Abstract
Giriş: Ludwig anjina (LA), submandibular, sublingual ve submental lojların nadir görülen, yaşamı tehdit eden bir enfeksiyonudur. Enfeksiyona esas olarak odontojenik enfeksiyonlar; özellikle mandibular molar dişlerin periapikal apseleri neden olur. İlgili lojlara yayılım nedeniyle boyunda ciddi şişlik, trismus ve yutma güçlüğü gözlenir. Patojenler Streptococcus viridans ve Staphylococcus aureus dahil olmak üzere aerobik ve anaerobik bakterilerdir. Tedavisi, erken müdahalenin önemi vurgulanarak hava yolunun güvence altına alınmasını takiben, antibiyotik profilaksisi altında cerrahi direnaj yapılmasıdır.
Vaka Raporu: 25 yaşında kadın hasta çenesinin sağ ve ön bölgesinde şişlik, kızarıklık ve ağrı ile kliniğimize başvurdu. Yapılan intraoral muayenede özellikle sağ submandibular ve sublingual bölgede boyunda ağrılı, kızarık, sert bir şişlik ile beraber boyun hareketlerinde kısıtlılık ve trismus saptandı. Hasta ilk olarak Ludwig anjina ön tanısıyla kulak burun boğaz bölümüne konsültasyon amaçlı sevk edildi ve boyun apsesinin direnajını takiben hastanın alt gömülü yirmi yaş dişleri çekildi.
Sonuç: Ludwig anjina hızlı ilerleyen, hayati tehlike oluşturan derin bir boyun enfeksiyonudur. Erken tanı ve hastanın zamanında hospitalize edilmesi mortaliteyi azaltmada önemli bir rol oynar.
References
- Lim HK, Wang JM, Hung ST, Ku HC. A dangerous cause of airway obstruction: deep neck infection. Signa Vitae 2021;17:4-9.A
- Hadad H, de Jesus LK, Santos AFP, Colombo LT, Silva NP, de Souza Rodrigues LG. Unusual Ludwig´s angina in systemic disabled patient related with periodontal disease. Rec Soc Dev 2021;10:e22510514896-e22510514896.
- Rao K, Navneeth T, Vivek S, Rathod S. Comparative study of the outcome of surgical decompression in Ludwig’s angina by conventional skin incision versus multiple interrupted skin incisions. Int J Otorhinolaryngol Head Neck Surg 2020;6:2054-7.
- Kumari P, Debta P, Dixit A. Oral potentially malignant disorders: etiology, pathogenesis, and transformation into oral cancer. Front Pharmacol 2022;13:825266.
- Pluksa P, Piromchai P. Efficacy of rubber tube drain versus Penrose drain to decrease hospital stay in Ludwig’s angina with upper airway obstruction. Thai Ent Journal 2024;25:3-14.
- Gunawan F, Ferriastuti W. Ludwig’s angina:An alarming radiology challenge. Radiol Case Rep 2022;17:3103-6.
- Sonar PR, Panchbhai A, Lande AN. Potentially Fatal Ludwig’s Angina: A Case Report. Cureus 2023;15:e48885.
- Bridwell R, Gottlieb M, Koyfman A, Long B. Diagnosis and management of Ludwig’s angina: An evidence-based review. Am J Emerg Med 2021;41:1-5.
- Vallée M, Gaborit B, Meyer J, Malard O, Boutoille D, Raffi F, et al. Ludwig’s angina: A diagnostic and surgical priority. Int J Infect Dis 2020;93:160-2.
- Tu A, Gilbert JD, Byard RW. Ludwig angina and sudden death. Forensic Sci Med Pathol 2021;17:506-9.
- Kovalev V. A Severe Case of Ludwig’s Angina with a Complicated Clinical Course. Cureus 2020;12:e7695.
- Romero J, Elkattawy S, Romero A, Latif A, Al-Fiky E, AlNasseri A, et al. Ludwig’s Angina. Eur J Case Rep Intern Med 2022;1:9:003321.
