Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 66
Ann Afr Med ; 18(2): 65-69, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31070146


Background: Ludwig's angina is a potentially life-threatening condition characterized by bilateral cellulitis of the submandibular, submental, and sublingual spaces. Intravenous (I.V) penicillin G or amoxicillin-clavulanate (Augmentin) has been recommended for use as empirical management before obtaining culture and sensitivity results. Aim: The aim of this study was to compare the therapeutic efficacies and clinical outcomes of I.V benzylpenicillin with I.V Augmentin in the empirical management of Ludwig's angina. Methods: This was a prospective randomized clinical study carried out to measure the rate of swelling reduction (using the lobar rate, Adam's rate, and interincisal distance) and other clinical parameters among the two drug groups (I.V penicillin G and Augmentin). Descriptive summaries of variables were generated, and Student's t-test was used to compare the mean outcomes of the two groups. Results: A total of 26 individuals participated in the study, consisting of 46% (12) males and 54% (14) females. The participants ranged from 13 to 61 years with mean and median of 34.4 (±12.7) and 35 years, respectively. Only 8% of the cases of Ludwig's angina were not attributable to odontogenic factors, compared to 92% resulting from odontogenic causes. There was no significant difference in the efficacy of the two antibiotics used in this study. Conclusion: The efficacies and the clinical outcomes of the two antibiotics were similar. Benzylpenicillin is probably a suitable empirical alternative where Augmentin cannot be afforded, to reduce the mortality associated with the condition.

Combinación Amoxicilina-Clavulanato de Potasio/administración & dosificación , Antibacterianos/administración & dosificación , Angina de Ludwig/tratamiento farmacológico , Penicilina G/administración & dosificación , Administración Intravenosa , Adolescente , Adulto , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Antibacterianos/uso terapéutico , Femenino , Ghana/epidemiología , Humanos , Angina de Ludwig/epidemiología , Masculino , Persona de Mediana Edad , Penicilina G/uso terapéutico , Estudios Prospectivos , Resultado del Tratamiento , Adulto Joven
Med Princ Pract ; 27(4): 362-366, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29886486


OBJECTIVE: To compare the treatment outcomes in patients with early stage Ludwig's angina who received intravenous antibiotics alone with those who received surgical decompression and intravenous antibiotics. SUBJECTS AND METHODS: Individuals with early stage Ludwig's angina were studied using a retrospective cohort study design from August 1997 to September 2017. Data were collected from case notes and logbooks. Appropriate statistical tests were chosen to analyze both the independent and outcome variables. Using 2-tailed test, a level of significance of 0.05 was chosen. RESULTS: A total of 55 patients comprising 38 (69.1%) males and 17 (30.9%) females were studied. The conservative group had a higher number of cases that developed airway compromise (26.3%) when compared to those with surgical approach (2.9%). There was an association between the treatment approach and the development of airway compromise (χ2[1] = 4.83, p = 0.03). CONCLUSION: There was a higher incidence of airway compromise in patients treated with intravenous antibiotics alone than in those treated with surgical decompression and intravenous antibiotics.

Antibacterianos/uso terapéutico , Angina de Ludwig/tratamiento farmacológico , Angina de Ludwig/cirugía , Cirugía para Descompresión Microvascular , Administración Intravenosa , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Cianosis/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Frecuencia Respiratoria , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Adulto Joven
Trop Doct ; 48(3): 179-182, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29759037


In order to study the bacteriological profile, antibiotic sensitivity and outcome following empirical therapy with early generation antibiotics in patients with deep head and neck infection, a retrospective review of 42 patients admitted for drainage and intravenous antibiotic therapy was performed. Ludwig's angina was the commonest infection, with the most common organisms isolated being Group F ß-haemolytic (15%) and non-haemolytic (12.5%) streptococcus. All streptococci and anaerobic gram-positive cocci were susceptible to penicillin. S. aureus isolates were oxacillin-sensitive and enterococcus isolates were ampicillin-sensitive. All 42 patients received empirical therapy with either intravenous penicillin or its derivatives. In only three patients was a change of antibiotic required based on culture and sensitivity results. Early generation antibiotics appear ideal as empirical therapy for deep head and neck infection.

