Ludwig’s angina: analysis of clinical features and their management strategy: a study of 30 patients

Background: Ludwig’s Angina is rapidly progressing infection of submandibular space that can cause severe airway compromise and death. The present study was done to evaluate the clinical features and management strategies in Ludwig’s angina. Methods: Thirty patients presenting with clinical diagnosis of Ludwig’s Angina were recruited in the study. All patients were given systemic antibiotics. Tooth extraction and surgical drainage was done wherever required. Patient records were reviewed for age, sex, duration of symptoms, clinical presentation, etiology, culture/sensitivity reports, requirement of surgical drainage or tracheostomy, hospital stay and complications. Results: The most common age group was third decade of life. Caries tooth was most common etiology followed by gingivitis. Difficulty in swallowing and pain in neck were the most common symptoms. Diabetes was the most common associated co-morbidity followed by chronic renal failure. Surgical treatment was required in twenty-one cases. Eight cases were treated medically while one patient expired during medical treatment. Necrotizing fasciitis was the most common complication. For most patients the hospital stay was between 1-2 weeks. Conclusion: We advocate that surgical management should be done at earliest in presence of respiratory difficulty as medical treatment alone can prove to be dangerous. It can be managed conservatively in younger patients without any associated co-morbidity or respiratory difficulty. However no single factor can predict the behaviour of this disease and it is advisable to be ready for immediate airway management.