Ludwig's angina - Revision history

Rossdonaldson1 at 20:01, 17 April 2024

2024-04-17T20:01:25Z

← Revisión anterior		Revisión del 20:01 17 abr 2024
Línea 58:		Línea 58:
	*[[Intubation]] may be very difficult due to trismus and posterior pharyngeal extension		*[[Intubation]] may be very difficult due to trismus and posterior pharyngeal extension
	*Preference for an awake fiberoptic [[intubation]] (ideally in OR if time allows) with setup immediately available for [[cricothyrotomy]]		*Preference for an awake fiberoptic [[intubation]] (ideally in OR if time allows) with setup immediately available for [[cricothyrotomy]]

	===Antibiotics===		===Antibiotics===
	{{Ludwig's Antibiotics}}		{{Ludwig's Antibiotics}}

Rossdonaldson1: /* Video */

2024-04-17T20:00:41Z

Video

← Revisión anterior		Revisión del 20:00 17 abr 2024
Línea 68:		Línea 68:
	*[[Retropharyngeal abscess]]		*[[Retropharyngeal abscess]]
	*[[Sore throat]]		*[[Sore throat]]

	~~==Video==~~
	~~{{#widget:YouTube\|id=qVn3jagukiw}}~~

	==References==		==References==

Rossdonaldson1: /* Clinical Features */

2021-03-25T16:32:22Z

Clinical Features

← Revisión anterior		Revisión del 16:32 25 mar 2021
Línea 8:		Línea 8:

	==Clinical Features==		==Clinical Features==
			[[File:Ludwig angina.jpg\|thumb\|Swelling in the submandibular area in a person with Ludwig's angina.]]
	[[File:Ludwigs_submandibular.jpeg\|thumb\|Significant submandibular swelling and discoloration typical in Ludwig's Angina]]		[[File:Ludwigs_submandibular.jpeg\|thumb\|Significant submandibular swelling and discoloration typical in Ludwig's Angina]]
	===Early Signs===		===Early Signs===

Elcatracho: /* Background */

2021-03-17T17:53:43Z

Background

← Revisión anterior		Revisión del 17:53 17 mar 2021
Línea 3:		Línea 3:
	*[[Cellulitis]] without clear fluctuance/[[abscess]] should heighten suspicion		*[[Cellulitis]] without clear fluctuance/[[abscess]] should heighten suspicion
	*85% of cases arise from an odontogenic source, usually [[periapical abscess]]es of mandibular molars		*85% of cases arise from an odontogenic source, usually [[periapical abscess]]es of mandibular molars
	*Source of infection often polymicrobial, most commonly [[Strep]], [[Staphylococcus]], and Bacteroides species		*Source of infection often polymicrobial, most commonly [[Strep]], [[Staphylococcus]], and [[Bacteroides]] species
	*Patients usually 20-60yr; male predominance <ref>Buckley M, O’Connor K. Ludwig’s angina in a 76-year-old man. Emerg Med J. 2009;26:679-680</ref>		*Patients usually 20-60yr; male predominance <ref>Buckley M, O’Connor K. Ludwig’s angina in a 76-year-old man. Emerg Med J. 2009;26:679-680</ref>
	*Often there is no lymphatic involvement and no [[abscess]] formation but infection rapidly spreads bilaterally		*Often there is no lymphatic involvement and no [[abscess]] formation but infection rapidly spreads bilaterally

