TREATMENT PLANNING & SEMINARS

Mohamad Adnan Hassoun 200810069 Jamal Eddin Mohammed 200810469

49 year old lady presented with aggressive swelling under both lower jaw and tongue. The swelling duration is 72 hours and was preceded and associated with pain, fever and difficulty in swallowing. Her PMH review revealed an antiphospholipid syndrome controlled by warfarin. Her INR was 7.6

Differential Diagnosis: Ludwigs Angina. Cellulitis. Cyst. Tumor. Sialadenitis of submandibular gland. Mandibular Fracture.

is a localized or diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin.

Cellulitis:-

is inflammation of a salivary gland. Its clinical features are painfull swelling, Reddened skin, Edema of the cheek, Periorbital region and neck, low grade fever and malaise.

Sialadenitis of Submandibular Gland:-

Mandibular Fractures:They usually occur due to trauma, leading to pain, numbness, trismus (difficulty opening the mouth), with extraoral swelling.

is a serious, potentially life-threatening cellulitis or connective tissue infection, of the floor of the mouth, usually occurring in adults with concomitant dental infections and if left untreated, may obstruct the airways.

Ludwigs Angina:-

The life threatening nature of this condition generally necessitates surgical management. Dental infections account for approximately eighty percent of cases of Ludwig's angina. Mixed infections, due to both aerobes and anaerobes, can cause the cellulitis associated with Ludwig's angina.

True Ludwig's Angina is a cellulitic facial infection. The signs are bilateral (meaning both sides) lower facial swelling around the lower jaw and upper neck.

This is because the infection has spread to involve the Submandibular, Sublingual and Submental spaces of the face . Localisation of infection to the sublingual space is accompanied by swelling of structures in the floor of the mouth as well as the tongue being pushed upwards and backwards.

TREATMAENT:Treatment involves appropriate antibiotic medications, monitoring and protection of the airway in severe cases, and/or dental consultation to incise and drain the collections. The antibiotic of choice is from the penicillin group. Incision and drainage of the abscess may be either intraoral or external. An intraoral incision and drainage procedure is indicated if the infection is localized to the sublingual space. External incision and drainage is performed if infection involves the perimandibular spaces.

A nasotracheal tube is sometimes warranted for ventilation if the tissues of the mouth make insertion of an oral airway difficult or impossible.

Her PMH review revealed an antiphospholipid syndrome controlled by warfarin. Her INR was 7.6

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