Fatal Ludwig's Angina: Cases of Lethal Spread of Odontogenic Infection

Abstract

We report two cases of deaths resulting from complications of odontogenic infections/submandibular space infections. In one case, the decedent had a history of toothache as well as facial and tongue swelling; autopsy revealed inflammation involving the tongue and larynx. In the second case, the decedent had a history of toothache, and at autopsy there was spread of infection to the mediastinum. Ludwig's angina is a form of submandibular space infection, which often is a result of odontogenic infection. The infection can spread into the deep spaces of the neck, producing complications including edema of the tongue and pharynx (causing airway obstruction), descending mediastinitis, pericarditis, necrotizing fasciitis, pleural empyema, and pneumonia. Gross findings at autopsy might reveal a dental abscess or other forms of infection of the head and neck, necrosis of the neck muscles and larynx, and infrequently, infection extending to the chest cavity. Microscopically, there is acute inflammation with necrosis and/or granulation tissue predominantly within the fascia. Without treatment, submandibular space infections can be life threatening and progression to death can be swift. These cases demonstrate the lethal effects of odontogenic infections. Without a clinical history of toothache or dental abscess, one can be alerted to a possible submandibular space infection by identifying isolated necrosis of the neck musculature.

Fortitude and resilience in service of the population: a case study of dental professionals striving for health in Sierra Leone

“…The findings suggest considerable unmet routine oral health needs (dental caries and periodontal diseases), together with rare and life-threatening oral conditions such as osteomyelitis and Ludwig’s Angina, which result from untreated common diseases. 83–85 Furthermore, Burkitt’s lymphoma, primarily seen in young children especially in Africa and commonly presenting as a tumour affecting the jaws, 86–88 was also reportedly seen on a frequent basis. The study highlighted significant challenges within SL which mainly revolved around five major themes: patients’ predisposition for traditional remedies and urgent care; practical hindrances (irregular dental and infrastructure resources) to deliver care; professional isolation and governance issues of dental personnel; place with pressing local crises such as the civil war and the Ebola epidemic which had disastrous effects; and political will in tackling dental care issues.…”

Angioedema, ACE inhibitor and COVID-19

“…9 Other differential diagnoses chiefly included deep space abscess and hereditary or acquired angioedema. We considered infectious processes such as a lingual abscess, 10 or Ludwig's angina, a form of submandibular space infection arising from the odontogenic origin 11 ; however, without fever, pain or specific fluctuant oedema, infectious processes were mostly ruled out. Trauma is a common cause of tongue swelling, particularly from epileptic tongue bites, 12 although the absence of personal history meant this was unlikely.…”

Angina de Ludwig associada a complicações mediastinais: Relato de caso

“…A angina de Ludwig (AL) descrita em 1836 por Wilhelm Frederick Von Ludwig é considerada uma situação infecto-inflamatório, de envolvimento polimicrobiano, que acomete áreas anatômicas submandibulares bilaterais, sublinguais e submentoniana (Bernardoni, et al, 2017;Mcdonnough, et al, 2019). Pode representar uma exacerbação de um processo infeccioso de origem dentária, traumatismo ósseo, laceração tecidual, acometimento por corpo estranho, amigdalite e fatores idiossincráticos (Cardoso, et al, 2020;Miller, et al, 2018).…”

“…Clinicamente, manifesta sinais como febre, taquipneia, taquicardia, trismo, edema, além de estar relacionada a queixa de sintomatologia dolorosa, disfagia e dispneia (Hisham, et Research, Society and Development, v. 9, n. 9, e764997824, 2020(CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i9.7824 4 al., 2017Vassa, et al, 2019). As condições sistêmicas dos pacientes devem ser levadas em consideração no diagnóstico, por ser um fator relacionado a um possível agravamento do quadro infeccioso (Lee, et al, 2019;Pereira, et al, 2019;Miller, et al, 2018).…”

“…As condutas iniciais para casos de AL devem ser rápidas, criteriosas e sequenciais (Manasia, et al, 2016;Pereira, et al, 2019). A manutenção da via aérea é fundamental, devido ao risco de rápida obstrução e, consequentemente, morte (Miller, et al, 2018;Mcdonnough, et al, 2019;Fernandes, et al, 2020). O tratamento inicial é feito por meio de terapia com antimicrobianos de amplo espectro, intravenosos, além da remoção de fatores etiológicos e, se necessária, drenagem cirúrgica (Lee, et al, 2019;Bernardoni, et al, 2017;Edetanlen & Saheeb, 2018).…”