0:01

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

0:05

submental space that was associated with a dental

0:09

inflammatory process involving

0:12

the mandibular teeth.

0:14

When you have extension of an odontogenic abscess

0:17

into the submandibular or sublingual space,

0:21

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

0:24

is usually manifested by fever, swelling,

0:28

pain and difficulty swallowing.

0:31

Dental infections are also a source of potential

0:35

involvement with necrotizing fasciitis.

0:38

This is an example of a patient who has necrosis of

0:42

the soft tissues, anterior to the hyoid bone and extending

0:47

over into the lateral side of the left neck,

0:50

you see the enlarged sternuchita mastoid muscle,

0:53

but there's associated air within this

0:56

soft tissue of necrotizing fasciitis.

0:59

So this is necrotizing fasciitis associated

1:03

with dental infection.

1:06

Necrotizing fasciitis is a disease process that has

1:09

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

1:13

spread often into the mediastinum, and from there

1:16

one can have disastrous complications

1:19

from pulmonary problems.

1:22

A couple of other examples. Patient with dental

1:25

extraction and developed the low-density

1:28

area here in the mandible.

1:30

You notice that there is some periosteal reaction

1:34

along the lingual surface of the mandible

1:38

representing osteomyelitis.

1:41

And if we look at the soft tissue windows,

1:43

you see that the masseter muscle here compared to the

1:46

normal masseter muscle is markedly enlarged with

1:50

an area of low-density representing purulent

1:53

material within the masseter muscle. And then continuing

1:57

into the submandibular space, you have a large abscess

2:01

that is multiloculated associated with cellulitis.

2:05

So from this simple dental extraction

2:09

superimposed infection,

2:10

one can have quite disastrous complications

2:13

including osteomyelitis of the mandible,

2:17

masticator space abscess,

2:19

some mandibular space abscess associated

2:22

with cellulitis and Ludwig's angina.

Case 16 - Summary: Ludwig's Angina

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