications. Materials and methods: A prospective study was conducted from January 2016 to December 2016 at the Department of ENT, Bangalore Medical College & Research Institute (BMC & RI), Bengaluru, India. Thirty patients with Ludwig\'s angina were studied. Age, sex, etiological factors, associated systemic diseases, microbiology, antibiotic therapy, duration of hospital stay, and social background of patients were evaluated. Results: Most patients were in the third decade of life; there was a preponderance of females in this study. Dental infection was the most common etiological factor (70%). Neck swelling (100%), pain (83%), fever (75%), and trismus (33%) were the most common complaints. Most common pathogens found were Streptococcus viridans (36.6%) followed by Staphylococcus aureus (16.6%), Streptococcus pyogenes (13.3%), and Klebsiella species (10%). Majority of patients (80%) were discharged by 2 weeks following the day of admission. Conclusion: Management of Ludwig\'s angina can often be challenging. Appropriate and aggressive antibiotic therapy, surgical decompression if required, and removal of infected foci can arrest the progress of disease process and prevent further complications.


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  1. Murphy SC. The person behind the eponym: Wilhelm Frederick von Ludwig (1790-1865). J Oral Pathol Med 1996 Oct;25(9):513-515.
  2. Wasson J, Hopkins C, Bowdler D. Did Ludwig's angina kill Ludwig? J Laryngol Otol 2006 May;120(5):363-365.
  3. Barakate MS, Jensen MJ, Hemli JM, Graham AR. Ludwig's angina: Report of a case and review of management issues. Ann Otol Rhinol Laryngol 2001 May;110 (5 Pt 1):453-456.
  4. Honrado CP, Lam SM, Karen M. Bilateral submandibular gland infection presenting as Ludwig's angina: First report of a case. Ear Nose Throat J 2001 Apr; 80(4):217-218, 222-223.
  5. Wong TY. A nationwide survey of deaths from oral and maxillofacial infections: The Taiwanese experience. J Oral Maxillofac Surg 1999 Nov;57(11):1297-1299.
  6. Williams AM, Southern SJ. Body piercing: To what depths? An unusual case and review of associated problems. Plast Reconstr Surg 2005 Mar;115(3):50e-54e.
  7. Perkins CS, Meisner J, Harrison JM. A complication of tongue piercing. Br Dent J 1997 Feb;182(4):147-148.
  8. Grodinsky M. Ludwig's angina: An anatomical and clinical study with review of the literature. Surgery 1939;5:678-696.
  9. Diarks E, Meyerhoft WL, Schuttz B, Finn R. Fulminate interaction of odontogenic origin. Laryngoscope 1987;97:271-273.
  10. Moreland LW, Corey J, Mckeuzie R. Ludwig's angina. Arch Intern Med 1988 Feb;148(2):461-465.
  11. Hartmann RW Jr. Ludwig's angina in children. Am Fam Physician 1999 Jul;60(1):109-112.
  12. Doldo G, Albanese I, Macheda S, Caminiti G. Ludwig angina: A disease of the past century. Case report. Minerva Anestesiol 2001 Nov;67(11):811-814.
  13. Britt JC, Josephson GD, Gross CW. Ludwig's angina in the pediatric population: Report of a case and review of the literature. Int J Pediatr Otorhinolaryngol 2000 Jan;52(1):79-87.
  14. Park K. Medicine and social sciences. In: Park's textbook of preventive and social medicine. 24th edition. Jabalpur: M/s Bansaridas Bhanot; 2017. pp. 726-727.
  15. Wang LF, Kuo WR, Lin CS, Lee KW, Huang KJ. Space infection of the head and neck. Kaohsiung J Med Sci 2002 Aug;18(8):386-392.
  16. Hanif M. Ludwig's angina: A study of 38 cases. Bangladesh J Otolaryngol 2000;6(1):3-5.
  17. Md. Abu Yusuf Fakir, Md. Arif Hossain Bhuyan, Md. Mosleh Uddin, Mustafizur Rahman HM, Syed Hasan Imam Al-Masum, Mohiuddin Khan AF. Ludwig's angina: A study of 50 cases. Bangladesh J Otorhinolaryngol 2008;14(2):51-56.
