Ludwig’s angina: an analysis of sixteen cases in a suburban Nigerian tertiary facility.

Abstract

Objective: To document the prevalence and management of Ludwig's angina in a suburban population. Methods: All consecutive cases of Ludwig's angina seen and managed at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria between 1988 and 2002. Results: There were 16 cases with 10 males and 6 females whose ages ranged from 8 to 75 years; mean+ SD; 43.8 + 19.9 years. Symptom duration ranged from one day to three weeks; mean + SD; 6.4 + 4.9 days of the onset of illness. Odontogenic infection was the commonest etiologic factor in 12 cases (75%) and 4 of these were attributed to post dental extraction sepsis. Seven patients had underlying disease such as diabetes mellitus, lobar pneumonia, severe anaemia and mental retardation. The commonest was diabetes mellitus in 4 cases. Microbiological investigations showed a polymicrobial nature of the infection with Staphylococcus aureus (6 cases) out of 11 patients that had the examination. Treatment involved high doses of broad-spectrum parenteral antibiotics, immediate surgical drainage under local and general anaesthesia in 14 (75%) and single patients respectively. This was in addition to extraction of involved tooth/teeth where applicable. The complications recorded in 5 cases (31.3%) were septicaemia, mediastinitis, empyema thoracic, necrotising fasciitis, laryngeal spasm and renal failure. Mortality occurred in 4 cases (25%). Conclusions: Ludwig's angina is a serious disease and late presentation remains a typical feature. Associated co-morbid condition is common. Prompt clinical evaluation and definitive care will considerably improve its prognosis and reduce the high mortality associated with the condition

A fatal case of empyema thoracis: the price for underestimating odontogenic infections

“…The shortage of skilled manpower in Nigeria (with a population of >170 million) for the management of odontogenic infections is a large problem and may contribute to the morbidity and mortality often associated with this infection in our environment. A mortality rate of 20%-28.5% has been reported in our local environment [33][34][35]. Poverty, shortage of skilled personnel, and a poorly implemented national health insurance scheme are the main contributory factors for the mortality recorded in this case report.…”

Angina de Ludwig. Experiencia en 29 pacientes Ludwig’s angina.

“…Además, se pone de manifiesto en el ingreso a unidades de terapia intensiva (12,16,24). A pesar de ello, no tuvimos mortalidad, la cual, en revisiones actuales, varía entre 0 y 25% (4,7,25).…”

Anaesthetic management of Ludwig’s angina in a full term pregnant patient

“…Such cases have a high mortality ranging from 8-25%. 7,8 Pregnancy with its anatomical and physiological changes makes the airway management further difficult. Also, CT scan is contraindicated in pregnancy due to which, extent of the infection cannot be assessed with certainty adding to the difficulty in airway management.…”

“…Furthermore laryngospasm leading to asphyxia and death have been reported following incision and drainage of Ludwig's angina under local anaesthesia. 8…”