Abstract
Introduction: Ludwig’s Angina (LA) is a rare, life-threatening infection of the mouth and submandibular spaces, mainly caused by odontogenic infections, particularly periapical abscesses in mandibular molars. The infection spreads through the submandibular and sublingual spaces, causing severe neck
swelling, trismus, and difficulty swallowing. The pathogens involved are a mix of aerobic and anaerobic bacteria, including Streptococcus viridans and Staphylococcus aureus. Treatment focuses on securing the airway, followed by antibiotics and surgical drainage, with an emphasis on early intervention.
Case Report: A 25-year-old woman presented to our clinic with swelling, redness, and pain in the right and anterior regions of the jaw and both sides of the neck. On examination, a painful, firm swelling with redness, especially in the right submandibular and sublingual regions, limited neck mobility and trismus were observed. The patient was initially referred to the otorhinolaryngology department following a preliminary diagnosis of Ludwig’s Angina, and the patient’s lower impacted wisdom teeth were extracted following drainage of neck abscess.
Conclusion: Ludwig’s Angina is a rapidly progressing, life threatening infection of the submandibular and sublingual regions. Early diagnosis and intervention, including securing the airway, administering broad-spectrum antibiotics, and performing surgical drainage are crucial for successful outcomes and reducing mortality.
References
- Lim HK, Wang JM, Hung ST, Ku HC. A dangerous cause of airway obstruction: deep neck infection. Signa Vitae 2021;17:4-9.A
- Hadad H, de Jesus LK, Santos AFP, Colombo LT, Silva NP, de Souza Rodrigues LG. Unusual Ludwig´s angina in systemic disabled patient related with periodontal disease. Rec Soc Dev 2021;10:e22510514896-e22510514896.
- Rao K, Navneeth T, Vivek S, Rathod S. Comparative study of the outcome of surgical decompression in Ludwig’s angina by conventional skin incision versus multiple interrupted skin incisions. Int J Otorhinolaryngol Head Neck Surg 2020;6:2054-7.
- Kumari P, Debta P, Dixit A. Oral potentially malignant disorders: etiology, pathogenesis, and transformation into oral cancer. Front Pharmacol 2022;13:825266.
- Pluksa P, Piromchai P. Efficacy of rubber tube drain versus Penrose drain to decrease hospital stay in Ludwig’s angina with upper airway obstruction. Thai Ent Journal 2024;25:3-14.
- Gunawan F, Ferriastuti W. Ludwig’s angina:An alarming radiology challenge. Radiol Case Rep 2022;17:3103-6.
- Sonar PR, Panchbhai A, Lande AN. Potentially Fatal Ludwig’s Angina: A Case Report. Cureus 2023;15:e48885.
- Bridwell R, Gottlieb M, Koyfman A, Long B. Diagnosis and management of Ludwig’s angina: An evidence-based review. Am J Emerg Med 2021;41:1-5.
- Vallée M, Gaborit B, Meyer J, Malard O, Boutoille D, Raffi F, et al. Ludwig’s angina: A diagnostic and surgical priority. Int J Infect Dis 2020;93:160-2.
- Tu A, Gilbert JD, Byard RW. Ludwig angina and sudden death. Forensic Sci Med Pathol 2021;17:506-9.
- Kovalev V. A Severe Case of Ludwig’s Angina with a Complicated Clinical Course. Cureus 2020;12:e7695.
- Romero J, Elkattawy S, Romero A, Latif A, Al-Fiky E, AlNasseri A, et al. Ludwig’s Angina. Eur J Case Rep Intern Med 2022;1:9:003321.
Details
| Primary Language | English |
|---|---|
| Subjects | Oral and Maxillofacial Surgery |
| Journal Section | Olgu Sunumu |
| Authors | |
| Publication Date | May 26, 2025 |
| Submission Date | January 14, 2025 |
| Acceptance Date | January 24, 2025 |
| Published in Issue | Year 2025 Volume: 14 Issue: 2 |
