Ludwig's angina. Case report, with review of bacteriology and current therapy

A fifty-two year old man in whom Ludwig's angina developed following tooth extraction is described, and the literature describing the bacteriology, pathogenesis and treatment of this syndrome is reviewed. Gram-negative organisms are isolated infrequently from these cases, but in the case cited Escherichia coli and Pseudomonas aeruginosa were recovered. Present emphasis in the management of patients with Ludwig's angina is on antimicrobial therapy for control of infection rather than surgical drainage procedures. Maintenance of an adequate airway is the most important therapeutic procedure. Since gram-negative and anaerobic organisms may be the infecting agents, initial antimicrobial therapy should be broad enough to inhibit these organisms. The hazard of sudden airway obstruction in this syndrome is demonstrated in the case presented.