No abstract available.
Humans ; Intubation* ; Ludwig's Angina*

Ludwig angina is known as rapidly spreading, diffuse, gangrenous cellulitis of submandibular, submental and sublingual spaces and upper cervical region. We have experienced a case of Ludwig angina in 7 years old female child and reviewed the pertinent literautres briefly.
Cellulitis ; Child ; Female ; Humans ; Ludwig's Angina*

Modern antibiotic therapy and rapid surgical intervention have greately reduced the complication from the spread of odontogenic infections. Nevertheless, fatalities from dental infections continue to occur. One of the most threaded, and probably lethal form is the mediastinal abscess. This is a case of Ludwig's angina dissected along deep cervical planes into the mediastinum caused a virulent mediastinitis and abscess, computed tomography precisely delineated the extent of the infection. Incomplete debridement resulted in a residual abscess and persistent systemic sepsis that culminated in the patient's death. Aggressive antibiotic treatment of the orofacial cellulitis along with complete mediastinal drainage are recommended for optimal outcome.
Abscess* ; Cellulitis ; Debridement ; Drainage ; Ludwig's Angina ; Mediastinitis ; Mediastinum ; Sepsis

This is a retrospective study on the Ludwig's angina patients treated in Dept of Oral and Maxillofacial Surgery of Pusan National University Hospital for the period of Jan. 1985 to March 1996. The used materials of this study were 30 in total, including 18 male patients, 12 female patients. The author analyzed the distribution and incidence of sex, age, etiologic factor, pus culture, involved systemic disease, treatment methods, mortality rate. The results were as follows; 1. The incidences was higher in sixth decades(26.7%) and prevalent in male. 2. The most cause was odontogenic(83.3%) and in 15 cases(50%), the symptom aggravated after dental treatment. 3. The causative organism isolated from pus culture were Streptococci (40.7%), Staphylococci(22.2%), Bacteroid(14.8%), Candida(11.1%), Pseudomonas(3.7%), Pneumococci(3.7%), Salmonella(3.7%). 4. The patients with systemic disease were 66.7%, involved disease were DM(25%), malnutrition(22.7%), rheumatoid arthritis(11.4%), pulmonary disease(11.4%), hypertension(11.4%). 5. In all patients, surgical I&D was done, and 5 cases(16.7%) required tracheostomy. 6. In all patients, we used combination antibiotics, and the most commonly used antibiotics in the treatment were combination of Penicillin, Cephalosporin and Aminiglycoside(46.7%), and combination of Cephalosporin, Aminiglycoside and Metronidazole(30%). 7. The mortality rate was 6.7%.
Anti-Bacterial Agents ; Busan ; Female ; Humans ; Incidence ; Ludwig's Angina* ; Male ; Mortality ; Penicillins ; Retrospective Studies ; Suppuration ; Surgery, Oral ; Tracheostomy

Maxillofacial infection often place the oral and maxillofacial surgeon in situations where timely decisions have to be made. These decisions can be lifesaving. Odontogenic infection are frequently encountered in the practice of oral and maxillofacial surgery. These infections often repond to surgical and antimicrobial management. Otheriwise odontogenic infections have the potential to spread via the fasical spaces in the head and neck region. They can compromise vital structures in this region or involve distant structures. The classic signs of maxillofacial infections include pain, swelling, fever, dysphagia, and dehydration. The goals of management should be to correct these conditions. We have undertaken clinical studies on infections in the oral and maxillofacial regions (facial space) by analyzing hospitalized patients in the Dept. of Oral and Maxillofacial Surgery, Kyung Hee University Hospital past 5 years from 1991. To 1995. And bacterial cultures and antibiotics sensitivity test were performed and the comparative analysis of the antibiotics was done. The results were as follows: 1. The most frequent cause of oral and maxillofacial infection was odontogenic 68% and in 23% patients with signs and symptom aggrevated after teeth extraction. 2. The most common fascial spaces involved was buccal space 36.1%, followed by submandibular space 12.3% and 3 cases were Ludwig's angina. 3. Antibiotics were administrated in all cases and surgical incision and drainage was performed in 88.6%. 4. The most causative organisms isolated from the pus cultures were streptococci group 51.1%.
Anti-Bacterial Agents ; Deglutition Disorders ; Dehydration ; Drainage ; Fever ; Head ; Humans ; Ludwig's Angina ; Neck ; Suppuration ; Surgery, Oral ; Tooth

