Ангина Людвига: Тяжелый целлюлит дна полости рта.

Form of severe cellulitis of the mouth floor
The majority of cases follow a dental infection. The infection spreads through the connective tissue of the floor of the mouth and is normally caused by infectious and invasive organisms such as Streptococcus, Staphylococcus, and Bacteroides. Prevention is by appropriate dental care including management of dental infections. Initial treatment is generally with broad spectrum antibiotics and corticosteroids.

Ludwig's angina is a form of severe, widespread cellulitis of the floor of the mouth, usually with bilateral involvement. Infection is usually primarily within the submandibular space, and the sublingual and submental spaces can also be involved. It presents with an acute onset and spreads very rapidly, therefore early diagnosis and immediate treatment planning is vital and lifesaving. The external signs may include bilateral lower facial swelling around the jaw and upper neck. Signs inside the mouth may include elevation of the floor of mouth due to sublingual space involvement and posterior displacement of the tongue, creating the potential for a compromised airway. Stridor, trismus, and cyanosis may also be seen when an impending airway crisis is nearing. accounting for approximately 75–90% of cases. Infections of the lower second and third molars are usually implicated due to their roots extending below the mylohyoid muscle. Periapical abscesses of these teeth also result in lingual cortical penetration, leading to submandibular infection. have also been documented as potential causes of Ludwig's angina. Patients with systemic illness, such as diabetes mellitus, malnutrition, compromised immune system, and organ transplantation are also commonly predisposed to Ludwig's angina.

Infections originating in the roots of teeth can be identified with a dental X ray. A CT scan of the neck with contrast material is used to identify deep neck space infections. If there is suspicion of the infection of the chest cavity, a chest scan is sometimes done. lingual carcinoma and sublingual hematoma formation following anticoagulation should be ruled out as possible diagnoses. Ludwig's angina is most often found to be polymicrobial and anaerobic. Some of the commonly found microbes are Viridans streptococci, Staphylococci, Peptostreptococci, Prevotella, Porphyromonas and Fusobacterium. There are four principles that guide the treatment of Ludwig's angina: Sufficient airway management, early and aggressive antibiotic therapy, incision and drainage for any who fail medical management or form localized abscesses, and adequate nutrition and hydration support.

The term "angina", is derived from the Latin word angere, which means "choke"; and the Greek word ankhone, which means "strangle". Placing it into context, Ludwig's angina refers to the feeling of strangling and choking, secondary to obstruction of the airway, which is the most serious potential complication of this condition.