Images in Clinical Medicine
Ludwig's Angina
N Engl J Med 2008; 359:1501October 2, 2008
- Article
A 58-year-old healthy man was evaluated for a toothache of 2 days' duration. He was treated with oral penicillin and an opiate analgesic and advised to have the affected teeth pulled. He returned less than 24 hours later reporting severe swelling in the neck, sore throat, chills, and chest pain. On examination, the floor of his oral cavity was indurated and woody, and he had marked tenderness and adenopathy throughout his neck. He had erythema spreading from his neck down over his anterior chest wall where his chest pain was localized (Panels A and B). He did not have appreciable stridor or trismus, and he was able to swallow his own secretions. Ludwig's angina is an infectious process involving the submental, sublingual, and submandibular spaces. It can rapidly progress to hemodynamic instability and airway obstruction; in rare cases, it spreads into the mediastinum. Compromise of the airway can progress rapidly, with lethal consequences; therefore, immediate consideration should be given to surgical débridement of the infected areas and antimicrobial therapy. In addition, options for surgical management of the airway should be available. The patient was admitted and underwent extensive surgical débridement. He recovered after a stay in the intensive care unit.
Jon Heavey, M.D.
Naren Gupta, M.D., Ph.D.
University of Virginia, Charlottesville, VA 22903
heavey@alum.dartmouth. org - Citing Articles (2)
Citing Articles
1
Pablo Santos Gorjón, Pedro Blanco Pérez, Ana Cristina Morales Martín, Juan Carlos del Pozo de Dios, Santiago Estévez Alonso, María Isabel Calle de la Cabanillas. (2012) Deep Neck Infection: Review of 286 Cases. Acta Otorrinolaringologica (English Edition) 63:1, 31-41
CrossRef2
Pablo Santos Gorjón, Pedro Blanco Pérez, Ana Cristina Morales Martín, Juan Carlos del Pozo de Dios, Santiago Estévez Alonso, María Isabel Calle de la Cabanillas. (2011) Infecciones cervicales profundas. Revisión de 286 casos. Acta Otorrinolaringológica Española
CrossRef