A 73-year-old woman presented to the emergency department with submandibular pain and swelling. The patient was diagnosed to have Ludwig's angina, and she was planned to undergo urgent incision and drainage under general anesthesia. However, her physical examination revealed severe diffuse swelling extending from the bilateral submandibular spaces to the submental space and further down to the neck. As our view was blocked by the patient's neck swelling, we did not perform a regional anesthesia of the airway or a transtracheal block. Several non-invasive alternatives were considered. The “spray-as-you-go” technique was chosen, and it was performed using the OptiScope®. However, the OptiScope did not have a working channel or syringe adaptor for the administration of the local anesthetic solution. To solve this problem, we combined the OptiScope with a 27-G tunneled epidural catheter (100 cm) for the administration of lidocaine and this combination made the awake intubation successful.
Aged ; Anesthesia, Conduction ; Anesthesia, General ; Catheters* ; Drainage ; Emergency Service, Hospital ; Female ; Humans ; Intubation* ; Lidocaine ; Ludwig's Angina* ; Neck ; Physical Examination ; Syringes

PURPOSE: To analyse the causes and radiologic findings in patients with mediastinitis and to evaluate theefficacy of chest CT scanning in patients with delayed diagnosis. MATERIALS AND METHODS: Seventeen patients withhistopathologically(n=15) or cliniclly diagnosed(n=2) mediastinitis were involved in this study. Eleven of theformer group underwent surgery, and in four, tube drainage was performed. All underwent chest radiography and CTscanning, and in seven patients, the causes of delayed diagnosis were analysed. RESULTS: The most common cause ofmediastinitis was esophageal rupture (n=11). Others were extension from neck abscess to the mediastinum(n=3),complications after a Benthall procedure(n=1), tuberculous lymphadenitis (n=1) and mycotic aneurysm(n=1). Patientswith esophageal rupture suffered from underlying diseases such as esophageal cancer(n=2), iatrogenic esophagealrupture(n=2), Boerhaave's syndrome(n=2), and esophagitis(n=1). In patients with neck abscess(n=3), each wassecondary to infected cystic hygroma, Ludwig angina, or deep neck infection, respectively. On chest CT, patientswith esophageal rupture(n=11) had an abscess in the posterior mediastinum; nine abscesses extended to the cervicalarea along the retropharyngeal space, and the patient with Ludwig angina had an abscess involving all compartmentsof the mediastinum. Among the total of 17 patients, diagnostic delays were found in seven, while five hadspontaneous esophageal ruptures and two suffered complications after a Benthall procedure and Tbc lymphadenitis,respectively. The causes of diagnostic delay varied. Among seven patients, pnevmonia was initially diagnosed intwo, who were treated ; one had multiorgan failure, and one was suffering from pericardial effusion and lungabscess. In three other patients, chest radiographs initially showed non-specific findings, leading to delayed CTexamination. CONCLUSION: The most common cause of mediastinitis was esophageal rupture, and in these patients,chest radiographs and clinical symptoms were sometimes not specific. CT was valuable for the detection ofmediastinitis, and for early diagnosis can be the modality of choice.
Abscess ; Delayed Diagnosis* ; Drainage ; Early Diagnosis ; Humans ; Ludwig's Angina ; Lymphangioma, Cystic ; Mediastinitis* ; Mediastinum ; Neck ; Pericardial Effusion ; Radiography ; Radiography, Thoracic* ; Rupture ; Thorax* ; Tomography, X-Ray Computed ; Tuberculosis, Lymph Node

