Relato de caso clínico de infecção odontogênica resultando em complicação cervicofacial / Reporte de caso clínico de infección odontogênica com resultado de complicación cervicofacial / Clinical case reportof odontogenic infectionresulting cervicofacial complication

Introdução: A saúde bucal é um aspecto que não deve ser subestimado pelos pacientes, principalmente se considerar que as infecções odontogênicas podem levar a quadros graves, incluindo complicações cervicotorácicas, como Mediastinite e cervicofaciais, como Angina de Ludwig. Para tanto, é imprescindível que os profissionais da odontologia saibam reconhecer os principais sinais e sintomas dessas infecções, sua evolução, conhecer as complicações associadas e qual o manejo adequado. Objetivo: Assim, é objetivo deste trabalho, relatar, discutir um caso clínico de uma infecção odontogênica grave que acarretou em complicação cervical, com trajeto em direção ao mediastino, necessitando manejo multidisciplinar, e explorar os principais aspectos desse quadro e a conduta necessária, que exige, no mínimo, intervenção cirúrgica, antibioticoterapia e manutenção das vias aéreas. Relato de caso: O caso trata de um paciente com infecção odontogênica, iniciada como uma pericoronarite do dente 38 semieruptado, que evoluiu para a área cervical, demandando imediata drenagem nesta região pois encaminhava-se para uma mediastinite. Após a drenagem cervical e antibioticoterapia e, assim que houve redução do trismo, foi removido o dente 38, evoluindo para a cura.Conclusões:As infecções odontogênicas, principalmente as que acometem os espaços fasciais e cervicais profundos, são potencialmente graves e devem ter suas principais manifestações clínicas entre os domínios de conhecimento dos profissionais Bucomaxilofaciais, pois necessitam de diagnóstico preciso, manejo rápido e tratamento adequado e precoce, considerando a velocidade com que podem evoluir (AU).

Introduction: Oral healthis an aspect that should not be underestimated by patients, especially considering that dental infections can lead to serious symptoms, including cervicothoracic complications, such as Mediastinitis and cervicofacial complications, such as Ludwig's Angina. Therefore, it is essential that dental professionals know how to recognize the main signs and symptoms of these infections, their evolution, know the associated complications and appropriate management.Objective: Thus, this work aims to report and discuss a clinical case of a serious odontogenic infection that resulted in a cervical complication, with a path towards the mediastinum, requiring multidisciplinary management, and to explore the main aspects of this condition and the necessary conduct, which requires, at least, surgical intervention, antibiotic therapy and airway maintenance.Case report: The case concerns a patient with odontogenic infection, which began as pericoronitis of semi-erupted tooth 38, which progressed to the cervical area, requiring immediate drainage in this region as it was heading towards mediastinitis. After cervical drainage and antibiotic therapy and, as soon as the trismus was reduced, tooth 38 was removed, progressing towards healing.Conclusions: Odontogenic infections, especially those that affect the fascial and deep cervical spaces, are potentially serious and should have their main clinical manifestations among the domains of knowledge ofOral and Maxillofacial professionals, as they require accurate diagnosis, rapid management and adequate and early treatment, considering the speed at which they can evolve (AU).

Introducción: La salud bucal es un aspecto que los pacientes no deben subestimar, especialmente considerando que las infecciones odontógenas pueden derivar en afecciones graves, incluidas complicaciones cervicotorácicas, como la mediastinitis, y complicaciones cervicofaciales, como la angina de Ludwig.Para ello, es fundamental que los profesionales odontológicos sepan reconocer las principales señalesy síntomas de estas infecciones, su evolución, conocer las complicaciones asociadas y el manejo adecuado.Objetivo: Así,el objetivo de este trabajo es reportar y discutir un caso clínico de infección odontogénica grave que resultó en una complicación cervical, con trayecto hacia el mediastino, que requirió manejo multidisciplinario, y explorar los principales aspectos de esta condicióny las medidas necesarias, que requiere, como mínimo, intervención quirúrgica, terapia con antibióticos y mantenimiento de las vías respiratorias.Reporte de caso: El caso se trata de un paciente con una infección odontogénica, que comenzó como pericoronaritis del diente 38 semi-erupcionado, la cual progresó hacia la zona cervical, requiriendo drenaje inmediato en esta región ya que se encaminaba para una mediastinitis.Después del drenaje cervical y la terapia antibiótica y, una vez reducido el trismo, se extrajo el diente 38, evolucijjonando hacia la cura.Conclusiones: Las infecciones odontogénicas, especialmente aquellas que afectan los espacios fasciales y cervicales profundos, son potencialmente graves y deben tener sus principales manifestaciones clínicas entre los dominios del conocimiento de los profesionales Orales y Maxilofaciales, pues requieren de un diagnóstico certero, un manejo rápido y un tratamiento adecuado y temprano, considerando la velocidad a la que pueden evolucionar (AU).

