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Ludwig‘s Angina
Aneta Dolezal, Nov. 2012

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Definition
lAka Angina ludovici, angina maligna, M. Strangularis
lNamed after German Wilhelm Friedrich von Ludwig in 1836
lRapidly expanding inflammation of the submandibular, submental and sublingual smooth connective
tissue
lBloating can cause obstruction of upper airways
là potentially life threating !
l
l

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Symptoms
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lFever, pain, chills, soreness along the chin
lPus is not produced, oedema appears as result of extracellulary exudate
lTongue is displaced on the palatina which forces the mouth open
l
l
lFurther:
lNeck swelling, dysphagia, breathing difficulties can lead to life threating situation
l

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Causes
lBacterial infection incl.: Streptococci, staphylococci, gram-neg., anaerobic organism
lInfection starts usually at the lower molars (3rd)
lMainly observed in patients with impaired immunity such as: immuncomprimised (chemo therapy,
cortisol treatment) malnutrition, diabetes etc.
lAlso seen in patients after lingual frenulum piercing procedure.

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Treatments
lAirway monitoring is mandatory
lNasotracheal tube for ventilation. CAVE: Tracheostomy is not indicated, to keep the infection from
spreading further
lParenteral antiobiotics: high dose Penicillin G or Clindamycin
lIncision and drainage of the oedema
l

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Summary
lPotentially life threating infection
l Mostly seen in immuncomprimised patients
lSymptons lead from pain, bleeding, fever to severe swelling of the neck and airway obstruction.
lAirway maintenance is compulsory
lHigh dosed antiobiotics, surgical incision and drainage

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