Ludwig’s angina in the pediatric population: report of a case and review of the literature

Britt, John C; Josephson, Gary D.; Gross, Charles W.

doi:10.1016/s0165-5876(99)00295-5

Cited by 59 publications

(58 citation statements)

References 23 publications

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“…Late, incorrect or non-treatment could lead to life-threatening complications, such as airway compromise [ [15]. In the pre-antibiotic era, odontogenic infections were associated with a mortality rate of 10% -40% [27]. The advent and implementation of modern antibiotics have significantly reduced mortality rates associated with odontogenic infections [4].…”

Section: Introductionmentioning

confidence: 99%

Steroids in Maxillofacial Space Infection: A Retrospective Cohort Study

Low¹,

Audimulam²,

Lim³

et al. 2017

OJST

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Maxillofacial space infection (MSI) is one of the most common conditions encountered in oral and maxillofacial surgery clinics. Early recognition and proper management of MSI could prevent a life-threatening event. Objectives: To report a series of MSI managed with antibiotics, surgical intervention and exogenous steroids as an adjunct, highlighting functional improvement following steroid administration. Methods: A retrospective cohort study was carried out from December 2013 to September 2016, involving 30 patients (n = 30, 22 males, 8 females) diagnosed with MSI. All patients were initially managed with intravenous empirical antibiotics, analgesics and removal of potential source of infection. A course of 3 doses of IV Dexamethasone 8 mg at an interval of 8 hours was started during the first day of hospital admission. Results: This series reports 30 patients presenting with MSI, who received prompt antibiotics and 3 doses of steroids as in-patients. Significant clinical improvement was noted in the form of amelioration of pain, rapid reduction in edema, and improved trismus, shortening hospital stay to an average of 3.5 days, and omission of surgical intervention in 50% of our cases. No adverse effects or drug reaction was noted. Conclusion: In conclusion, the value of synergistic use of corticosteroids with antibiotics in management of MSI is significant. Despite these promising findings, there is scarce evidence in the literature to fully support the use of corticosteroids in abscess management. The role of corticosteroids in treatment of MSI should be explored further.

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Section: Introductionmentioning

confidence: 99%

Steroids in Maxillofacial Space Infection: A Retrospective Cohort Study

Low¹,

Audimulam²,

Lim³

et al. 2017

OJST

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“…Complications of Ludwig's angina include sepsis, pneumonia, asphyxia, empyema, pericarditis, mediastinitis, and pneumothorax [7]. The mortality rate from Ludwig's angina is currently 10-17% in the pediatric population [13].…”

Section: Discussionmentioning

confidence: 99%

“…Some experts believe that intravenous steroids decrease edema and cellulitis, which helps maintain airway integrity, improves antibiotic penetration into the infected area, and reduces the length of hospital stay [6]. Surgical decompression is indicated in case of poor response to medical therapy or in patients who show clinical evidence of localized abscess formation upon initial physical examination [7]. Contrast-enhanced CT imaging should be considered to assess the extent of the abscess and detect possible odontogenic etiology [14].…”

Section: Discussionmentioning

confidence: 99%

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Group B Streptococcus Infection Presenting as Ludwig's Angina Beyond Infancy

Jabery¹,

Kaabi²,

Kaabi³

et al. 2017

Pediatric Infect Dis

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Ludwig's angina is a serious and rapidly progressive cellulitis of the floor of the mouth which involves the submandibular, sub-maxillary, and sublingual spaces of the face. It uncommonly occurs in adults and children and its early recognition is paramount. With early diagnosis, airway observation and management, aggressive intravenous antibiotic therapy, and judicious surgical intervention, this disease should resolve without any complications. Here we report a case of an immunocompetent adolescent who developed Ludwig's Angina due to Group B Streptococcus (GBS) infection who was successfully treated with surgical intervention and antibiotics therapy. To our knowledge this is the first reported case of GBS infection beyond infancy presenting as Ludwig's Angina in an immunocompetent adolescent. There are other reported cases in the literature of GBS infection presenting beyond infancy but none of the cases presented with Ludwig's Angina.

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“…Ludwig's Angina (LA) is a rapidly progressive soft tissue cellulitis of the sub-mandibular space, first described by Hippocrates in the 4 th century BC as producing a tongue which "… from a soft consistency it grows hard, instead of being flexible, it becomes inflexible, so that the patient would soon be suffocated unless speedily relieved" [1]. In 1836 German surgeon Wilhelm Frederick von Ludwig described the necropsy features [2] and a century later Grodinsky and Holyoke outlined specific clinical criteria for diagnosis (Table 1) [3].…”

Section: Introductionmentioning

confidence: 99%

Ludwig?s Angina: Paediatric Case Report and Literature Review

Brotherton¹,

Templeton²

2014

Intern Med

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Ludwig's Angina (LA) is an uncommon but potentially fatal cellulitis of the submandibular space, complicated by contiguous spread of infection within the respiratory tract and acute airway obstruction. A 13 month-old female developed LA following upper respiratory tract infection with Parainfluenza-3 virus. There was rapid deterioration due to acute airway obstruction and emergency endoctracheal intubation was necessary. A literature review identified thirty-five paediatric cases of LA with a 14% mortality rate. It occurs predominantly in immunocompetent children with an odontogenic source of infection in a third and unknown source of infection in a third of cases. This is the first reported case of a child with preceding respiratory viral infection who developed LA and it is proposed that respiratory viruses may play a previously unrecognized role in the aetiology of Ludwig's angina in children.

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Ludwig’s angina in the pediatric population: report of a case and review of the literature

Cited by 59 publications

References 23 publications

Steroids in Maxillofacial Space Infection: A Retrospective Cohort Study

Steroids in Maxillofacial Space Infection: A Retrospective Cohort Study

Group B Streptococcus Infection Presenting as Ludwig's Angina Beyond Infancy

Ludwig?s Angina: Paediatric Case Report and Literature Review

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