Surgical management of Ludwig's angina.
BACKGROUND
Ludwig's angina (LA) is a dangerous surgical condition that can cause severe airway compromise and death. There is controversy regarding the best way to manage the airway of patients with LA. Options range from conservative management involving close observation and i.v. antibiotics to airway intervention, including tracheostomy and endotracheal intubation using fibre-optic nasoendoscopy. We present evidence supporting a role for conservative airway management in a select subset of patients.


METHODS
This paper reviews 9 years' experience of treating patients with LA at Liverpool Hospital.


RESULTS
Twenty-one out of 29 (72%) of our patients were treated conservatively following initial clinical assessment. One of these patients subsequently deteriorated requiring emergency intubation. Of those treated non-conservatively at initial presentation, seven patients were able to be intubated using fibre-optic nasoendoscopy and one patient required tracheostomy under local anaesthesia.


CONCLUSIONS
A general discussion of issues related to the management of LA is presented. Based on our experience we conclude that there is a subset of patients with LA who can be managed safely with conservative management.
Greenberg
Simon L L
SL
Department of Ear, Nose and Throat Surgery, Liverpool Hospital, Sydney, New South Wales, Australia. tssbdj@hotmail.com
Huang
Johnson
J
Chang
Robert S K
RS
Ananda
Subramaniam N
SN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007442:Intubation, Intratracheal; D008158:Ludwig's Angina / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies