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Cervico-Fascial Infections & Ludwig’s Angina

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  • 17/02/2012 at 5:51 pm #10348
    drsushant
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    Cervico-Fascial Space Infections / Cervico-Facial Cellulitis / 

    Peri-Mandibular Infections

    Due to the strategic position of the wisdom tooth (3rd molar) at the junction of a
    number of different     fascial spaces, any infection in this area must be taken
    seriously as an infection here can easily spread along the     fascial planes and
    compromise the airway.

            

    17/02/2012 at 5:52 pm #15189
    drsushant
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     The head and neck (cervical) region has a large number of fascial spaces.  These 

    ‘spaces’ are bounded by the fascia, which may stretch or be perforated by the 

    purulent exudates (pus), facilitating the spread of infection.  These ‘spaces’ are 

    potential areas and do not exist in healthy individuals.  There are a number of them 

    including the:

     

            

    17/02/2012 at 5:55 pm #15190
    drsushant
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    Sub-masseteric infections occupy the potential space between the lateral border of 

    the     mandible and the masseter muscle.  This is not a fascial-lined space; infection 

    in this area is in direct contact with the     masseter muscle and usually induces 

    intense spasm in the muscle, resulting in a profound limitation in mouth opening 

    (    trismus).

    Internal pterygoid space infections occupy the fascia-lined space between the 

    internal pterygoid muscle and the medial aspect of the mandible.  Infections in this 

    area cause a less profound     trismus but can result in airway embarrassment.  They 

    can also result from     Inferior Alveolar Nerve block.

    The sub-mandibular space consists of a splitting of the investing fascia of the neck 

    to enclose the     submandibular salivary gland and is in continuity with the internal 

    pterygoid     and para-pharyngeal spaces.  Infections in this region can cause airway 

    embarrassment and, when bilateral with associated     cellulitis, is termed Ludwigs 

    Angina    .  This is very serious and potentially life-threatening.

    Infections occur between the pharyngeal mucosa and superior constrictor muscle.  

    Infections in this region are also potentially life-threatening and require urgent 

    attention.

            

    18/02/2012 at 4:40 pm #15191
    drmithila
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    Exams and Tests
    An examination of the neck and head shows redness and swelling of the upper neck, under the chin. The swelling may reach to the floor of the mouth. The tongue may be swollen or out of place.
    A CT scan of the neck may be recommended. Culture of fluid from the tissues may show bacteria.
    Back to TopTreatment
    If the swelling blocks the airway, emergency medical help is needed to maintain an open airway. This may involve placing a breathing tube through the mouth or nose and into the lungs, or surgery called a tracheostomy that creates an opening through the neck into the windpipe.
    Antibiotics, usually penicillin or a penicillin-like medication, are given to fight the infection. They are usually given through a vein until symptoms go away. Antibiotics taken by mouth may be continued until tests show that the bacteria have gone away.
    Dental treatment may be needed for tooth infections that cause Ludwig’s angina.
    Surgery may be needed to drain fluids that are causing the swelling.
    Back to TopOutlook (Prognosis)
    Ludwig’s angina can be life threatening. However, it can be cured with proper protection of the airways and appropriate antibiotics.

     

     

            

    18/02/2012 at 4:41 pm #15192
    drmithila
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    Alternative Names
    Submandibular space infection; Sublingual space infection
    Back to TopCauses
    Ludwig’s angina is a type of cellulitis that involves the floor of the mouth, under the tongue. It often occurs after an infection of the roots of the teeth (such as tooth abscess) or a mouth injury.
    This condition is uncommon in children.
    Back to TopSymptoms
    Swelling of the tissues occurs quickly. It may block the airway or prevent you from swallowing saliva.
    Symptoms include:
    Breathing difficulty
    Confusion or other mental changes
    Fever
    Neck pain
    Neck swelling
    Redness of the neck
    Weakness, fatigue, excess tiredness
    Other symptoms that may occur with this disease:
    Difficulty swallowing
    Drooling
    Earache
    Speech that is unusual and sounds like the person has a "hot potato" in the mouth

     

            

    18/02/2012 at 4:42 pm #15193
    drmithila
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    Possible Complications
    Airway blockage
    Generalized infection (sepsis)
    Septic shock
    Back to TopWhen to Contact a Medical Professional
    Breathing difficulty is an emergency situation. Immediately go to the emergency room or call your local emergency number (such as 911).
    Call your health care provider if you have symptoms of this condition, or if symptoms do not improve after treatment.
    Back to TopPrevention
    Regular visits to the dentist, and prompt treatment of mouth or tooth infections can prevent the conditions that increase the risk of developing Ludwig’s angina

     

            

    18/02/2012 at 4:43 pm #15194
    drmithila
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