Management of Ludwig's angina with small neck incisions: 18 years experience.
OBJECTIVE
To review Ludwig's angina medical and surgical approach with small incisions.


METHODS
Retrospective, open, noncomparative, longitudinal.


METHODS
All patients with Ludwig's angina who received medical, metabolic, airway management, and surgical treatment from January 1, 1983 to December 31, 2000.
Antibiotic treatment, surgical treatment, hospitalization time, associated diseases, etiologic factors, recuperation time.


RESULTS
Age range was 18 to 87 years, with a female-to-male ratio of 1.1:1 (68 females, 53 males). Thirty patients belonged to middle or high socioeconomic status. The primary site of infection was odontogenic in 107 of the patients. All the patients were managed with surgical drainage made within the first 12 hours after hospital admission. The most common antibiotic treatments were the combination of clindamycin with crystalline penicillin G. The hospital stay for more than half of patients was 6 days or less. In 62 patients we found extension into the parapharyngeal space and in 32 cases we found retropharyngeal extension of the Ludwig's angina. Forty-six patients had or were diagnosed as having diabetes mellitus. Tracheotomy was required in 34 patients. The airway of the rest of patients was controlled with nasotracheal intubation. Only 33 patients had major complications, such as mediastinitis, sepsis, or death.


CONCLUSIONS
Drainage using small incisions is a safe and effective method as part of treatment of Ludwig's angina.
Bross-Soriano
Daniel
D
Division of Otorhinolaryngology, Dr. Manuel Gea González General Hospital. dbross@glw.com.mx
Arrieta-Gómez
José R
JR
Prado-Calleros
Héctor
H
Schimelmitz-Idi
Jose
J
Jorba-Basave
Santiago
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D001707:Biopsy, Needle; D003413:Cricoid Cartilage / Q000601:surgery; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008158:Ludwig's Angina / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D013965:Thyroidectomy; D014140:Tracheotomy
D000900:Anti-Bacterial Agents