Ludwig’s angina: an analysis of sixteen cases in a suburban Nigerian tertiary facility.

Abstract

Objective: To document the prevalence and management of Ludwig’s angina in a suburban population. Methods: All consecutive cases of Ludwig’s angina seen and managed at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria between 1988 and 2002. Results: There were 16 cases with 10 males and 6 females whose ages ranged from 8 to 75 years; mean+ SD; 43.8 + 19.9 years. Symptom duration ranged from one day to three weeks; mean + SD; 6.4 + 4.9 days of the onset of illness. Odontogenic infection was the commonest etiologic factor in 12 cases (75%) and 4 of these were attributed to post dental extraction sepsis. Seven patients had underlying disease such as diabetes mellitus, lobar pneumonia, severe anaemia and mental retardation. The commonest was diabetes mellitus in 4 cases. Microbiological investigations showed a polymicrobial nature of the infection with Staphylococcus aureus (6 cases) out of 11 patients that had the examination. Treatment involved high doses of broad-spectrum parenteral antibiotics, immediate surgical drainage under local and general anaesthesia in 14 (75%) and single patients respectively. This was in addition to extraction of involved tooth/teeth where applicable. The complications recorded in 5 cases (31.3%) were septicaemia, mediastinitis, empyema thoracic, necrotising fasciitis, laryngeal spasm and renal failure. Mortality occurred in 4 cases (25%). Conclusions: Ludwig’s angina is a serious disease and late presentation remains a typical feature. Associated co-morbid condition is common. Prompt clinical evaluation and definitive care will considerably improve its prognosis and reduce the high mortality associated with the condition

Key words: Ludwig’s Angina, Suburban Population, Tertiary Facility.