Lack of Dental Care and Ludwig Angina: Could It Have Been Prevented

Clinical Image

Volume 4, Issue 8 (August Issue)

Lack of Dental Care and Ludwig Angina: Could It Have Been Prevented

Katherine Tobin¹, Laila Tul Qadar², Hannah Owens¹ and Ahmed H Abdelfattah^3*

¹PA students, Internal Medicine/Hospital Medicine, University of Kentucky College of Medicine, Lexington, USA

²Internal Medicine, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, Pakistan

³Assistant Professor of Internal Medicine, Internal Medicine/Hospital Medicine, University of Kentucky College of Medicine, Lexington, USA

^*Corresponding author: Ahmed H Abdelfattah, Assistant Professor of Internal Medicine, Internal Medicine/Hospital Medicine, University of Kentucky College of Medicine, Lexington, USA. E-mail: AhmedAbdelfattah@uky.edu

Received: July 19, 2022; Accepted: August 01, 2022; Published: August 12, 2022

Citation: Tobin K, Qadar LT, Owens H, Abdelfattah AH. Lack of Dental Care and Ludwig’Angina: Could It Have Been Prevented? Clin Image Case Rep J. 2022; 4(8): 253.

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Abstract

A 57-year-old man presented with a one-week history of right-sided dental pain, swelling, and trouble swallowing that has gradually worsened. He reported having limited access to dental care and, as a result, has poor dental health. He was evaluated for small right-sided facial swelling four days ago and was prescribed methylprednisolone and clindamycin upon the initial visit.

The swelling worsened despite taking the medication as prescribed. A review of systems was positive for odynophagia and negative for shortness of breath and sore throat. Physical examination was significant for right-sided submandibular swelling (Figure 1) with purulent drainage from superficial skin, trismus, tenderness, swelling, and pain on movement and palpation of the jaw. A complete blood count (CBC) with differential, complete metabolic panel, and blood cultures were done. The CBC revealed leukocytosis with an increased number of absolute neutrophils. Blood cultures were negative. A computed tomography (CT) scan revealed a 4.2 x 3.3 x 4.3 cm abscess around the posterior right mandibular molar (#32) with soft tissue swelling (Figure 2).

After Oral and Maxillofacial Surgery consultation, he was diagnosed with Ludwig’s angina and a right submandibular abscess. IV clindamycin and levofloxacin were started for broad coverage, given he has a penicillin allergy. He underwent a surgical incision, drainage of the abscess (Figure 3), and removal of all maxillary teeth. A Penrose drain was placed during surgery. Streptococcus constellatus was the organism identified from the abscess's tissue and gram stain analysis. Fungal cultures were negative. The antibiotics were changed to oral levofloxacin and metronidazole for five days post-surgical drainage.

Ludwig’s angina is a rare, life-threatening entity with poor oral hygiene contributing to its development. Ludwig’s angina, if it has concurrent soft tissue involvement, requires prompt diagnosis and treatment, including initiation of broad-spectrum antibiotics, securing airway, and surgical consult.