Objectives
Ludwig's angina is a potentially lethal submandibular space infection. We aim to describe the epidemiological characteristics of Ludwig's angina patients presenting to the emergency department (ED) and to examine outcomes and resource utilization to determine their burden on ED and hospitals.
Methods
Using the Nationwide Emergency Department Sample database, a nationally representative all‐payer database, we retrospectively reviewed all ED visits between 2006 and 2014 for patients admitted with a primary diagnosis of Ludwig's angina (International Classification of Diseases, Ninth Revision, 528.3). We collected information including demographics, ED and inpatient charges, airway interventions, length of stay, and mortality.
Results
A total of 5,855 patients met our inclusion criteria. In our study population, the mean age was 44.5 years, with 54% males and 46% females. There were 75% insured and 25% uninsured. Overall median ED charges were $1,352 and median inpatient charges were $18,017.54, with a median length of stay of 3 days. As part of their management, 47.2% of the patients received a surgical drainage procedure, 3.3% required a surgical airway, and 4.6% required a nonsurgical airway. The overall mortality rate was 0.3%.
Conclusion
Ludwig's angina remains a rare and potentially life‐threatening condition. The mortality rate appears to be decreased from previous historical accounts, with airway intervention remaining a significant part of management.
Level of Evidence
3
Laryngoscope, 129:2041–2044, 2019
FA is the major IBMFS with associated hearing loss, which is most commonly conductive. Radial hypoplasia or aplasia and characteristic congenital ear malformations are associated with hearing loss in patients with FA. Recognition of these syndrome-specific abnormalities should lead to earlier management of hearing loss.
Extranodal natural killer (NK)/T-cell lymphoma, nasal type (NNKTL) is a rare and highly aggressive non-Hodgkin lymphoma originating from NK or γδ T cells infected by Epstein-Barr virus (EBV). In the United States, NNKTL is usually noted in people of Asian or Hispanic descent. Natural killer/T-cell lymphoma, nasal type commonly involves the upper aerodigestive tract, including the nasopharynx, nasal cavity, Waldeyer’s ring, and oropharynx. Extensive local destruction and invasion has been noted, especially of the paranasal sinuses, hard palate, and central nervous system; involvement of the nasolacrimal duct with dacryocystitis is yet to be reported. We report a rare case of a Hispanic man with extranodal NNKTL masquerading as persistent dacryocystitis and necrotizing sinusitis unresponsive to antibiotics and surgical intervention. An extensive background of necrosis and inflammation was noted on pathology, and additional analysis with immunohistochemistry and in situ hybridization after repeat biopsy were necessary for accurate diagnosis.
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