Comparison of Outcomes in Conservative versus Surgical Treatments for Ludwig’s Angina

Abstract

Objective: To compare the treatment outcomes in patients with early stage Ludwig’s angina who received intravenous antibiotics alone with those who received surgical decompression and intravenous antibiotics. Subjects and Methods: Individuals with early stage Ludwig’s angina were studied using a retrospective cohort study design from August 1997 to September 2017. Data were collected from case notes and logbooks. Appropriate statistical tests were chosen to analyze both the independent and outcome variables. Using 2-tailed test, a level of significance of 0.05 was chosen. Results: A total of 55 patients comprising 38 (69.1%) males and 17 (30.9%) females were studied. The conservative group had a higher number of cases that developed airway compromise (26.3%) when compared to those with surgical approach (2.9%). There was an association between the treatment approach and the development of airway compromise (χ²[1] = 4.83, p = 0.03). Conclusion: There was a higher incidence of airway compromise in patients treated with intravenous antibiotics alone than in those treated with surgical decompression and intravenous antibiotics.

Characteristics and outcomes of Ludwig's angina in patients admitted to the intensive care unit: A 6-year retrospective study of 29 patients

“…The critically ill patients with LA in our study had a wide age range from 8 to 78 years, which is a wider age range than in previous studies of patients with LA. 11 , 13 This is because children and older adults have low resistance to disease, and are therefore more likely to progress into critically ill patients requiring intensive care.…”

Ludwig's angina: a multidisciplinary concern

“…These patients may decompensate rapidly, developing complications including aspiration, pneumonia, empyema, mediastinitis, pericarditis, carotid artery or internal jugular vein thrombosis or erosion, and sepsis, (Filippone, 2004). A recent paper comparing outcomes of conservative treatment versus surgical treatment for Ludwig's angina concluded that there was a higher incidence of airway compromise in the conservative treatment approach (Edetanlen and Saheeb, 2018).…”

“…He was therefore managed conservatively with extremely close monitoring in the 'resuscitation' area of the department. He was placed on 15l high flow oxygen therapy via a facemask, placed into an upright-seated position on the trolley with continuous cardiac and oxygen saturation monitoring, and IV Metronidazole (500mg) was commenced (Edetanlen and Saheeb, 2018). At this point consideration was given to Mr Jones' observations.…”

Ludwig's angina in a COVID positive patient—An atypical case report

“…2,3 Early surgical drainage supported by medical management being the mainstay of treating Ludwig's angina, decreases the stress on airway and provides better antibiotic penetration. 4 Antibiotic sensitivity testing and culture can aid in administration of culture specific antibiotics. Ludwig's angina requires a complex multidisciplinary approach and this may be further complicated if the patient is positive for COVID-19 because of the need © 2021 Special Care Dentistry Association and Wiley Periodicals LLC for isolation and extensive care to avoid sepsis and airway collapse.…”