Cervico-Fascial Infections & Ludwig’s Angina

[drsushant]

 

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.

        

[drsushant]

 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:

• buccal space
  
• buccinator space
  
• para-pharyngeal space
  
• sub-mandibular space
  
• sub–lingual space
  
• lateral pharyngeal and
  
• pterygoid space

 

        

[drsushant]

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.

        

[drmithila]

 

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.

 

 

        

[drmithila]

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

 

        

[drmithila]

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

 

        

[drmithila]

 

        

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