A Rare Cause of Neck Swelling: Ludwig’s Angina

Yıl 2013, Cilt: 4 Sayı: 1, 38 - 40, 01.01.2013

Hakan Hasman Emin Uysal Serkan Dilmen Erdem Çevik

Öz

Ludwig’s Angina is a rare complication of periodontal infection that can result in severe upper airway obstruction and potentially death. A 22-year-old male presented to the emergency department of a public hospital with fever, chills, left-sided neck pain and swelling. The left submandibular area was indurated with palpable crepitus. Computed tomography showed the extension to deep neck spaces. The patient was treated with ampicillin-sulbactam, metronidazole and analgesics. He was tansported to a tertiary medical center for definitive care. Ludwig’s angina is a potentially lethal disease. We believe that many emergency departments have limited experience of the disease because of its rare occurrence. In addition, technical opportunities and early surgery capacity of the emergency room have an effect on survey. Management should contain early diagnosis and the immediate aggressive medical approach. Securing and maintaining the airway is the primary goal in all patients presenting with Ludwig’s Angina

Anahtar Kelimeler

Ludwig’s Angina, neck swelling, upper airway obstruction

Boyunda Şişliğin Nadir Bir Sebebi: Ludwig Anjini

Öz

Ludwig Anjini, periodontal enfeksiyonların nadir bir komplikasyonu olan, üst hava yolu tıkanıklığı ve ölümle sonuçlanabilecek
bir hastalıktır. Yirmi iki yaşında erkek hasta devlet hastanesinin
acil servisine boynunun sol kısmında şişlik, ağrı, ateş ve titreme
şikayeti ile başvurdu. Hastanın sol submandibular bölgesinde
krepitasyon veren şişlik mevcuttu. Bilgisayarlı tomografide derin boyun boşluklarındaki yumuşak dokularda genişleme tespit
edildi. Hastaya parenteral ampisilin-sulbaktam, metronidazol ve
aneljezik verildi. Genel durumu stabil olan hasta ileri tedavi için 3.
basamak sağlık hizmeti veren merkeze nakledildi. Ludwig Anjini,
ölümcül bir hastalıktır. Acil servislerde nadir rastlanan bir hastalık
olduğu için bu hastalıkla ilgili deneyimlerin sınırlı olduğunu düşünüyoruz. Buna ilaveten acil servislerin teknik imkanları ve erken cerrahi olanaklarının sağ kalımda etkili olduğuna inanıyoruz.
Hastalığın yönetiminde erken tanı ve erken agresif tedavi esastır.
Daha da önemlisi hava yolunun sağlanması bu hastalarda öncelikli hedef olmalıdır

Anahtar Kelimeler

Ludwig Anjini, boyunda şişlik, üst hava yolu tıkanıklığı

Kaynakça

• Topazian RG, Goldberg MH, Hupp JR. Oral and Maxillofacial Infections. 4th ed. Philadelphia, Pa:W.B. Saunders; 2002.
• Saifeldeen K, Evans R. Ludwig’s angina. Emerg Med J 2004; 21: 242-3. [CrossRef]
• Durand M, Joseph M. Infections of the upper respiratory tract.In Harrison’s Principles of Internal Medicine Volume 1. 16th edition.Edited by: Braunwald E, Fauci AS, Kasper DL, Braunwald E, Hauser S,Longo D, Jameson JL. New York: McGraw-Hill; 2001: 191.
• Spitalnic SJ, Sucov A. Ludwig’s angina: case report and review. J Emerg Med 1995; 13: 499-503. [CrossRef]
• Ovassapian A, Tuncbilek M, Weitzel EK, Joshi CW. Airway management in adult patients with deep neck infections: A case series and review of the literature. Anesth Analg 2005; 100: 585-9. [CrossRef]
• Marple BF. Ludwig angina. A review of current airway management. Arch Otolaryngol Head Neck Surg 1999; 125: 596-9.
• Parhiscar A, Har-EL E. Deep neck abscess. A retrospective review of 210 cases. Ann Otol Rhinol Laryngol 2001; 110: 1051-4.
• Iwu CO. Ludwig’s angina: a report of seven cases and review of current concepts in management. Br J Oral Maxillofac Surg 1990; 28: 189-93. [CrossRef]
• 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: 453-6.
• Bush RF, Shaha D. Ludwig’s angina- improved treatment. Otolaryngol Head Neck Surg 1997; 117: 172-5.
• Freud B, Timon C. Ludwig’s angina: a place for steroid therapy in its ma- nagement. Oral Health 1992; 82: 23-5.
• MacDonnell SPJ, Timmins AC, Watson JD. Adrenalin administred via a nebuliser in adult patients with upper airway obstruction. Anaesthesia 1995; 50: 35-6. [CrossRef]
• Parhiscar A, Har-El G. Deep neck abscess: a retrospective review of 210 cases. Ann Otol Rhinol Laryngol 2001; 110: 1051-4.
• Furst IM, Ersil P, Caminiti M. A rare complication of tooth abscess- Ludwig’s angina and mediastinitis. J Can Dent Assoc 2001; 67: 324-7.
• Kulkarni AH, Pai SD, Bhattarai B, Rao ST, Ambareesha M. Ludwig’s angina and airway considerations: a case report. Cases Journal 2008; 1: 1-19. [CrossRef]
• Patterson HC, Kelly JH, Strome M. Ludwig’s angina: an update.Laryngos- cope 1982; 92: 370-8. [CrossRef]
• McGuire G, El-Beheiry H. Complete upper airway obstruction during awake fiberoptic intubation in patients with unstable cervical spine fractures. Can J Anaesth 1999; 46: 176-8. [CrossRef]
• Shaw IC, Welchew EA, Harrison BJ, Michael S. Complete airway obstruc- tion during awake fiberoptic intubation. Anaesthesia 1997; 52: 582-5. [CrossRef]
• Mason RA, Fielder CP. The obstructed airway in head and neck surgery [editorial]. Anaesthesia 1999; 54: 625-8. [ ]