Ludwig's angina by Salmonella Typhi: a clinical dilemma.

Salmonella Typhi has rarely been associated with focal abscesses; and in literature, there is no evidence of its association with abscesses in the neck spaces. Ability of Salmonella Typhi to invade and localise in the neck spaces not only poses a diagnostic challenge but also underscores the necessity to understand the mechanisms that facilitate Salmonella Typhi to establish infections at sites completely non-traditional to the organism.

Post-mortem CT findings in a case of necrotizing cellulitis of the floor of the mouth (Ludwig angina).

Ludwig angina is a rare but potentially lethal infection of the submandibular space that can cause significant upper airway obstruction. We report a case of undiagnosed Ludwig angina that progressed rapidly to death. Ludwig angina was suspected after post-mortem computed tomography (PMCT) found swollen mylohyoid muscle with stranding in subcutaneous fat, thickening of deep fascia, and local lymphadenopathy. Subsequently, an autopsy revealed woody induration of the submental region and liquefactive necrosis of the mylohyoid muscle, confirming the diagnosis. It is likely that the dental abscess identified on PMCT was the source of infection. Multiple invasive medical procedures were performed on the subject by the ambulance crew prior to his death. PMCT assisted further in determining procedural success.

Airway management in submandibular abscess patient with awake fibreoptic intubation--a case report.

Securing the airway is a core skill in anaesthesia, the gold standard of which is tracheal intubation. Normally this is achieved after induction of anaesthesia. However, some circumstances demand an awake approach. Skilful airway management is critical in deep neck space infections. There is currently no universal agreement on the ideal method of airway control for these patients because this depends on various factors including available local expertise and equipment. Compromised airway is still a challenge to the anesthesiologist in spite of all modalities available. Any flaw in airway management may lead to grave morbidity and mortality. We present a morbidly obese case of submandibular abscess with difficult intubation underwent incision and drainage. Large facial [jaw] swelling, TRISMUS-limited mouth opening, edema, protruding teeth and altered airway anatomy makes airway management more difficult. The case was further complicated by morbid obesity. Chances of rupture of abscess intraorally and aspiration under GA is a major threat. During GA, there is no change in mouth opening and loss of airway under muscle relaxation, "difficult to ventilate, difficult to intubate" makes these cases most challenging. On the basis of our experience case was successfully intubated by awake fibreoptic intubation.

Spread of odontogenic infections in Port Harcourt, Nigeria.

PURPOSE: Odontogenic infections constitute a substantial portion of diseases encountered by oral and maxillofacial surgeons. Infections start from dental tissues and sometimes rapidly spread to contiguous spaces. The consequence is a fulminant disease with significant morbidity and mortality. The study was aimed at studying the pattern of spread, approach to management, and outcome of these infections at a Nigerian teaching hospital. PATIENTS AND METHODS: A retrospective study of all patients with orofacial infections who presented to our center over an 18-month period was carried out. The medical records were reviewed to retrieve the following: age, gender, source of infection, anatomic fascial spaces involved, associated medical conditions, various treatment modalities, types of antibiotics administered, causative micro-organisms, length of stay in the hospital, and any complications encountered. Infections were classified into 2 categories: those that are confined to the dentoalveolar tissues belong to category I, and those that have spread into the local/regional soft tissue spaces and beyond belong to category II. RESULTS: Odontogenic infections constituted 11.3% of the total oral and maxillofacial surgery cases. A total of 261 patients were treated for odontogenic infections. There were 146 female patients (59.8%) and 98 male patients (40.2%) in the first category, whereas the second category comprised 10 male patients (58.8%) and 7 female patients (41.2%). The fascial spaces involved, in descending order, were submasseteric in 10 (22.7%), submandibular in 9 (20.5%), and sublingual in 6 (13.6%). The causative micro-organisms commonly found were Klebsiella and Streptococcus spp. Incision and drainage were performed in the 17 cases with spreading infection. Amoxicillin, amoxicillin/clavulanate, and metronidazole were the most routinely administered antibiotics. CONCLUSIONS: Our experience shows that delay in presentation, self-medication, aging, male gender, and unusual causative agents are some of the factors associated with spread. Therefore efforts must be made to further improve public dental awareness.