  18. Marra S, Hotaling AJ. Deep neck infections. Am J Otolaryngol 1996 Sep-Oct;17(5):287-298.
  19. Kurien M, Mathew J, Job A, Zachariah N. Ludwig's angina. Clin Otolaryngol 1997 Jun;22(3):263-265.
  20. Hamza NS, Farrel J, Strauss M, Bonomo RA. Deep fascial space infection of the neck: A continuing challenge. South Med J 2003 Sep;96(9):928-932.
  21. Bansal A, Miskoff J, Lis RJ. Otolaryngologic critical care. Crit Care Clin 2003 Jan;19(1):55-72.
  22. Folz BJ, Tennie J, Lippert BM, Werner JA. Natural history and control of epistaxis in a group of German patients with Rendu–Osler–Weber disease. Rhinology 2005 Mar;43(1):40-46.
  23. Wirsching KE, Kuhnel TS. Update on clinical strategies in hereditary hemorrhagic telangiectasia from an ENT point of view. Clin Exp Otorhinolaryngol 2017 Jun;10(2):153-157.
  24. Rotenberg B, Noyek S, Chin CJ. Radiofrequency ablation for treatment of hereditary hemorrhagic telangiectasia lesions: “how i do it”. Am J Rhinol Allergy 2015 May-Jun;29(3): 226-227.
  25. Joshi H, Woodworth BA, Carney AS. Coblation for epistaxis management in patients with hereditary haemorrhagic telangiectasia: a multicenter case series. J Laryngol Otol 2011 Nov;125(11):1176-1180.
  26. Mortuaire G, Boute O, Hatron PY, Chevalier D. Pilot study of submucosal radiofrequency for epistaxis in hereditary hemorrhagic telangiectasia. Rhinology 2013 Dec;51(4):355-360.
  27. Kumar PS, Matthews CR, Joshi V, de Jager M, Aspiras M. Tobacco smoking affects bacterial acquisition and colonization in oral biofilms. Infect Immun 2011 Nov;79(11): 4730-4738.
  28. Namiot Z, Namiot DB, Kemona A, Gołebiewska M, Bucki R. The effect of cigarette smoking and alcohol consumption on efficacy of Helicobacter pylori eradication. Pol Arch Med Wewn 2000 Sep;104(3):569-574.
  29. Linder JA, Sim I. Antibiotic treatment of acute bronchitis in smokers: a systematic review. J Gen Intern Med 2002 Mar;17(3):230-234.
  30. Lee WK, Ramanathan M Jr, Spannhake EW, Lane AP. The cigarette smoke component acrolein inhibits expression of the innate immune components IL-8 and human betadefensin 2 by sinonasal epithelial cells. Am J Rhinol 2007 Nov-Dec;21(6):658-663.
  31. Kamath PM, Shenoy VS, Mittal N, Sharma NK. Microbiological analysis of paranasal sinuses in chronic sinusitis—a south Indian coastal study. Egypt J Ear Nose Throat All Sci 2013 Nov;14(3):185-189.
  32. Bezerra TF, Pádna FG, Ogawa AI, Gebrim EM, Saldiva PH, Voegels RL. Biofilms in chronic rhinosinusitis with nasal polyps: pilot study. Braz J Otorhinolaryngol 2009 Nov- Dec;75(6):788-793.
  33. Hashemi M, Sadeghi MMM, Omrani MR, Torabi MA. Microbiology and antimicrobial resistance in chronic resistant rhino sinusitis with or without polyp after functional endoscopic sinus surgery. J Res Med Sci 2005;10(3):167-171.
  34. Farahani F, Youse Mashouf R, Hashemian F, Esmaeili R. Antimicrobial resistance patterns of aerobic organisms in patients with chronic rhinosinusitis in Hamadan, Iran. Avicenna J Clin Microb Infec 2014 Aug;1(2):e18961..
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