Ludwig’s Angina: Case series with description of the ultrasonographic features of the emergency conditions

Year 2020, Volume: 11 Issue: 4, 111 - 115, 28.12.2020

Antigoni Delantoni Apostolos Sarafopoulos Gavriil Tsiropoulos Ahsen Deniz , Kaan Orhan

https://doi.org/10.33706/jemcr.800027

Cited By: 1

https://izlik.org/JA88RB74PR

Abstract

Ludwig’s Angina (LA) is a rare but rapidly evolving form of toxic cellulitis with heavy clinical symptoms and the potential of a rapid spread to adjacent cervical triangles. possible expansion.
Although the diagnosis of Ludwig's angina is more clinical, ultrasound is a necessary complementary examination to delineate the extent of the inflammation and to highlight its most common complications, such as obstruction of the airway, abscess formation, osteomyelitis and vascular clots which are indications for more immediate treatment. The use of ultrasound for evaluating the extent of the condition is not often reported (and it is reported as isolated case reports) in the literature which allows for a high end and detailed estimation of the infection and its surrounding tissues. This case series describe the USG features examination of and highlights the importance of USG imaging of spreading infections caused by dentomaxillofacial pathologies.

Keywords

Ludwig’s Angina , Ultrasonography , infection , emergency

References

• 1. Goldberg MH, Topazian RG. Odontogenic Infections and Deep Fascial Space Infections of Dental Origin. In: Topazian RG, Goldberg MH, Hupp JR (eds). Oral and maxillofacial infections (4nd edn)
• 2. Larawin V, Naipao J, Dubey SP. Head and neck space infections. Otolaryngol Head Neck Surg 2006 Dec; 135(6):889-93.
• 3. Saifeldeen K, Evans R. Ludwig’s Angina. Emerg Med J 2004 Mar; 21(2):242-3.
• 4. 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; 110:453-456.
• 5. Bramwell KJ, Davis DP. Ludwig's angina. J Emerg Med 1998; 3:481-483.
• 6. Har-El G, Aroesty JH, Shaha A, Lucente FE. Changing trends in deep neck abscess. A retrospective study of 110 patients. Oral Surg Oral Med Oral Pathol 1994; 77: 446-450.
• 7. Iwu CO. Ludwig's angina: report of seven cases and review of current concepts in managment. Br J Oral Maxillofac Surg 1990; 28:189-193.
• 8. Polat G, Sade R. Radiologic Imaging of Ludwig Angina in a Pediatric Patient. J Craniofac Surg Sep 2018; 29(6):e603-e604.
• 9. Barsamian JG, Scheffer RBQ. Spontaneous pneumothorax: an unusual occurrence in a patient with Ludwig's angina. J Oral Maxillofac Surg 1987; 45:157-159.
• 10. Dugan MJ, Lazow SK, Berger JR. Thoracic empyema resulting from direct extension of Ludwig's angina: a cese report. J Oral Maxillofac Surg 1998; 56:968-971.
• 11. Busch RF, Shah D. Ludwig's angina: improved treatment. Otolaryngol Head Neck Surg 1997; 117:172-175.
• 12. Busch RF. Ludwig angina: early aggressive therapy. Arch Otolaryngol Head Neck Surg 1999; 125:1283-1284. 13. Shih CC, Wang JC, Chen SJ, Hsu YP. Focused Ultrasound Assists in Diagnosis and Management of Difficult Airway in Ludwig’s Angina. J Med Ultrasound Apr-Jun 2019; 27(2):101-103.
• 14. Kremer MJ, Blair T. Ludwig angina: forewarned is forearmed. AANA J 2006; 74:445-51.
• 15. Murphy SC. The person behind the eponym: Wilhelm Frederick von Ludwig (1790-1865). J Oral Pathol Med 1996; 25:513-515.
• 16. Hutsinson IL, James DR. New treatment for Ludwig's angina. Br J Oral Maxillofac Surg 1989; 27:83-84. 17. Hart BT. Tracheotomy for Ludwig's angina. Oral Surg oral Med Oral Pathol 1994; 78:414-415.
• 18. Neff SP, Merry AF, Anderson B. Airway management in Ludwig's angina. Anaesth Intensive Care 1999; 27:659-61.
• 19. Pynn BR, Sands T. Ludwig's angina. Ann Emerg Med 1997; 30:713-715.
• 20. Ruiz CC, Labajo DR, Vilas Y, Paniagua J. Thoracic complications of deeply situated serous neck infections. Journal of Cranio-Maxillofacial Surgery 1993; 21:76-81.
• 21. Kurien Μ, Mathew J, Job A, Achariah Ν. Ludwig's angina. Clin Otolaryngol 1997; 22:263-265.
• 22. Bernardoni B, Grosso R, Powell E, Tilney PVR. Case Study in Critical Care Transport: A 51-Year-Old Male with Ludwig Angina. Air Med J Mar-Apr 2017; 36(2):45-48.
• 23. Linder H. The anatomy of the fasciae of the face and neck with particular reference to the spread and treatment of intraoral infections (Ludwig’s) that have progressed into the adjacent fascial spaces. Ann Surg 1986; 204:705–14.
• 24. Bansal A, Miskoff J, Lis RJ. Otolaryngologic critical care. Crit Care Clin 2003; 19:55–72.
• 25. Allen D, Loughman T, Ord R. A re-evaluation of the role of tracheostomy in Ludwig’s angina. J Oral Maxillofac Surg 1985; 43:436 –9
• 26. Schliamser S, Berggren D, Kercoff Y. Ludwig’s angina and associated systemic complications. Bacteriology and current therapy. Scand J Infect Dis 1986; 18(5):477-81.
• 27. Finch R, Snider G, Sprinkle P. Ludwig’s angina. JAMA 1980; 243:1171–3.
• 28. Moreland L, Corey J, McKenzie R. Ludwig’s angina: report of a case and review of the literature. Arch Intern Med 1988; 148:461– 6.
• 29. Lakhal K, Delplace X, Cottier JP, Tranquart F, Sauvagnac X, Mercier C, et al. The feasibility of ultrasound to assess subglottic diameter. Anesth Analg 2007; 104:611-14.
• 30. Shibasaki M, Nakajima Y, Ishii S, Shimizu F, Shime N, Sessler DI. Prediction of pediatric endotracheal tube size by ultrasonography. Anesthesiology 2010; 113:819-24.
• 31. Long SS, Pickering LK, Prober CG. Principles and practice of pediatric infectious diseases. Philadelphia, PA: W.B. Saunders, 2003.
• 32. Gross S, Nieburg P. Ludwig angina in childhood. Am J Dis Child 1977; 131:291–2.
• 33. Barkin R, Bonis S, Elzhammer R, Todd JK. Ludwig angina in children. J Pediatr 1975; 87:563–5.
• 34. Adhikari S, Zeger W, Schmier C, Crum T, Craven A, Frrokaj I, et al. Pilot study to determine the utility of point-of-care ultrasound in the assessment of difficult laryngoscopy. Acad Emerg Med 2011; 18:745-8.