Antibacterianos/uso terapéutico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Angina de Ludwig/tratamiento farmacológico , Absceso Peritonsilar/tratamiento farmacológico , Absceso Retrofaríngeo/tratamiento farmacológico , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Angina de Ludwig/microbiología , Masculino , Persona de Mediana Edad , Absceso Peritonsilar/microbiología , Absceso Retrofaríngeo/microbiología , Estudios Retrospectivos , Succión
Rev. esp. anestesiol. reanim ; 64(7): 415-418, ago.-sept. 2017. ilus
Artículo en Español | IBECS | ID: ibc-164838


La afección cervical aguda puede determinar un serio compromiso de la vía aérea como consecuencia de la distorsión anatómica secundaria a la obstrucción o desviación de la vía aérea superior, escenarios en los que cualquier dispositivo puede fracasar. El paso de un fibrobroncoscopio para exponer la glotis puede ser muy difícil, y la traqueotomía puede ser imposible o arriesgada en casos avanzados. Presentamos el uso del TotalTrack VLM en cirugía urgente para asegurar la vía aérea en 2 pacientes no cooperadores con vía aérea difícil debido a una angina de Ludwig y a un hematoma cervical, respectivamente, ambos acompañados de trismus (AU)

Acute cervical pathology may lead to serious airway compromise resulting from anatomical distortion secondary to obstruction or deviation of the upper airway, scenarios where any airway device can be fallible. Passage of a fiberoptic bronchoscopy to expose the glottis may be very difficult and tracheostomy may be impractical or risky in advanced cases. We present the use of the TotalTrack VLM to secure the airway for emergent surgery in 2 uncooperative patients with difficult airway due to Ludwig's angina and neck hematoma, respectively, both accompanied by trismus (AU)

Humanos , Femenino , Adulto , Persona de Mediana Edad , Intubación Intratraqueal/instrumentación , Anestesia Endotraqueal/instrumentación , Anestesia Endotraqueal , Angina de Ludwig/tratamiento farmacológico , Trismo/tratamiento farmacológico , Manejo de la Vía Aérea/métodos , Extubación Traqueal/métodos , Edema/complicaciones
Rev. medica electron ; 38(1)ene.-feb. 2016. ilus
Artículo en Español | CUMED | ID: cum-63492


La angina de Ludwig es una enfermedad de causa infecciosa que afecta fundamentalmente al suelo de la boca. Se produce esencialmente por abscesos de segundo y tercer molar; tiene un comienzo insidioso, por lo que se debe pensar en ella, ya que de retrasarse el diagnóstico puede tener consecuencia fatales Las complicaciones más graves son la obstrucción de la vía aérea superior, edema de la glotis y mediastinitis descendente. Su tratamiento se basa en tres pilares esenciales, dados por medidas generales, tratamiento antibiótico y quirúrgico(AU)

Ludwigs angina is an infection-caused disease mainly affecting the floor of the mouth. It is essentially produced by second and third molar abscesses; it has an insidious beginning, so it has to be always taken into account because if it is diagnosed late, it may have fatal consequences. The most serious complications are the obstruction of the high air ways, glottis edema and descendant mediastinitis. The treatment is based in three essential supports, given by general measures, antibiotic and surgical treatment(AU)

Humanos , Femenino , Anciano , Angina de Ludwig/diagnóstico , Angina de Ludwig/tratamiento farmacológico , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Informes de Casos
Kulak Burun Bogaz Ihtis Derg ; 25(2): 102-8, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25935062


