Ludwig's Angina: a Retrospective Study of Seven Cases

Objective: To evaluate the clinical outcome and morbidity of patients diagnosed with Ludwig's angina treated at the National University of Malaysia Hospital.Patients and Methods: This retrospective study reviewed the cases of 7 patients (6 males and 1 female) between the ages of 19 and 69 years (mean, 38.7 years) who were treated between July 2001 and April 2005. Demographics, aetiology, microbiology, associated systemic diseases, treatment, airway management, duration of hospital stay and outcome were reviewed.Results: Dental infection was documented as the most common cause (71%) of Ludwig's angina, followed by infection of the submandibular gland (29%). Systemic illnesses included type I and II diabetes mellitus, hepatitis B and C hypertension and chronic renal failure. Intravenous antibiotics were started immediately in all patients. Only 1 patient underwent emergency tracheostomy. All but 1 patient underwent incision and drainage under general anaesthesia using fibreoptic intubation technique. Infected teeth were also removed at the same time. Postoperatively, the airway was secured by either endotracheal intubation (71.4%) or tracheostomy (14.3%); in 14.3% of the cases, no artificial airway was used. Five patients were managed in the intensive care unit for 1 to 3 days. All except 1 patient made uneventful recoveries, and they were discharged after 4 to 26 days of hospitalisation (mean, 11.6 days).Conclusions: Airway protection, aggressive antibiotic therapy and surgical decompression can significantly alter the mortality rates associated with odontogenic infection in Ludwig's angina.