Predicting factors for patients with Ludwig’s angina have been treated at Viet Duc University hospital
Department of Septic Surgery and Wound Care, Viet Duc University Hospital, Hanoi, Vietnam.
Case Study
GSC Advanced Research and Reviews, 2022, 12(02), 069–078.
Article DOI: 10.30574/gscarr.2022.12.2.0216
Publication history:
Received on 08 July 2022; revised on 16 August 2022; accepted on 18 August 2022
Abstract:
Introduction: Ludwig's angina remains a severe infection pathology with a high mortality risk despite many advances in treatment. Prognostic death factors such as age, underlying disease, spreading infection, and airway compression have been mentioned. The purpose of the study was to determine the predicting factors to improve management outcomes.
Materials and methods: All patients diagnosed with Ludwig's angina were treated at Viet Duc University Hospital from 2019 to 2021, including death. Data were processed by software SPSS.20.0
Results: A total of 29 patients were enrolled during the study period. Male patients covered 79.3%, female patients accounted for 20%. The age group between 50 and 69 accounted for 51.7%. The most common cause was dental infection, which accounted for 82.8%; meanwhile, comorbidities accounted for 69%, including diabetes mellitus 34.5%, hypertension 24.1%, and cardiovascular disease 31.0%.
Classification of airway compression according to Mallampatti score: Class III accounted for 51.7%, and class IV accounted for 10.3%. There were 20 patients associated with comorbidities, accounting for 69%.
Spreading infection: Localized floor of mouth accounts for 49.7% including one side 41.4%, two sides 48.3%, extending to mediastinum accounts for 10.3%. Most common manifestations were neck swelling 100%, pain 82.8%, dyspnea 62.1%, fever 62.1%, dysphagia 41.4%. Septic shock and trimus accounted for 27.6% and 24.1% respectively.
Bacterial isolations: Streptococcus species was the most common at 31%, and Peptostreptococcus accounted for 24.1%. Acinetobacter Baumanii and Klebsiella pneumoniae both accounted for 13.8%
Airway management: 3 cases needed tracheostomy at emergency department, accounting for 10.3%.
There were 12 cases of postoperative complications, accounted for 41.4%. Six died, accounted for 20.7%.
Conclusions and recommendations: Ludwig's angina mortality remains high so far. Risk factors should be assessed as soon as the patient is admitted to the hospital for aggressive management, notably airway management and antibiotic strategies.
Keywords:
Ludwig's angina; Mediastinitis; Airway decompression; Submandibular space
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