OBJECTIVES: This retrospective study aims to detect the prognostic factors which affect the duration of hospital stay and evaluate the complications which develop in patients with deep neck infection. PATIENTS AND METHODS: The study included 77 patients (40 males, 37 females; mean age 42.4±20.1 years; range 11 to 88 years) treated with a diagnosis of deep neck infection in our clinic between November 2006 and November 2012. Patients' demographic and clinical features were analyzed to detect their associations with development of complications and hospitalization time. RESULTS: Odontogenic origin and submandibular localization were the most frequently observed clinical appearance. Of eight patients (10.4%) who developed serious complications, two (2.6%) died. Age, comorbidity, presence of anemia alone, Ludwig's angina and retropharyngeal involvement were associated with increased rate of complications (p<0.05); while sex, antibiotic usage prior to admittance and primary location of infection were not related (p>0.05). Submandibular localization and absence of leucopenia reduced the risk of complications (p<0.05). The mean duration of hospital stay was 12.9±8.7 days (range 2-59 days). Age, presence of comorbidity and development of complications extended the hospitalization period (p<0.05). CONCLUSION: In spite of the improvements in diagnosis and treatment, deep neck infection may be an important cause of mortality if complications develop. Comorbid anemia, Ludwig's angina and retropharyngeal involvement were identified as the strongest predictors in terms of development of complications. Duration of hospital stay extended in patients who developed complications.

Antibacterianos/uso terapéutico , Fascitis Necrotizante/etiología , Angina de Ludwig/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación/tendencias , Angina de Ludwig/complicaciones , Angina de Ludwig/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Cuello , Estudios Retrospectivos , Adulto Joven
Rev. medica electron ; 35(5)sep.-oct. 2013. ilus
Artículo en Español | CUMED | ID: cum-55713


La angina de Ludwing es una entidad conocida desde la época de Hipócrates. Es caracterizada por una tumefacción bilateral del espacio sublingual, submandibular, y submentoniano, dolorosa al tacto, no fluctuante y de consistencia firme; que puede elevar el piso de la boca y la lengua, dificultando la función respiratoria, la deglución y el habla. Se caracteriza por una progresión rápida y silenciosa del cuadro clínico. Es infrecuente en la edad pediátrica. En las últimas décadas, tras la aparición de los antibióticos, ha contribuido a disminuir su incidencia, lo que ha favorecido que los médicos en general, y en particular los pediatras no estén familiarizados con esta patología, pudiendo ocasionar retraso en el diagnóstico y tratamiento preciso de la misma, favoreciendo a la aparición de complicaciones, a menudo fatales. Se describe un caso clínico diagnosticado en la sala H del Hospital Provincial Pediátrico Docente Eliseo Noel Caamaño, de Matanzas, destacando las nuevas tendencias de manejo y la terapia antibiótica para disminuir el riesgo de complicaciones mortales sobre todo la asfixia(AU)

The Ludwings angina is an entity known since the times of Hippocrates. It is characterized by a sublingual, sub mandibular, and sub chin space bilateral tumefaction, painful at touch, no fluctuant and of firm consistence that can raise the floor of the mouth and the tongue, making it difficult the respiratory function, swallowing and speaking. There is a fast and silent progression of the clinical picture. It is infrequent in pediatric age. In the last decades, after the appearance of the antibiotics, they have diminished its incidence, leading to the fact that physicians in general and particularly pediatricians are not familiarized with this disease, perhaps causing delays in its precise diagnosis and treatment, favoring the occurrence of frequently fatal complications. We describe a clinical case diagnosed in the ward H of the Provincial Teaching Pediatric Hospital Eliseo Noel Caamaño, of Matanzas, highlighting the new management tendencies and the antibiotic therapy to diminish the risk of mortal complications, especially asphyxia(AU)

Humanos , Masculino , Niño , Angina de Ludwig/diagnóstico , Angina de Ludwig/tratamiento farmacológico , Informes de Casos
ANZ J Surg ; 81(3): 168-71, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21342390


INTRODUCTION: Ludwig's angina (LA) is an uncommon and potentially life-threatening condition of the upper aero-digestive tract that often requires the coordinated efforts of the surgical, anesthetic and intensive care teams to optimize management. The purpose of the present study was to investigate the documented clinical features and the surgical and airway management of LA at Alice Springs Hospital for the purpose of assessing surgical outcomes with particular reference to length of stay (LOS). METHODS: Retrospective chart review from January 1998 to January 2008 examined patients admitted with LA at Alice Springs Hospital. Documented clinical features, interventions, and operative findings including floor of mouth swelling, Mallampati score, and airway compromise were collected. Outcomes, with particular respect to LOS, for those who received intravenous (IV) or inhalational induction and those that received awake fibre-optic intubations were compared. RESULTS: Of 30 patients with LA, 28 (93%) were managed with operative drainage with a LOS in the intensive care unit (ICU) of 2 days and a hospital LOS of 5 days. Seven received awake fibre-optic intubation and 21 had IV or inhalational anesthesia with none requiring tracheotomy. There was no statistical difference in LOS between those patients whose microbiological culture results showed no growth and those whose cultures had positive growth. DISCUSSION: Management was generally operative decompression with IV antibiotics. LOS is not affected by the presence or absence of culture positive infection. It is proposed that operative intervention is safe, effective, and is associated with shorter patient stays in the intensive care unit and the hospital overall.

