0:01

This was an individual who had dental issues and

0:05

inflammation and was being evaluated for

0:08

the possibility of Ludwig's Angina.

0:10

Ludwig's Angina refers to an odontogenic process

0:14

that involves the floor of the mouth and then leads

0:18

to cellulitis in the submandibular

0:21

and submental space.

0:22

From that space, it can spread to the carotid sheath.

0:27

So let me have side-by-side appearance

0:31

to the bone and the soft tissues,

0:34

so that way we can look at the teeth as well as

0:37

the soft tissues of the floor of the mouth.

0:40

So, as you can see here,

0:41

there is inflammation that is around

0:44

the submandibular gland,

0:46

which is extending superficially

0:48

out over the platysma muscle.

0:51

Here's the normal thickness of the platysma

0:54

muscle and the clean fat.

0:55

Here on the contralateral side, you see a thickened

0:58

platysma muscle with injected edema

1:01

of the subcutaneous fat.

1:04

And this is all around both sides

1:06

of the lower mandible.

1:08

This inflammation of the floor of the mouth leads

1:12

to enlargement of the mylohyoid muscle.

1:15

And in addition, as you can see,

1:17

the carotid sheath structures,

1:20

which is back here also show that same sort of

1:24

hazy grayness around the carotid artery,

1:28

which is the spread from the submandibular space

1:32

across the prestyloid parapharyngeal space

1:35

to the poststyloid parapharyngeal space.

1:38

Once again, compare and contrast the normal internal

1:41

carotid artery and jugular vein versus that which

1:44

is inflamed secondary to Ludwig's Angina.

1:49

So we look then at the CT scan

1:52

and we see a bad tooth.

1:54

So this is the lucency around the

1:57

right mandibular molar tooth,

1:59

which is inflammation in the periodontal

2:03

endodontal cavity.

2:04

And that has led to the adjacent inflammation

2:08

that you see along the mandible.

2:10

So once again, Ludwig's Angina,

2:12

usually an odontogenic source that leads to the

2:16

inflammation in the floor of the mouth.

2:19

And from that, one can have spread to the

2:21

submandibular and submental space.

2:23

Here you see this low density submental space

2:26

inflammation and secondarily may

2:29

involve the carotid sheath.