Ludwig's angina is a progressive gangrenous cellulitis and edema of the soft tissues of the neck and floor of the mouth. Ludwig's angina can be fatal as a result of progressive swelling of the soft tissues of the neck and elevation and posterior displacement of the tongue, resulting in airway obstruction. We report the case of a 77-yearold man who was admitted to the dental hospital with a toothache and headache. He was diagnosed with left submandibular space abscess. Four days post-admission, the submandibular and submental abscess was incised and drained. After the operation, the patient suddenly developed dyspnea and suffered cardiopulmonary arrest and died. An autopsy was performed, and exploration of the neck revealed a submental and submandibular abscess with massive inflammation, edema, and an abscess in multiple layers of the cervical subcutaneous tissue. After autopsy, the cause of death was confirmed as Ludwig's angina with a deep neck abscess. Ludwig's angina is a rapidly progressive cellulitis that often results in death by asphyxia or sepsis and is rarely seen in a forensic autopsy practice. Here in we report a case of Ludwig's angina and present a review of the literature.
Abscess ; Airway Obstruction ; Asphyxia ; Autopsy* ; Cause of Death ; Cellulitis ; Dyspnea ; Edema ; Headache ; Heart Arrest ; Humans ; Inflammation ; Ludwig's Angina* ; Mouth ; Neck ; Sepsis ; Subcutaneous Tissue ; Tongue ; Toothache

Intraoperative airway obstruction is perplexing to anesthesiologists because the patient may fall into danger rapidly. A 74-year-old woman underwent an emergency incision and drainage for a deep neck infection of dental origin. She was orally intubated with a 6. 0 mm internal diameter reinforced endotracheal tube by video laryngoscope using volatile induction and maintenance anesthesia (VIMA) with sevoflurane, fentanyl (100 µg), and succinylcholine (75 mg). During surgery, peak inspiratory pressure increased from 22 to 38 cmH₂O and plateau pressure increased from 20 to 28 cmH₂O. We maintained anesthesia because we were unable to access the airway, which was covered with surgical drapes, and tidal volume was delivered. At the end of surgery, we found a longitudinal fold inside the tube with a fiberoptic bronchoscope. The patient was reintubated with another tube and ventilation immediately improved. We recognized that the tube was obstructed due to dissection of the inner layer.
Aged ; Airway Obstruction* ; Anesthesia ; Bronchoscopes ; Drainage ; Emergencies ; Female ; Fentanyl ; Humans ; Intubation ; Laryngoscopes ; Ludwig's Angina* ; Neck ; Succinylcholine ; Surgical Drapes ; Tidal Volume ; Ventilation

OBJECTIVES: Infection involving the orbit, zygomatic space, lateral pharyngeal space, or hemifacial and oral floor phlegmon is referred to as cervicofacialvinfection (CFI). When diagnosis and/or adequate treatment are delayed, these infections can be life-threatening. Most cases are the result of odontogenic infections. We highlight our experiences in the management of this life-threatening condition. MATERIALS AND METHODS: This was a retrospective study of patients who presented with CFI from December 2005 to June 2012 at the Oral and Maxillofacial Surgery Clinic or the Accident and Emergency Unit of Ahmadu Bello University Teaching Hospital (Zaria, Nigeria). The medical records of all patients who presented with either localized or diffuse infection of the maxillofacial soft tissue spaces were retrospectively collected. Data collected was analyzed using SPSS version 13.0 and are expressed as descriptive and inferential statistics. RESULTS: Of the 77 patients, 49 patients (63.6%) were males, a male to female ratio of 1:7.5. The ages ranged from two years to 75 years with a mean of 35.0+/-19.3 years, although most patients were older than 40 years. The duration of symptoms prior to presentation ranged from 6 to 60 days, with a mean of 11.0+/-9.4 days. More than 90% of the patients presented to the clinic within the first 10 days. The most commonly involved anatomical space was the submandibular space (n=29, 37.7%), followed by hemifacial space (n=22, 28.6%) and buccal space (n=7, 9.1%). Ludwig angina accounted for about 7.8% of the cases. CONCLUSION: CFI most commonly involves the submandibular space, typically affects individuals with a low level of education, and is influenced by traditional medical practices. Despite improved health care delivery, CFI remains a significant problem in developing countries.
Cellulitis ; Delivery of Health Care ; Developing Countries ; Diagnosis ; Education ; Emergency Service, Hospital ; Female ; Hospitals, Teaching ; Humans ; Ludwig's Angina ; Male ; Medical Records ; Orbit ; Retrospective Studies* ; Surgery, Oral