Descompresión Quirúrgica , Tiempo de Internación/estadística & datos numéricos , Angina de Ludwig/cirugía , Adolescente , Adulto , Anciano , Manejo de la Vía Aérea , Niño , Preescolar , Femenino , Humanos , Lactante , Angina de Ludwig/tratamiento farmacológico , Angina de Ludwig/microbiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
Artículo en Inglés | MEDLINE | ID: mdl-20656528


INTRODUCTION: Orofacial space infections are common presentations in maxillofacial clinics even in the post-antibiotic era. One of the main factors determining the spread of infection is the host defense mechanism. Diabetes is one of the most common systemic illness suppressing the immunity of an individual and increasing their susceptibility to infections. This study was carried out to compare the spaces involved, the severity of infection, the virulent organism, the efficacy of empirical antibiotics, the length of hospital stay, and the complications encountered in the management of maxillofacial space infection of odontogenic origin in diabetic patients as compared with nondiabetic patients. METHODOLOGY: A 4-year prospective study was carried out on patients with maxillofacial space infection of odontogenic origin. The patients were divided into 2 groups on the basis of presence or absence of diabetes. RESULTS: A total of 111 patients were identified out of which 31 were diabetic. The organisms commonly isolated were Streptococcus species with submandibular space being the most common space involved in both the groups. The empirical antibiotic used was amoxicillin plus clavulanic acid combined with metrogyl in 70.27% cases. CONCLUSION: Streptococcus species is still the most common causative pathogen irrespective of the diabetic status of the patient. The same empirical antibiotic therapy of amoxicillin plus clavulanic acid combined with metrogyl along with hyperglycemia control and surgical drainage of infection yielded satisfactory resolution of infection in the diabetic patients as well.

Complicaciones de la Diabetes/tratamiento farmacológico , Infección Focal Dental/complicaciones , Enfermedades de la Boca/complicaciones , Infecciones Estreptocócicas/complicaciones , Adolescente , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Antibacterianos/uso terapéutico , Estudios de Casos y Controles , Drenaje , Combinación de Medicamentos , Infección Focal Dental/tratamiento farmacológico , Infección Focal Dental/cirugía , Humanos , Hiperglucemia/terapia , Infecciones por Klebsiella/complicaciones , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/cirugía , Tiempo de Internación , Angina de Ludwig/complicaciones , Angina de Ludwig/tratamiento farmacológico , Angina de Ludwig/cirugía , Metronidazol/uso terapéutico , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Enfermedades de la Boca/tratamiento farmacológico , Enfermedades de la Boca/cirugía , Estudios Prospectivos , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/cirugía
Rev. para. med ; 24(2): 71-75, abr.-jun. 2010. ilus
Artículo en Portugués | LILACS | ID: lil-593648


Objetivo: relatar um caso clínico de complicação sistêmica de Angina de Ludwig. Relato do caso: homem de 25 anos,atendido no Pronto Socorro Municipal de Belém apresentando aumento de volume na região cervical e sintomatologiana região submandibular. Após realização de exames clínicos e radiográficos contatou-se que a infecção tinha origemodontogênica. Durante a internação, a infecção disseminou-se para o mediastino e para os rins ocasionando nefropatiacrônica bilateral. O paciente obteve alta melhorado, sendo encaminhado para hemodiálise. Considerações finais: a anginade Ludwig deve ser diagnosticada e tratada o mais breve possível já que pode evoluir para complicações sistêmicas.

