STUDY NOTES ⚕️

It refers to the cellulitis of the submandibular and submental regions combined with inflammatory oedema.

Causes:

🔍 Streptococcal organisms are responsible for the infection around the submandibular region.

🔍 Anaerobes also play a major role.

Clinical Features:

👩‍⚕️ Elderly patients who present with a diffuse swelling in the submandibular and submental regions (brawny oedema).

👨‍⚕️ Oedema of the floor of the mouth is seen which causes elevation of the tongue that in turn results in difficulty in swallowing.

👩‍⚕️ High grade fever with toxicity.

👨‍⚕️ Putrid halitosis is also characteristic of Ludwig’s angina.

Treatment:

💊 Rest and hospitalization

💊 Appropriate antibiotics should be given.

💊 Intravenous fluids to correct dehydration and Ryle’s tube feeding.

💊 If conservative management is not responsive in the patient, then surgery is preferred.

Surgery:

✂️ Under General Anaesthesia, a 5-6 cm curved incision is made below the mandible in the submandibular region and over the most prominent part of the swelling.

✂️ The submandibular gland is mobilised, mylohyoid muscle is divided, and the pus is drained.

✂️ Even if there’s no pus, the oedematous fluid comes out which in itself will improve the patient condition greatly.

✂️ The wound is closed by loose sutures, after cleansing the cavity with antiseptics and a drainage tube is inserted.

Complications:

⚠️ Mediastinitis and Septicaemia.

⚠️ Oedema of the glottis which is caused due to the spread of the cellulitis via a tunnel connecting stylohyoid muscle and submucosa of the glottis.

SOURCE: Manipal Manual of Surgery (3rd edition)

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~Sunantha✍️