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Case 16 - Summary: Ludwig's Angina

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Here we have an example of a low-density collection in the

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submental space that was associated with a dental

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inflammatory process involving

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the mandibular teeth.

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When you have extension of an odontogenic abscess

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into the submandibular or sublingual space,

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we refer to that as Ludwig's angina, and this

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is usually manifested by fever, swelling,

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pain and difficulty swallowing.

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Dental infections are also a source of potential

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involvement with necrotizing fasciitis.

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This is an example of a patient who has necrosis of

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the soft tissues, anterior to the hyoid bone and extending

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over into the lateral side of the left neck,

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you see the enlarged sternuchita mastoid muscle,

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but there's associated air within this

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soft tissue of necrotizing fasciitis.

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So this is necrotizing fasciitis associated

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with dental infection.

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Necrotizing fasciitis is a disease process that has

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about a 50% mortality and that's because they're

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spread often into the mediastinum, and from there

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one can have disastrous complications

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from pulmonary problems.

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A couple of other examples. Patient with dental

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extraction and developed the low-density

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area here in the mandible.

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You notice that there is some periosteal reaction

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along the lingual surface of the mandible

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representing osteomyelitis.

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And if we look at the soft tissue windows,

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you see that the masseter muscle here compared to the

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normal masseter muscle is markedly enlarged with

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an area of low-density representing purulent

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material within the masseter muscle. And then continuing

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into the submandibular space, you have a large abscess

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that is multiloculated associated with cellulitis.

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So from this simple dental extraction

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superimposed infection,

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one can have quite disastrous complications

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including osteomyelitis of the mandible,

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masticator space abscess,

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some mandibular space abscess associated

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with cellulitis and Ludwig's angina.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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