Ludwig's angina

With better dental hygiene and greater medical awareness, Ludwig's angina is becoming a rare clinical entity. The current variety of antibiotics keeps most physicians well prepared to treat any one of a number of possible pathogens. Penicillin remains the drug of choice for initial therapy because most common oral pathogens are sensitive to it. The broad-spectrum cephalosporins and aminoglycosides can be reserved for resistant or more aggressive organisms. A patent airway remains the chief priority in each case. Every effort must be made to insure that airway obstruction, the most common life-threatening complication, is diverted. Elective tracheostomy with local rather than general anesthesia is recommended, particularly when considering the complications of intubations in these patients. Surgical drainage is now reserved for treatment of patients with substantial fluctuation, documented abscesses or lack of response to antibiotic therapy.