Ludwig’s angina

Disease class: Infection

Disease class: Mouth diseases

This refers to a type of cellulitis affecting the floor of the mouth.
This is a surgical emergency.

 

Etymology

From the Greek word ankhone = choke
From the Latin word angere = strangle

Angina refers to a feeling of strangling and choking.
In severe Ludwig's angina there is signficiant airway obstruction.

 

Causes

• Dental infections (75% to 90%)

Surgical emergencies

Surgery homepage

These are situations which require immediate management by a surgeon.

 

Always a surgical emergency

When these situations are significantly probable, urgent surgical review is indicated.
Immediate surgical intervention may prevent disability or death.

1. Acute angle-closure glaucoma
2. Acute pancreatitis
3. Anterior ischaemic optic neuropathy
4. Ruptured aortic aneurysm
5. Aortic dissection
6. Aortic transection
7. Appendicitis
8. Avascular necrosis
9. Cardiac tamponade
10. Cardiac trauma
11. Cauda equina syndrome
12. Central retinal artery occlusion
13. Clostridial myonecrosis
14. Compartment syndrome
15. Critical limb ischaemia 
16. Eclampsia
17. Ruptured ectopic pregnancy
18. Endophthalmitis
19. Fournier gangrene
20. Intestinal obstruction
21. Intracranial aneurysm
22. Ischaemic colitis
23. Ludwig’s angina
24. Major trauma
25. Mesenteric ischaemia
26. Microbial keratitis  
27. Necrotising fasciitis
28. Ocular burn 
29. Open-globe injury
30. Orbital cellulitis
31. Ovarian torsion
32. Paraphimosis
33. Penile fracture
34. Pericardial effusion
35. Peritonsillar abscess
36. Priapism
37. Pyogenic flexor tenosynovitis
38. Rhegmatogenous retinal detachment 
39. Skin avulsion injuries
40. Strangulated hernia
41. Subarachnoid haemorrhage 
42. Testicular torsion
43. Traumatic amputation
44. Ventricular septal rupture

 

Always an emergency, could be medical or surgical

These are emergencies which may be resolved by urgent surgical, medical or anaesthetic intervention. There may be resolution without any surgical involvement.

• Amoebic liver abscess
• Brain herniation
• Giant-cell arteritis 
• Infective endocarditis
• Necrotising enterocolitis 
• Septic arthritis

 

Potentially an emergency

These situations are variable: they range from mild to severe.
There are specific indications for urgent surgical involvement (e.g. magnitude of fluid loss, age of patient, signs of neurovascular dysfunction).

• Acute mastoiditis 
• Burns
• Epistaxis 
• Extravasation injury
• Flail chest 
• Haemorrhage
• Ruptured ovarian cyst 
• Polytrauma
• Supracondylar fracture of humerus
• Traumatic brain injury
• Acute urinary retention
• Urolithiasis

The respiratory tract

Also known as the airways.
This includes the larynx, trachea, bronchi, bronchioles, and the lungs.

 

Anatomy

• Air enters the body through the mouth and nose.
• The nasopharynx descends to the oropharynx. The oropharynx descends to become the laryngopharynx.
• The laryngopharynx descends to the larynx.
• The epiglottis sits above the larynx. This is a piece of cartilage which can be pulled down by muscles to act as a laryngeal lid during swallowing.
• The larynx can protect the trachea by closing the vocal folds.
• The trachea splits into 2 primary bronchi.
• The right bronchi splits into 3 secondary bronchi. The left bronchi splits into 2 secondary bronchi.
• In the right lung, there are 10 tertiary bronchi. In the left lung, there are 8-10 tertiary bronchi.
• Beyond tertiary bronchi, the airways become bronchioles. This would be impractical to illustrate here as they are numerous and small. 
• At the terminal end of the respiratory tree, the bronchioles reach alveoli. These are expandable sacks which are inflated with air during inspiration.

Schematic of the respiratory tract. Red = upper lobe, orange = middle lobe, yellow = lower lobe.
Drawn with guidance from the schematic by Dr. Jonathan Simmonds M.D.

 

Pathology

• Ludwig’s angina
• Peritonsillar abscess
• Retropharyngeal abscess
• Foreign body aspiration
• Epiglottitis
• Laryngomalacia
• Laryngeal papillomatosis
• Laryngotracheal stenosis
• Laryngotracheobronchitis
• Bronchiectasis
• Whooping cough
• Asthma 
• Bronchiolitis
• Chronic obstructive pulmonary disease

[Maxillofacial surgery] Introduction

Maxillofacial surgeons specialise in diseases of the face and jaws.
There is significant overlap with dentistry, neurosurgery, orthopaedics, otorhinolaryngology, and plastic surgery.

 

Etymology

Latin maxilla, maxillae = jaw
Latin faciēs, faciēī = face

 

Stomatognathic diseases

 

Relevant diseases:

•  Impaction
• Wisdom teeth impaction
• Pericoronitis
• Temporomandibular joint dysfunction
• Tooth decay (dental caries)
• Dental abscess
• Tooth injuries
• Prognathism
• Cleft lip 
• Cleft palate
• Osteomyelitis
• Osteonecrosis of the jaw 
• Ludwig's angina 
• Alveolar bone loss

[Dentistry] Introduction

Dentists specialise in diseases of the teeth, gums, and jaws.
There is significant overlap with maxillofacial surgery and otorhinolaryngology.

 

Etymology

Latin dēns, dentis = tooth
Latin -ista, -istae = -ist; one who practises or believes.

 

Stomatognathic diseases

 

Relevant diseases:

•  Impaction
• Wisdom teeth impaction
• Pericoronitis
• Temporomandibular joint dysfunction
• Tooth decay (dental caries)
• Dental abscess 
• Tooth injuries
• Prognathism
• Cleft lip and cleft palate
• Osteomyelitis
• Osteonecrosis of the jaw 
• Ludwig's angina