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TREATMENT PLANNINGSEMINARSMohamad Adnan Hassoun 2008100
Jamal Eddin Mohammed 2008104
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49 year old lady presented with agswelling under both lower jaw
and tongswelling duration is 72hours and was and associated with
pain, fever and difficswallowing. Her PMH review
reveaantiphospholipid syndrome controllwarfarin. Her INR was
7.6
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Differential Diagnosis:- Ludwigs Angina. Cellulitis. Cyst.
Tumor. Sialadenitis of submandibular gland. Mandibular
Fracture.
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Cellulitis:-is a localized or diffuse inflammation of cotissue
with severe inflammation of dermsubcutaneous layers of the
skin.Sialadenitis of Submandibular Gland:-is inflammation of a
salivary gland. Its clinicalare painfull swelling, Reddened skin,
Edemacheek, Periorbital region and neck, low grade fmalaise.
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Mandibular Fractures:-They usually occur due to trauma,
leadpain, numbness, trismus (difficulty openmouth), with extraoral
swelling.
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Ludwigs Angina:-is a serious, potentiallylife-threatening
cellulitisor connective tissueinfection, of the floor ofthe mouth,
usuallyoccurring in adults withconcomitant dentalinfections and if
leftuntreated, may obstruct
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The life threatening natureof this condition
generallynecessitates surgicalmanagement. Dentalinfections account
forapproximately eightypercent of cases ofLudwig's angina.
Mixedinfections, due to bothaerobes and anaerobes,can cause the
cellulitisassociated with Ludwig'sangina.
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True Ludwig's Anginais a cellulitic facialinfection. The
signsare bilateral (meaningboth sides) lowerfacial swelling
aroundthe lower jaw andupper neck.
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This is because the infection has sprinvolve the Submandibular,
SublinguSubmental spaces of the face . Localof infection to the
sublingual spaccompanied by swelling of structuresfloor of the
mouth as well as the being pushed upwards and backwards.
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TREATMAENT:-Treatment involves appropriate antibiotic
memonitoring and protection of the airway in severe casedental
consultation to incise and drain the collectantibiotic of choice is
from the penicillin group. Incdrainage of the abscess may be either
intraoral or extintraoral incision and drainage procedure is
indicatinfection is localized to the sublingual space. Externaand
drainage is performed if infection invoperimandibular spaces.
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A nasotracheal tube is sometimes warranted for ventilatitissues
of the mouth make insertion of an oral airway difimpossible.
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Her PMH review revealed an antiphospholipid syncontrolled by
warfarin. Her INR was 7.6
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