Ludwigs Angina: List of Resources

EDD 711 Head and Neck Anatomy students have been looking for information on Ludwig’s Angina.  Bibby Library has put together a list of resources, which we will continue to update.

Electronic Books
The following electronic books contain information on Ludwig’s Angina.  URMC affiliates may access the books by selecting the book title from the alphabetical list.

  • MD Consult – search “all sections” for Ludwigs Angina
  • Merck Manual of Diagnosis and Therapy
  • Peterson’s Principles of Oral and Maxillofacial Surgery
  • Pickard’s Manual of Operative Dentistry

The following articles review the topic of Ludwig’s Angina.  All of the cited journals are available at Bibby Library. URMC affiliates may access electronic versions by entering the journal title in the e-journals search box and then navigating to the article.

1. Severe soft tissue infections of the head and neck: primer for critical care physicians.Lung. 2009 Sep-Oct;187(5):271-9.
Reynolds, Chow
Patients with severe infections of the potential spaces of the head and neck are commonly managed in the ICU. These infections may present with devastating complications such as airway obstruction, jugular septic thrombophlebitis, lung abscess, upper airway abscess rupture with asphyxiation, mediastinitis, pericarditis, and septic shock. A thorough understanding of the anatomy and  microbiology of these infections is essential for proper management of these patients. Retropharyngeal, danger, prevertebral, lateral pharyngeal, and submandibular space infections and their site-specific clinical manifestations, complications, and therapeutic interventions are discussed.

2. Ludwig’s angina in the pediatric population. Clin Pediatr (Phila). 2009 Jul;48(6):583-7. Lin HW, O’Neill A, Cunningham

As many as 1 in 3 of cases of Ludwig’s angina occur in children and adolescents,  and pediatricians are therefore ideally situated to detect these individuals at an early stage of their potentially life-threatening disease. The early identification and referral of children afflicted with Ludwig’s angina to tertiary care centers allows for the rapid initiation of medical therapy and the  consultation of those emergency services critical to providing such patients with optimal diagnostic and therapeutic interventions. This review provides an overview of the anatomical and pathophysiological considerations in Ludwig’s angina and describes practical management principles to assist pediatricians in the diagnosis and treatment of this disease. Included in this review is an evidence-based algorithm for airway management.

3. A case of Ludwig angina: case report and review of the literature. Am J Forensic Med Pathol. 2008 Sep;29(3):255-9. Marcus BJ, Kaplan J, Collins KA.
Ludwig angina is a rapidly progressing submaxillary, submandibular, and sublingual necrotizing cellulitis of the floor of the mouth that can have lethal consequences due to airway obstruction. Various aerobic and anaerobic microorganisms, and less often fungi, have been implicated to cause Ludwig angina, including oral flora such as streptococci and staphylococci. Early recognition and the use of parenteral antibiotics can prevent mortality and morbidity. We report a case of a 25-year-old white man who was admitted to the hospital by his dentist after being diagnosed with Ludwig angina secondary to periodontal abscesses involving teeth #17 and #32. Although antibiotics were administered, while in the hospital, the decedent had difficulty swallowing and was drooling. He suddenly began to have seizure-like activity thought to be anoxic myoclonus. The decedent was aggressively resuscitated and taken to the operating room for neck exploration and a tracheostomy. Neck exploration revealed severe necrotizing acute inflammation of the deep soft tissues and musculature of the neck. He remained on life support for 7 days until he was declared brain dead. Ludwig angina is a progressive cellulitis that often results in death by asphyxia. Ludwig angina can be complicated by subsequent deep neck infection. The underlying etiologies and common scenarios are examined, and significant autopsy findings and dissecting procedures are discussed. The pathophysiology of Ludwig angina is studied with a review of the current literature.

4. Ludwig angina: forewarned is forearmed. AANA J. 2006 Dec;74(6):445-51. Kremer MJ, Blair T.
While the incidence of Ludwig angina is decreasing, this is an important disease process because failure to control the airway can have catastrophic consequences. Accurate diagnosis, airway control, antibiotic therapy, and, occasionally, surgical management are essential for patient safety. Ludwig angina is caused by  a rapidly expanding cellulitis of the floor of the mouth and is characterized by  hardened in duration of the floor and suprahyoid region bilaterally with an elevation of the tongue potentially obstructing the airway. In the preantibiotic  era, Ludwig angina was frequently fatal; however, antibiotics and aggressive surgical treatment have significantly lowered mortality.

5. Ludwig’s angina. Dimens Crit Care Nurs. 2004 Jul-Aug;23(4):153-4. Little C.
Ludwig’s angina is a serious, often fatal infectious disease process that requires prompt intervention of life-saving therapies. The critical care nurses caring for a patient with Ludwig’s angina must be able to recognize subtle changes in the patient’s status and intervene quickly to prevent death by airway edema or profound sepsis.

6. Ludwig’s angina. Emerg Med J. 2004 Mar;21(2):242-3. Saifeldeen K, Evans R.
The case is described of an occurrence of Ludwig’s angina with advanced stage of  the disease with progressive and rapid airway compromise and fatal consequence. A review of the literature is undertaken to gain a better understanding of the disease, and gives the opportunity for presenting a summary of the key issues regarding this dreaded disease, particularly the immediate management of it in the emergency department.

7. A review of Ludwig’s angina for nurse practitioners.  J Am Acad Nurse Pract. 2003 Dec;15(12):546-9. Winters S.
To discuss the causative factors, clinical course, and current treatment modalities for Ludwig’s angina, a submandibular cellulitis, and to raise nurse practitioners’ (NPs’) awareness of this condition. SOURCES: Recent clinical  articles, research, case studies, and medical texts. Ludwig’s angina may be fatal. Early diagnosis, aggressive antibiotic therapy, and management involving a multidisciplinary team approach are imperative for the patient to progress without complications. Education and awareness are crucial for successful diagnosis of and management of treatment for Ludwig’s angina. Although NPs have a limited role in the treatment of Ludwig’s angina, their ability to recognize the signs and symptoms will prompt emergency care and treatment and facilitate better outcomes for their clients.

8. Ludwig’s angina. Gen Dent. 1994 Jan-Feb;42(1):84-7. Owens BM, Schuman NJ. No abstract available.


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