Objective: report a case of systemic complication of Ludwig?s Angina. Case report: a man of 25 years sought carein Pronto Socorro Municipal of Belém presenting a volume increase in symptoms in the neck and submandibularregion. After clinical and radiographic examination contacted that the infection was odontogenic origin. Duringhospitalization, the infection spread to the mediastinum and the bilateral kidneys causing chronic nephropathy.Thepatient was discharged improved and was reffered for hemodialysis. Final considerations: the Ludwig?s Anginashould be diagnosed and treated as soon as possible as it can progress to systemic complications

Humanos , Masculino , Adulto , Infección Focal Dental , Angina de Ludwig/diagnóstico , Angina de Ludwig/tratamiento farmacológico , Mediastinitis
Int J Pediatr Otorhinolaryngol ; 73(9): 1313-5, 2009 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-19560216


Ludwig's angina is a rapidly progressive cellulitis of the submandibular space and has the potential for significant upper airway obstruction. Most reported cases follow an odontogenic infection. We present the case of a 13-year-old girl who underwent a frenuloplasty to correct speech disturbances and subsequently developed a life-threatening infection of the floor of mouth. Immediate intubation, surgical decompression and antibiotic therapy successfully resolved the episode. To our knowledge, this is the first report of an iatrogenic Ludwig's angina attributable to a frenuloplasty performed for ankyloglossia. We briefly review the literature on ankyloglossia, pediatric Ludwig's angina and postoperative infections.

Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Frenillo Labial/cirugía , Angina de Ludwig/etiología , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Adolescente , Antibacterianos/uso terapéutico , Clindamicina/uso terapéutico , Femenino , Humanos , Angina de Ludwig/diagnóstico , Angina de Ludwig/tratamiento farmacológico , Conductos Salivales/cirugía , Tomografía Computarizada por Rayos X
Clin Pediatr (Phila) ; 48(6): 583-7, 2009 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-19286617


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.

Antibacterianos/uso terapéutico , Glucocorticoides/uso terapéutico , Angina de Ludwig , Algoritmos , Antibacterianos/administración & dosificación , Terapia Combinada , Quimioterapia Combinada , Tratamiento de Urgencia , Medicina Basada en la Evidencia , Glucocorticoides/administración & dosificación , Humanos , Inyecciones Intravenosas , Angina de Ludwig/tratamiento farmacológico , Angina de Ludwig/etiología , Angina de Ludwig/patología , Angina de Ludwig/cirugía , Guías de Práctica Clínica como Asunto , Resultado del Tratamiento
Minerva Stomatol ; 56(11-12): 639-47, 2007.
Artículo en Inglés, Italiano | MEDLINE | ID: mdl-18091716


The clinical presentation of Ludwig's angina consists in a severe expanding cellulitis causing swelling of the floor of the mouth, tongue and submandibular region, thus resulting in a possible obstruction of the airway and in a rapid progress in deep neck soft tissue infection and mediastinitis with potentially fatal consequences. Frequently, submandibular cellulitis develops from an acute infection spreading from the lower molar teeth. Mandibular fractures, traumatic laceration of the floor of the mouth, and peritonsillar abscesses are other concomitant clinical features. A case of Ludwig's angina associated with a large erupted odontoma and with a deeply impacted third molar displaced to the border of the mandible is described. The patient was affected by enlargement of submandibular space, marked face swelling causing an evident face deformity, tenderness and redness of the neck and limited movement of the neck and mouth. In the past, Ludwig's angina was frequently fatal, however aggressive surgical and medical therapy have significantly reduced the mortality rate. The reported case can be considered as important, not only because of the rarity of the odontoma eruption in the oral cavity, but mainly for the extent of the clinical manifestation of a lesion usually described in literature as asymptomatic.

Angina de Ludwig/etiología , Neoplasias Mandibulares/complicaciones , Tercer Molar/patología , Odontoma/complicaciones , Infecciones Estreptocócicas/etiología , Diente Impactado/complicaciones , Adulto , Antibacterianos/uso terapéutico , Terapia Combinada , Drenaje , Femenino , Humanos , Angina de Ludwig/tratamiento farmacológico , Angina de Ludwig/cirugía , Neoplasias Mandibulares/cirugía , Tercer Molar/cirugía , Odontoma/cirugía , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/cirugía , Extracción Dental , Diente Impactado/cirugía