Therapeutic And Clinical Traits Of Ludwig’s Angina: A 10-year Retrospective Study Of 24 Patients
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Abstract
Introduction: Ludwig’s angina is a life-threatening infection that affects the floor of mouth and originates from odontogenic infections in more than 90% of cases.Materials and Methods: In this retrospective study, medical records of hospitalized patients in the Oral and Maxillofacial Department, Tehran Taleghani Hospital between 2006-2016 with deep neck infections and Ludwig’s angina diagnosis were checked. Then patients were compared in terms of demographic, anatomical, risk factors, clinical course and treatment characteristics. Data were analyzed with SPSS software version 18. Results: The results showed that of 325 studied patients, 24 patients (7.38%) had Ludwig’s angina which of these, 3 patients (12.5%) died ultimately. There was a statistically significant relationship between the occurrence of dyspnea, involved anatomical areas and days of hospitalization in ICU and death; however, there was no significant relationship between gender, age, socioeconomic status, fever, maximum and minimum blood pressure, heart rate, white blood cells count, odynophagia, origin of infection, received antibiotics, hospitalized days and systemic diseases with death.Conclusion: Ludwig’s angina is a fatal infection and requires immediate intervention and results showed involved about 8% of Deep Infections of Head and Neck Area, and the mortality rate of these patients is approximately 12.5%. Therefore, diagnosis and treatment of this disease is important in emergencies.Keywords: Ludwig’s angina; Deep head and neck infections; Mortality; Odontogenic infection.
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2. McDonnough, J. A., Ladzekpo, D. A., Yi, I., Bond, W. R., Jr.,, Ortega, G., & Kalejaiye, A. O. (2019). Epidemiology and resource utilization of ludwig's angina ED visits in the United States 2006-2014. The Laryngoscope, 129(9), 2041–2044. . doi: 10.1002/lary.27734. Epub 2019 Feb 20. PMID: 30786031.
3. Costain N, Marrie TJ. Ludwig's angina. The American journal of medicine. 2011;124(2):115-7. doi: 10.1016/j.amjmed.2010.08.004. Epub 2010 Oct 19. PMID: 20961522.
4. Boscolo-Rizzo P, Da Mosto MC. Submandibular space infection: a potentially lethal infection. J Bone Jt Infect . 2009;13(3):327-33. doi: 10.1016/j.ijid.2008.07.007. Epub 2008 Oct 25. PMID: 18952475.
5. Busch RF, Shah D. JAMA Otolaryngol Head Neck Surg. 1997;117(6):S172-S5. doi: 10.1001/jamaoto.2022.3131. PMID: 37289219.
6. Irani B, Martin-Hirsch D, Lannigan F. Infection of the neck spaces: a present day complication. . 1992;106(05):455-8. doi: 10.1017/s0022215100119826. PMID: 1613380.
7. Har-El G, Aroesty JH, Shaha A, Lucente FE. Changing trends in deep neck abscess: a retrospective study of 110 patients. J Oral Maxillofac Surg Med Pathol . 1994;77(5):446-50. doi: 10.1016/0030-4220(94)90221-6. PMID: 8028865.
8. Wang, L. F., Kuo, W. R., Tsai, S. M., & Huang, K. J. (2003). Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003; 24(2):111-7. doi: 10.1053/ajot.2003.31. PMID: 12649826.
9. Parhiscar A, Har-El G: Deep neck infection: a retrospective review of 210 cases. Ann Otol Rhinol Laryngol.2001; 110 (11):1051-1054.doi: 10.1177/000348940111001111. PMID: 11713917.
10. Tom MB, Rice DH: Presentation and management of neck abscess: A retrospective analysis. Laryngoscope.1988: (98):877-880. doi: 10.1288/00005537-198808000-00017. PMID: 3398666.