Angina de Ludwig: considerações sobre conduta e relato de caso / Ludwig's angina: procedures approach and case report

A angina de Ludwig é uma celulite frequentemente originada de uma infecção odontogênica classicamente localizada no segundo e terceiro molares inferiores, que envolve os espaços submandibular, sublingual e submentoniano. A sintomatologia típica inclui dor, aumento de volume em região cervical, disfagia, odinofagia, trismo, edema do assoalho bucal, protrusão lingual, febre, linfadenopatia e calafrios. Métodos de imagem são utilizados para determinar a severidade da infecção. Radiografias planas convencionais são úteis na abordagem inicial. Os exames por tomografia computadorizada e ressonância magnética indicam a extensão da lesão, o comprometimento das vias aéreas e a presença de gases entremeados nos tecidos musculares. O tratamento concentra-se em manutenção das vias aéreas, incisão e drenagem, antibioticoterapia e eliminação do fator causal. Um caso é apresentado, contendo características clínicas e imaginológicas. O diagnóstico baseado em exames clínicos e imaginológicos aliados a medicação efetiva e intervenção cirúrgica precoces são primordiais para a manutenção da vida do paciente.

Ludwig's angina is a cellulitis often caused by an odontogenic infection classically located in the lower second and third molars, which involves the submandibular, sublingual and submentonian spaces. The typical symptoms include pain, increase in cervical volume, dysphagia, odinophagia, trismus, mouth floor edemas, tongue protrusion, fever, chills and lymphadenopathy. Image methods are used to determine the severity of infection. Plan conventional radiographies are usefull for initial evaluation. Examinations by computed tomography and magnetic resonance images indicate the extension of the lesion, commitment of the air space and gases interlocking muscular tissues. Treatment concentrated in maintenance air space, incision and drainage, antibiotic therapy and disposal of causal factor. A case is presented, containing clinical and imaginological characteristics. The diagnosis based on clinical examination and imaginological allies to effective medication and early surgery are crucial for maintaining the life of the patient.

Ludwig's angina in the pediatric population.

As many as 1 in 3 of cases of Ludwig's angina occur in children and adolescents, and pediatricians are therefore ideally situated to detect these individuals at an early stage of their potentially life-threatening disease. The early identification and referral of children afflicted with Ludwig's angina to tertiary care centers allows for the rapid initiation of medical therapy and the consultation of those emergency services critical to providing such patients with optimal diagnostic and therapeutic interventions. This review provides an overview of the anatomical and pathophysiological considerations in Ludwig's angina and describes practical management principles to assist pediatricians in the diagnosis and treatment of this disease. Included in this review is an evidence-based algorithm for airway management.

A rare cause of Ludwig's angina by Morganella morganii.

Ludwig's angina is a rapidly spreading and potentially lethal infection involving the floor of the mouth and neck. We present a rare case of Ludwig's angina caused by an unusual microorganism, Morganella morganii, and the group D alpha-hemolytic streptococcus. To our knowledge, this is the first case of Ludwig's angina and deep neck infection caused by Morganella morganii. Adequate airway maintenance, appropriate use of antibiotics and surgical drainage resulted in survival of the patient without complications.

