What is Ludwig angina? how to cure this?

[Sujit]

Hello, my 65-year-old uncle reported to the local hospital with inability to open the mouth, pain and difficulty in swallowing with a swelling in relation to the lower jaw and neck for the past 4 days. His temperature was normal with a pulse rate of 80 beats per minute (BPM), blood pressure (BP) of 100/70 mmHg, and a respiratory rate of 22 breaths per minute. Mouth opening was limited to 1.5 cm (interincisal distance). Extra-oral swelling was indurated and non-fluctuant with bilateral involvement of the submandibular and sublingual region. An infected third molar had been extracted 3 days earlier. Doctor has diagnosed Ludwig's angina and the my uncle was sent for surgical decompression under local anesthesia. What is Ludwig angina? how to cure this? Please comment.

[Shubhendu]

@sujit Ludwig's angina is a severe diffuse cellulitis that presents an acute onset and spreads rapidly, affecting the submandibular, sublingual, and submental spaces bilaterally resulting in a state of emergency because of impending airway obstruction. Ludwig's angina usually starts with submandibular space infection from second or third lower molar then it spreads to the sublingual space of the same side. From there it crosses to the opposite side sublingual space and thence to the contralateral submandibular space. The involvement of submental space is by lymphatic spread. It can also start from sublingual space and progress to the submandibular space. Infection from the sublingual space spreads posteriorly in the substance of the tongue in the cleft between the hypoglossus and genioglossus muscles and reaches epiglottis which causes edema of the glottis and respiratory obstruction. In Ludwig's angina, patients demonstrate swelling in the floor of the mouth and neck, pain, malaise, fever, and dysphagia. In these patients, inability to swallow saliva and stridor indicate imminent airway compromise. The most feared complication is airway obstruction due to elevation and posterior displacement of the tongue and edema of the glottis.