Ludwig's angina: an analysis of 14 cases

Ludwig's angina remains a potentially lethal disease entity as it causes rapidly progressive airway obstruction, although the current mortality rate is low. Early surgical intervention should be carried out in severe cases which show signs of fluctuation, abscess formation or other serious complications. We report our experience with 14 cases of Ludwig's angina, 12 of which (86%) were of dental origin. Only one case was complicated with Klebsiella pneumoniae septicemia which resolved upon treatment. There were no deaths. Surgical procedures including incision and drainage and tooth extraction were performed in 11 cases (78%). Antibiotics were administered to all patients. Most of them were treated with crystalline penicillin with or without an aminoglycoside. Only one patient received a tracheostomy in this series. The number of tracheostomies or intubations carried out was much lower than in previous reports. We suggest that an aggressive antimicrobial therapy, early surgical intervention and careful monitoring of the respiratory symptoms would reduce both the need for tracheostomy and the mortality rate.