Elcatracho: /* Background */

2021-03-17T17:52:31Z

Background

← Revisión anterior		Revisión del 17:52 17 mar 2021
Línea 3:		Línea 3:
	*[[Cellulitis]] without clear fluctuance/[[abscess]] should heighten suspicion		*[[Cellulitis]] without clear fluctuance/[[abscess]] should heighten suspicion
	*85% of cases arise from an odontogenic source, usually [[periapical abscess]]es of mandibular molars		*85% of cases arise from an odontogenic source, usually [[periapical abscess]]es of mandibular molars
	*Source of infection often polymicrobial, most commonly [[Strep]] [[Staphylococcus]] and Bacteroides species		*Source of infection often polymicrobial, most commonly [[Strep]], [[Staphylococcus]], and Bacteroides species
	*Patients usually 20-60yr; male predominance <ref>Buckley M, O’Connor K. Ludwig’s angina in a 76-year-old man. Emerg Med J. 2009;26:679-680</ref>		*Patients usually 20-60yr; male predominance <ref>Buckley M, O’Connor K. Ludwig’s angina in a 76-year-old man. Emerg Med J. 2009;26:679-680</ref>
	*Often there is no lymphatic involvement and no [[abscess]] formation but infection rapidly spreads bilaterally		*Often there is no lymphatic involvement and no [[abscess]] formation but infection rapidly spreads bilaterally

Elcatracho: /* Clinical Features */

2021-01-27T03:07:44Z

Clinical Features

← Revisión anterior		Revisión del 03:07 27 ene 2021
Línea 8:		Línea 8:

	==Clinical Features==		==Clinical Features==
			[[File:Ludwigs_submandibular.jpeg\|thumb\|Significant submandibular swelling and discoloration typical in Ludwig's Angina]]
	===Early Signs===		===Early Signs===
	*[[Dysphagia]]		*[[Dysphagia]]

ClaireLewis: /* Complications */

2019-09-30T21:07:40Z

Complications

← Revisión anterior		Revisión del 21:07 30 sep 2019
Línea 31:		Línea 31:
	*[[Empyema]]		*[[Empyema]]
	*[[Pericardial effusion]]		*[[Pericardial effusion]]
	*[[Pleural effusion[[		*[[Pleural effusion]]
	*Mandibular [[~~Osteomyelitis~~]]		*Mandibular [[osteomyelitis]]
	*Subphrenic abscess		*Subphrenic [[abscess]]
	*[[aspiration pneumonia and pneumonitis\|Aspiration pneumonia]]		*[[aspiration pneumonia and pneumonitis\|Aspiration pneumonia]]
	*[[Cavernous sinus thrombosis]]		*[[Cavernous sinus thrombosis]]

ClaireLewis at 21:07, 30 September 2019

2019-09-30T21:07:17Z

← Revisión anterior		Revisión del 21:07 30 sep 2019
Línea 2:		Línea 2:
	*Bilateral infection of submental, submandibular, and sublingual spaces		*Bilateral infection of submental, submandibular, and sublingual spaces
	*[[Cellulitis]] without clear fluctuance/[[abscess]] should heighten suspicion		*[[Cellulitis]] without clear fluctuance/[[abscess]] should heighten suspicion
	*85% of cases arise from an odontogenic source, usually periapical ~~abscesses~~ of mandibular molars		*85% of cases arise from an odontogenic source, usually [[periapical abscess]]es of mandibular molars
	*Source of infection often polymicrobial, most commonly [[Strep]] [[Staphylococcus]] and Bacteroides species		*Source of infection often polymicrobial, most commonly [[Strep]] [[Staphylococcus]] and Bacteroides species
	*Patients usually 20-60yr; male predominance <ref>Buckley M, O’Connor K. Ludwig’s angina in a 76-year-old man. Emerg Med J. 2009;26:679-680</ref>		*Patients usually 20-60yr; male predominance <ref>Buckley M, O’Connor K. Ludwig’s angina in a 76-year-old man. Emerg Med J. 2009;26:679-680</ref>
Línea 21:		Línea 21:
	*Tongue protrusion		*Tongue protrusion
	*Trismus		*Trismus
	*Dysphonia		*[[Dysphonia]]
	*Cyanosis		*Cyanosis
	*Acute ~~Laryngospasm~~		*Acute laryngospasm