11. Ovassapian A, Tuncbilek M, Weitzel EK, Joshi CW. Airway management in adult patients with deep neck infections: a case series and review of the literature. A A Case Rep. 2005;100(2):585-9. doi: 10.1213/01.ANE.0000141526.32741.CF. PMID: 15673898.
12. Chou Y-K, Lee C-Y, Chao H-H. An upper airway obstruction emergency: Ludwig angina. Pediatr Emerg Med Pract . 2007;23(12):892-6. doi: 10.1097/pec.0b013e31815c9d4a. PMID: 18091599.
13. Ridder GJ, Technau-Ihling K, Sander A, Boedeker CC. Spectrum and management of deep neck space infections: an 8-year experience of 234 cases JAMA Otolaryngol Head Neck Surg . 2005;133(5):709-14. doi: 10.1016/j.otohns.2005.07.001. PMID: 16274797.
14. Botha A, Jacobs F, Postma C. Retrospective analysis of etiologyand comorbid diseases associated with Ludwig’s angina. Ann Maxillofac Surg. 2015;5(2):168- 73. doi:10.4103/2231-0746.175758. PMID: 26981465; PMCID: PMC4772555.
15. Rowe DP, Ollapallil J. Does surgical decompression in Ludwig’sangina decrease hospital length of stay? ANZ J Surg. 2011; 81(3):168-71.doi: 10.1111/j.1445-2197.2010.05496.x. Epub 2010 Oct 1. PMID: 21342390.
16. Britt JC, Josephson GD, Gross CW. Ludwig’s angina in the pediatric population: report of a case and review of the literature. Int J Pediatr Otorhinolaryngol Extra . 2000;52(1):79-87. doi: 10.1016/s0165-5876(99)00295-5. PMID: 10699244.
17. Honrado CP, Lam SM, Karen M. Bilateral submandibular gland infection presenting as Ludwig's angina: first report of a case. Clin Med Insights Ear Nose Throat . 2001;80(4):217-8. PMID: 11338645.
18. Srirompotong S, Art-smart T. Ludwig's angina: a clinical review. Eur Arch Otorhinolaryngol Suppl . 2003;260(7):401-3.doi: 10.1007/s00405-003-0588-9. Epub 2003 Feb 13. PMID: 12937916.
19. Greenberg SL, Huang J, Chang RS, Ananda SN. Surgical management of Ludwig’s angina. ANZ journal of surgery. 2007;77(7):540-3. doi: 10.1111/j.1445-2197.2007.04146.x. PMID: 17610689.
2. McDonnough, J. A., Ladzekpo, D. A., Yi, I., Bond, W. R., Jr.,, Ortega, G., & Kalejaiye, A. O. (2019). Epidemiology and resource utilization of ludwig's angina ED visits in the United States 2006-2014. The Laryngoscope, 129(9), 2041–2044. . doi: 10.1002/lary.27734. Epub 2019 Feb 20. PMID: 30786031.
3. Costain N, Marrie TJ. Ludwig's angina. The American journal of medicine. 2011;124(2):115-7. doi: 10.1016/j.amjmed.2010.08.004. Epub 2010 Oct 19. PMID: 20961522.
4. Boscolo-Rizzo P, Da Mosto MC. Submandibular space infection: a potentially lethal infection. J Bone Jt Infect . 2009;13(3):327-33. doi: 10.1016/j.ijid.2008.07.007. Epub 2008 Oct 25. PMID: 18952475.
5. Busch RF, Shah D. JAMA Otolaryngol Head Neck Surg. 1997;117(6):S172-S5. doi: 10.1001/jamaoto.2022.3131. PMID: 37289219.
6. Irani B, Martin-Hirsch D, Lannigan F. Infection of the neck spaces: a present day complication. . 1992;106(05):455-8. doi: 10.1017/s0022215100119826. PMID: 1613380.
