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Abstract
Ludwig's angina is potentially life-threating, rapidly spreading involving bilaterally submandibular, sublingual and sub mental spaces. It is characterized by induration of mouth, swelling, elevation of tongue and airway obstruction. There is three main points with early diagnosis which are airway management, intravenous antibiotic therapy and surgical intervention. We present a case of Ludwig's angina in a 14-year-old boy. The etiology, management and potential complications of Ludwig's angina are discussed.
Case report (J Int Dent Med Res 2014; 7: (3), pp. 60-62)
Keywords: Ludwig's angina, systemic diseases and, maxillofacial infection.
Received date: 28 august 2014 Accept date: 11 November 2014
Introduction
Ludwig's angina is potentially life-threatening, rapidly spreading involving bilaterally submandibular, sublingual and submental spaces.1 Ludwig's angina was described by Wilhelm Frederick von Ludwig in 1836 as a rapidly progressive, gangrenous cellulitis and edema of the softtissues of the neck and floor of the mouth.2 It is characterized by brawny induration and elevation of the tongue with the airway obstruction.3 Mortality rates for Ludwig's angina exceeded 50% in the pre-antibiotic era.4 As a result of antibiotic therapy, mortality recently averages approximately 8 %.5-6 Mortality is a result of upper airway obstruction.7-8
Odontogenic infection is the major etiologic factor of the Ludwig's angina and primarily resulting from infection of the second and third molars.6-9 The roots of these teeth penetrate the mylohyoid ridge and because of that any dental infection or abscess has gateway to the submaxillary space.10 Infection spreads contiguously to the sublingual and submental space, posteriorly to the parapharyngeal and retropharyngeal space.11-12 Other etiologic factors are mandibular fractures, oral lacerations, infection of an oral malignancy, peritonsillar or parapharyngeal abscesses and submandibular sialadenits.10 Predisposing factors include dental caries, recent dental treatment, systemic illness such as malnutrition, diabetes mellitus, compromised immune system such as immunodeficiency syndrome (AIDS), organ transplantation and trauma .13-14
Case Report
A 14- year-old boy was presented to our clinic complaining of severe painful tissues to the touch, diffuse swelling, difficulty swallowing. In his medical history, systemic lupus erythematosus (SLE) and Familial Mediterranean Fever (FMF) were present. The patient was febrile (temperature 38.4 °C), blood pressure was 123 / 72 mm Hg, and he was seemed uncomfortable, anxious, toxic appearance (Figure 1a). The patient's erythrocyte sedimentation rate (ESR) was 27 mm/h...