	===Complications===		===Complications===
	*Carotid sheath infection		*Carotid sheath infection
	*IJ thrombophlebitis ([[Lemierre's Disease]])		*IJ thrombophlebitis ([[Lemierre's Disease]])
	*Mediastinitis		*[[Mediastinitis]]
	*Empyema		*[[Empyema]]
	*Pericardial effusion		*[[Pericardial effusion]]
	*Pleural effusion		*[[Pleural effusion[[
	*Mandibular Osteomyelitis		*Mandibular [[Osteomyelitis]]
	*Subphrenic abscess		*Subphrenic abscess
	*Aspiration pneumonia		*[[aspiration pneumonia and pneumonitis\|Aspiration pneumonia]]
	*Cavernous sinus thrombosis		*[[Cavernous sinus thrombosis]]
	*Brain abscess		*[[Brain abscess]]

	==Differential Diagnosis==		==Differential Diagnosis==
Línea 43:		Línea 43:
	==Evaluation==		==Evaluation==
	*Clinical diagnosis, based on history and physical exam.		*Clinical diagnosis, based on history and physical exam.

	~~===Workup===~~
	*CT face with contrast will help delineate area of infection		*CT face with contrast will help delineate area of infection
	**Only necessary to obtain imaging if diagnosis is in question - imaging should not delay emergent airway management or transfer to OR for definitive care		**Only necessary to obtain imaging if diagnosis is in question - imaging should not delay emergent airway management or transfer to OR for definitive care
Línea 50:		Línea 48:
	*CBC		*CBC
	*Chem		*Chem
	*Lactate		*[[Lactate]]
	*Blood Cultures		*Blood Cultures

Línea 56:		Línea 54:
	*Emergent ENT or OMFS consult for operative I&D and extraction of dentition if source is dental abscess		*Emergent ENT or OMFS consult for operative I&D and extraction of dentition if source is dental abscess
	===Airway Management===		===Airway Management===
	*Intubation may be very difficult due to trismus and posterior pharyngeal extension		*[[Intubation]] may be very difficult due to trismus and posterior pharyngeal extension
	*Preference for an awake fiberoptic [[intubation]] (ideally in OR if time allows) with setup immediately available for [[cricothyrotomy]]		*Preference for an awake fiberoptic [[intubation]] (ideally in OR if time allows) with setup immediately available for [[cricothyrotomy]]
	===Antibiotics===		===Antibiotics===
Línea 76:		Línea 74:

	[[Category:ENT]]		[[Category:ENT]]
			[[category:ID]]

Gheid: /* Late signs */

2019-06-23T18:58:47Z

Late signs

← Revisión anterior		Revisión del 18:58 23 jun 2019
Línea 19:		Línea 19:
	*[[Stridor]]		*[[Stridor]]
	*Drooling		*Drooling
			*Tongue protrusion
	*Trismus		*Trismus
	*Dysphonia		*Dysphonia

Gheid: /* Background */

2019-06-23T18:57:05Z

Background

← Revisión anterior		Revisión del 18:57 23 jun 2019
Línea 2:		Línea 2:
	*Bilateral infection of submental, submandibular, and sublingual spaces		*Bilateral infection of submental, submandibular, and sublingual spaces
	*[[Cellulitis]] without clear fluctuance/[[abscess]] should heighten suspicion		*[[Cellulitis]] without clear fluctuance/[[abscess]] should heighten suspicion
	*85% of cases arise from an odontogenic source, usually mandibular molars		*85% of cases arise from an odontogenic source, usually periapical abscesses of mandibular molars
	*Source of infection often polymicrobial, most commonly [[Strep]] [[Staphylococcus]] and Bacteroides species		*Source of infection often polymicrobial, most commonly [[Strep]] [[Staphylococcus]] and Bacteroides species
	*Patients usually 20-60yr; male predominance <ref>Buckley M, O’Connor K. Ludwig’s angina in a 76-year-old man. Emerg Med J. 2009;26:679-680</ref>		*Patients usually 20-60yr; male predominance <ref>Buckley M, O’Connor K. Ludwig’s angina in a 76-year-old man. Emerg Med J. 2009;26:679-680</ref>