Angina de Ludwig associada à presença de corpo estranho em região sublingual / Ludwig´angina associated to the presence of foreing body in the floor of the mouth

A angina de Ludwig, apesar de incomum, ainda é considerada uma condição de emergência em razão do risco de obstrução das vias aéreas superiores. O tratamento é baseado no diagnóstico precoce, administração parenteral de antibióticos apropriados, proteção às vias aéreas e denagem cirúrgica. É apresentado um caso clínico de angina de Ludwig causada pela remoção cirúrgica de um terceiro molar inferior e associada à presença de corpo estranho na região sublingual

[Ludwig's angina]. / Angine de Ludwig.

Ludwig's angina is a rare infectious condition originating in the oropharyngeal region, most commonly from the teeth. The principal symptoms consist of cervical pain, dyspnea, dysphagia, symmetrical neck swelling and fever. Serious complications include respiratory collapses, mediastinitis, pleural empyema, pericarditis and pericardial tamponade, and may result in the death of the patient. The most useful investigations in patients with suspected Ludwig's angina are clinical assessment, a cervico-thoracic CT-scan to determine the extent of the lesions, microbiological examination and panoramic radiography to detect possible dental focuses of infection. Treatment consists of ensuring adequate ventilation by securing the upper airways, broad spectrum antibiotic therapy, eradication of the source of infection, and often early surgical decompression may be necessary. Rapid diagnosis and appropriate treatment can reduce the mortality rate to 10%.

Abscesos cervicales profundos: presentación y manejo médico-quirúrgico, en el Hospital Regional Honorio Delgado de Arequipa, de 1985 a 1996

Se realizó un estudio de 26 pacientes con el diagnóstico de absceso cervical profundo, quienes fueron vistos entre los años de 1985 a abril de 1996. La edad fluctuó entre un rango de 1 a 79 años, siendo el promedio de 25 años. Hubo predominio del sexo femenino sobre el masculino (18/8). Basados en la clínica y en los hallazgos operarios, estos abscesos fueron categorizados como angina de Ludwing (7 pacientes), absceso periamigdalino (15 pacientes), absceso laterofaríngeo (2 pacientes) o absceso periamigdalino y laterofíngeo simultaneamente (2 pacientes). El foco de origen más frecuente fue el odontogénico (42 por ciento), luego el faringo-amigdalino (31 por ciento), no se determinó la causa en el 4 por ciento. Los síntomas principales fueron la disfagia/odinofagia, la sensación febril, el dolor en la tumoración, el ardor de garganta, la disfonía, y el malestar general. En cuanto a los principales signos estos fueron la anormalidad orofaríngea, la tumoración cervical, la anormalidad dental, el trismus y la adenopatía cervical, principalmente. La temperatura al ingreso fluctuó en un rango de 36,3 a 39,8 ºC siendo el promedio de 37,8 ºC. El 71 por ciento de los pacientes recibieron algún tipo de antibiótico antes de ser hospitalizados. Los exámenes auxiliares más utilizados fueron el hemograma-hemoglobina, en donde el recuento leucocitario promedio fue de 11,345/mm3, y el 36 por ciento de los pacientes tubo leucocitosis con desviación izquierda. El gram y cultivo se realizó en pocos pacientes, en donde predominó el Stafilococo Aureos. El tratamiento médico se dió al 19 por ciento de los pacientes, y el tratamiento médico-quirúrgico al 81 por ciento de los pacientes y mala en el 19 por ciento. No hubieron fallecidos. Se presentaron complicaciones en 6 pacientes (23 por ciento). Los resultados fueron comparados con otros reportes.

Odontogenic infections: Part one. Anatomy and radiology.

Odontogenic infections are frequently encountered by the dentist. The signs and symptoms of these common dental emergencies are outlined in this two-part article. A thorough knowledge of the fascial planes and anatomical routes of infection spread is a critical prerequisite to understanding the clinical manifestations, potential complications, and appropriate management of these infections.

Ludwig's angina: report of seven cases and review of current concepts in management.

Ludwig's angina is a rare type of facial infection, which formerly invariably was fatal, but now, with adequate surgical and antibiotic treatment, has a much reduced mortality. Seven cases, two of which were fatal, were managed at the University of Benin Dental Hospital, Nigeria between 1981 and 1986. In five cases large doses of antibiotics, incision and drainage and extraction of involved teeth, proved to be effective therapy without the need for tracheostomy. In the two fatal cases, death was associated with inadequate antibiotic therapy.