Ludwig’s Angina

Ludwig’s Angina

Q. 1

Ludwig’s angina is:

 A

Membrane over tonsil

 B

Infection of submandibular space

 C

Peritonsillar abscess

 D

Chest pain

Q. 1

Ludwig’s angina is:

 A

Membrane over tonsil

 B

Infection of submandibular space

 C

Peritonsillar abscess

 D

Chest pain

Ans. B

Explanation:

Q. 2

All of the following statements regarding Ludwigs angia are true except

 A

Cellulitis of floor of mouth

 B

Infection can spread to retropharyngeal space

 C

It is usually caused by both aerobic and anaerobic organisms

 D

Can cause aphthous ulcer in the pharynx

Q. 2

All of the following statements regarding Ludwigs angia are true except

 A

Cellulitis of floor of mouth

 B

Infection can spread to retropharyngeal space

 C

It is usually caused by both aerobic and anaerobic organisms

 D

Can cause aphthous ulcer in the pharynx

Ans. D

Explanation:

Apthous ulcers are idiopathic in origin, it is not related to ludwig’s angina.

Ludwigs angina is a rapidly progressing cellulitis of submandibular space often resulting from an underlying dental infection.

Infection is caused by both aerobic and anaerobic organisms, and can spread to involve the entire submandibular space.


Q. 3

Which of the following statements best represent Ludwig’s angina?

 A

A type of coronary artery spasm

 B

An infection of the cellular tissues around submandibular salivary gland

 C

Oesophageal spasm

 D

Retropharyngeal infection

Q. 3

Which of the following statements best represent Ludwig’s angina?

 A

A type of coronary artery spasm

 B

An infection of the cellular tissues around submandibular salivary gland

 C

Oesophageal spasm

 D

Retropharyngeal infection

Ans. B

Explanation:

Answer is ‘b’ ie an infection of the cellular tissues around submandibular salivary gland

  • Ludwig’s angina is a rapidly progressive cellulitis of the submandibular space that can cause airway obstruction and death.
  • The submandibular space lies between.

– Mucous membrane of the floor of mouth and tongue on one side and.

– Superficial layer of deep cervical fascia extending between the hyoid bone and mandible on the other.

  • The submandibular space is divided into 2 compartments by the mylohyoid muscle.

a. Sublingual compartment (above the mylohyoid).

b. Submaxillary and submental (below the mylohyoid)

The two compartments are continuous around the posterior border of mylohyoid muscle.

  • Aetiology – Dental infections are the most common cause.
  • The infection is most often caused by a virulent streptococcus (Group A streptococcus are most common) along with anaerobes.
  • Clinical Features

– Odynophagia (painful swallowing).

– Trismus (difficulty in opening mouth).

When infection is localized to sublingual space, structures in the floor of month are swollen and tongue seems to be pushed up and back.

– When infection spreads to submaxillary space, the submental and submandibular regions become swollen and tender with woody hard feeling.

  • Complications

– Airway obstruction due to laryngeal oedema, or swelling and push back of the tongue.

Spread of infection to parapharyngeal, retropharyngeal spaces and thence to the mediastinurri. Aspiration pneumonia.

Septicemia.

  • Treatment

– Consists of giving high doses of broad-spectrum antibiotics, combined with metronidazole to combat the anaerobes immediately until the results of cultures and sensitivity tests are available.

In advanced cases when the swelling does not subside rapidly with antibiotics, incision and drainage is advised.


Q. 4

True about Ludwig’s angina:

 A

Involves both submandibular and sublingual spaces

 B

Most common cause is dental infection

 C

Bilateral

 D

a and b

Q. 4

True about Ludwig’s angina:

 A

Involves both submandibular and sublingual spaces

 B

Most common cause is dental infection

 C

Bilateral

 D

a and b

Ans. D

Explanation:

Q. 5

Ludwig’s angina is characterized by all the following except:

 A

Cellulitis of the floor of the mouth

 B

Caused by anaerobic organisms

 C

Aphthous ulcers in the pharynx

 D

Infection spreads to retropharyngeal space

Q. 5

Ludwig’s angina is characterized by all the following except:

 A

Cellulitis of the floor of the mouth

 B

Caused by anaerobic organisms

 C

Aphthous ulcers in the pharynx

 D

Infection spreads to retropharyngeal space

Ans. C

Explanation:

 

  • Ludwig’s Angina is a rapidly spreading cellulitis of the floor of the mouth which involves submandibular space secondary to dental infection.
  • Submandibular space is divided into sublingual space (above the mylohyoid) and submaxillary space (below the mylohyoid muscle) 

Bacteriology: Mixed infections involving both aerobes and anaerobes are common like, alpha haemolytic streptococci, staphylococci bacteriodes and E. coll. H. influenzae is a rare cause.

 

Clinical features: In Ludwig’s angina, there is usually cellulitis of the tissue rather than frank abscess.

  • Marked difficulty in swallowing (odynophagia).
  • Varying degrees of trisumus.
  • On involvement of sublingual space, floor of the mouth is swollen, edematous and tongue seems to be pushed up and back.
  • On involvement of the submaxillary space, the submental and submandibular regions become swollen and tender and impart woody-hard feel.Tongue is progressively pushed upward and backward threatening the airway.
  • Laryngeal edema may appear, if it spreads to parapharyngeal or retropharyngeal space.

Treatment: Systemic antibiotics

  • I and D should be postponed as long as possible because pus is seldom found.
  • Tracheostomy is required if airway is endangered.
  • If incision and drainage for Ludwig’s angina is done under GA-there are increased chances of aspiration and shock as tongue is pushed up and back in Ludwig angina.

Q. 6

Infection of submandibular space is seen in:

 A

Ludwig’s angina

 B

Vincent angina

 C

Prinzmetal angina

 D

Unstable angina

Q. 6

Infection of submandibular space is seen in:

 A

Ludwig’s angina

 B

Vincent angina

 C

Prinzmetal angina

 D

Unstable angina

Ans. A

Explanation:

Q. 7

Ludwigs angina usually begins in ‑

 A

Submandibular space

 B

Sublingual space

 C

Parotid space

 D

Retropharyngeal space

Q. 7

Ludwigs angina usually begins in ‑

 A

Submandibular space

 B

Sublingual space

 C

Parotid space

 D

Retropharyngeal space

Ans. A

Explanation:

Ans. is ‘a’ i.e., Submandibular space

Ludwig’s angina is a rapidly spreading bilateral cellulitis that involves the floor of mouth, under the tongue.

Floor of mouth is comprised of sublingual space, submandibular space and submental space.

Ludwig’s angina usually begins in the submandibular space, and then rapidly spreads to involve the subligual space, usually on a bilateral basis.

Most common cause is infection of the root of the teeth (Dental infection), especially 2nd and 3nd mandibular molar.

Other causes are mouth injury, mandibular fracture, and submandibular sialadenitis.



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