7. Har-El G, Aroesty JH, Shaha A, Lucente FE. Changing trends in deep neck abscess: a retrospective study of 110 patients. J Oral Maxillofac Surg Med Pathol . 1994;77(5):446-50. doi: 10.1016/0030-4220(94)90221-6. PMID: 8028865.
8. Wang, L. F., Kuo, W. R., Tsai, S. M., & Huang, K. J. (2003). Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. 2003; 24(2):111-7. doi: 10.1053/ajot.2003.31. PMID: 12649826.
9. Parhiscar A, Har-El G: Deep neck infection: a retrospective review of 210 cases. Ann Otol Rhinol Laryngol.2001; 110 (11):1051-1054.doi: 10.1177/000348940111001111. PMID: 11713917.
10. Tom MB, Rice DH: Presentation and management of neck abscess: A retrospective analysis. Laryngoscope.1988: (98):877-880. doi: 10.1288/00005537-198808000-00017. PMID: 3398666.
11. Ovassapian A, Tuncbilek M, Weitzel EK, Joshi CW. Airway management in adult patients with deep neck infections: a case series and review of the literature. A A Case Rep. 2005;100(2):585-9. doi: 10.1213/01.ANE.0000141526.32741.CF. PMID: 15673898.
12. Chou Y-K, Lee C-Y, Chao H-H. An upper airway obstruction emergency: Ludwig angina. Pediatr Emerg Med Pract . 2007;23(12):892-6. doi: 10.1097/pec.0b013e31815c9d4a. PMID: 18091599.
13. Ridder GJ, Technau-Ihling K, Sander A, Boedeker CC. Spectrum and management of deep neck space infections: an 8-year experience of 234 cases JAMA Otolaryngol Head Neck Surg . 2005;133(5):709-14. doi: 10.1016/j.otohns.2005.07.001. PMID: 16274797.
14. Botha A, Jacobs F, Postma C. Retrospective analysis of etiologyand comorbid diseases associated with Ludwig’s angina. Ann Maxillofac Surg. 2015;5(2):168- 73. doi:10.4103/2231-0746.175758. PMID: 26981465; PMCID: PMC4772555.
15. Rowe DP, Ollapallil J. Does surgical decompression in Ludwig’sangina decrease hospital length of stay? ANZ J Surg. 2011; 81(3):168-71.doi: 10.1111/j.1445-2197.2010.05496.x. Epub 2010 Oct 1. PMID: 21342390.
16. Britt JC, Josephson GD, Gross CW. Ludwig’s angina in the pediatric population: report of a case and review of the literature. Int J Pediatr Otorhinolaryngol Extra . 2000;52(1):79-87. doi: 10.1016/s0165-5876(99)00295-5. PMID: 10699244.
17. Honrado CP, Lam SM, Karen M. Bilateral submandibular gland infection presenting as Ludwig's angina: first report of a case. Clin Med Insights Ear Nose Throat . 2001;80(4):217-8. PMID: 11338645.
18. Srirompotong S, Art-smart T. Ludwig's angina: a clinical review. Eur Arch Otorhinolaryngol Suppl . 2003;260(7):401-3.doi: 10.1007/s00405-003-0588-9. Epub 2003 Feb 13. PMID: 12937916.
19. Greenberg SL, Huang J, Chang RS, Ananda SN. Surgical management of Ludwig’s angina. ANZ journal of surgery. 2007;77(7):540-3. doi: 10.1111/j.1445-2197.2007.04146.x. PMID: 17610689.
| Files | ||
| Issue | Vol 10, No 4 (Autumn 2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jcr.v10i4.15310 | |
| Keywords | ||
| Ludwig’s angina Deep head and neck infections Mortality Odontogenic infection | ||
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How to Cite
1.
Dehghani N, Abbasi H, Azarsina M, Omidpanah N, Bagheri E. Therapeutic And Clinical Traits Of Ludwig’s Angina: A 10-year Retrospective Study Of 24 Patients. J Craniomaxillofac Res. 2024;10(4):178-184.
