Angina Ludwiga, also known as floor phlegmon, is an inflammatory disease that is potentially severe. It usually occurs in young people, and if left untreated, it can lead to serious complications, so it is important to recognize it quickly and implement appropriate treatment.

Angina Ludwiga( phlegmon of the floor of the mouth ) is known primarily as a complication of other conditions that affect the area around the mouth. Very often, even in about 80% of cases, it occurs as a result of an ongoing carious process, after tooth extraction (extraction) or periodontitis. People with injuries of the oral mucosa, tongue, and those suffering from inflammation of the salivary glands or tonsils are also at risk. Another important factor is the lack of hygiene and neglect of the daily care of the teeth and mouth.

There are reports of patients in whom Ludwig's angina developed after tongue piercing.

The etiology has not been clearly described so far. Both aerobic and anaerobic bacteria are responsible for developing Ludwig's angina. Bacteria, which in physiological conditions are present in the oral cavity and do not pose a threat to humans, are also dangerous, but in the case of reduced immunity, they can cause disease in previously damaged tissues of the oral cavity. Also, fungal infections are not excluded.

Angina Ludwiga: symptoms

The course of phlegmon of the floor of the mouth is usually very dynamic, and the infection is rarely only a limited inflammatory process. The infection gradually spreads into the submandibular and sublingual space. Initially, the patient complains of fever, chills, general weakness and headaches.

The submandibular area is red, painful, and becomes more and more swollen with time, which causes the tongue to be pushed up and lifted. The tissues of the floor of the mouth are tense, drooling occurs and there is increasing difficulty in speaking because phlegmon restricts the mobility of the tongue.

Angina Ludwiga is descending, which means that from the area of ​​the oral cavity it spreads to lower and lower organs. Phlegmon is not delimited by any fibrous tissue, so it can easily spread along the tissues, causing their destruction.

What is itthe natural course of Ludwig's angina?

If the disease is not diagnosed at an early stage, the inflammatory process will begin to spread around the throat and esophagus, which will result in difficult and painful swallowing (the so-called dysphagia and odynophagia). Phlegmon of the floor of the mouth in the later stages is a disease that can significantly threaten the patient's life. If phlegmon foci begin to spread along the deep tissues of the neck, they may spread to the wall of the internal carotid artery and contribute to the formation of the so-called infected aneurysms that may rupture at some point and pose a direct threat to life. The infection may gradually spread to other craniofacial organs as well as to the mediastinum.

With what should Ludwig's angina be differentiated?

Swelling of the soft tissues around the oral cavity is not characteristic of Ludwig's angina. A similar clinical picture may be presented, for example, by actinomycosis, which in its initial stage closely resembles the developing phlegmon of the floor of the mouth. The infection with mycobacterium tuberculosis and a tumor in this area should also be taken into account, however, in these diseases, the dynamics of symptoms is in the vast majority of cases less intense.

Angina Ludwiga: treatment methods

Therapeutic options in the case of Ludwig's angina are largely dependent on the stage of the disease the patient sees a doctor in, but the diagnosis of oral fundus phlegmon itself is an absolute indication for hospitalization due to the possibility of developing dangerous complications.

Due to the bacterial etiology, treatment should primarily include intravenous antibiotics (mainly penicillins and metronidazole). Any pus point should always be evacuated from the body, so in the case of Ludwig's angina, incision and tissue drainage are usually necessary. The procedure can be performed on the floor of the mouth or outside in the submandibular area, depending on where the inflammatory process is taking place. The patient very often requires intubation because independent breathing is difficult due to the pressure of the swollen tissues on the airways. Treatment also includes parenteral nutrition and proper hydration of the patient.

What to do to protect yourself from Ludwig's angina?

Phlegmon of the floor of the mouth can be very dangerous in its course, so if you experience early symptoms, contact your doctor immediately. Decayed teeth must always be treated, and the wound healing process should be monitored after dental procedures. In the case of bleeding, lowered gums or teeth hypersensitivity to hot or cold foods, alwaysconsult a specialist, as these may be symptoms of periodontal disease, which are equally at risk of developing phlegmon of the floor of the mouth.

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ENT