MCQ MAHE 2000 ENT Answer 07

The Correct Answer is A

Ludwig's Angina is a cellulitis of the submandibular space, frequently occurring as a result of infections of the second or third lower molars.

• presents a swelling of the floor of mouth, tongue and submandibular region-leads to restricted neck movement, dysphagia, sore throat, dyspnea and possibly respiratory obstruction secondary to laryngeal edema

In his original description in 1836, Ludwig noted the absence of concomitant pharyngeal inflammation, the “woody” induration of the neck and floor of mouth, the limitation of involvement in the neck to the submental and submandibular triangles and the lack of cervical lymphadenopathy. Some authors now recommend that the term “Ludwig’s angina” be reserved for those infections that meet the following five criteria:

1. a cellulitic process of the submandibular space, not an abscess;
2. involvement of only the submandibular space, although this could be bilateral;
3. the finding of gangrene with foul serosanguinous fluid on incision, but no frank purulence;
4. involvement of the fascia, muscle and connective tissue, with sparing of the glandular tissue; and
5. direct spread of infection rather than spread by lymphatics.

Patients with a true Ludwig’s angina present with tender, firm swelling in the anterior neck without fluctuance, a muffled or “hot potato” voice and sialorrhea. Tachypnea, dyspnea and stridor signal impending airway compromise and warrant immediate treatment.

Category: MAHE 2000 MCQs