1
|
Huang CT, Lien WC. Submandibular Sialolithiasis Mimicking Ludwig's Angina: A Case Report and Brief Clinical Review. J Emerg Nurs 2024; 50:491-495. [PMID: 38960547 DOI: 10.1016/j.jen.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 07/05/2024]
Abstract
The "double tongue sign" is a characteristic finding in patients with Ludwig's angina, a potentially life-threatening infection due to airway compromise. Management primarily focuses on early airway protection and antibiotic administration. Submandibular sialolithiasis, on the other hand, could present with the double tongue sign without symptoms suggestive of airway involvement. Unlike Ludwig's angina, conservative treatment is usually the first-line approach for sialolithiasis. The importance of rapidly recognizing and distinguishing between the 2 conditions is emphasized through effective triage and risk stratification, particularly in rural areas where physicians are not readily available.
Collapse
|
2
|
Sahoo NK, Thakral A, Pandey S, Vaswani H, Vashisht S, Maheshwari I. Incidence of Mortality and Its Relation to Comorbidity in Ludwig's Angina: A Retrospective Study. J Maxillofac Oral Surg 2024; 23:581-588. [PMID: 38911416 PMCID: PMC11189848 DOI: 10.1007/s12663-024-02116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/13/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Ludwig's angina is a serious life-threatening infective condition of maxillofacial region due to odontogenic origin which is clinically diagnosed by its clinical signs and symptoms. Airway management and early surgical decompression is the main stay of management. The mortality rates in Ludwig's angina remains multivariate. There is a paucity in literature regarding the mortality rates of this disease. Aim and Objectives Aim of this retrospective study is to describes the characteristics, probable cause of death and mortality rates of patients with co-morbidities presenting to the emergency department (ED) who were subsequently admitted with a primary diagnosis of Ludwig's angina. Materials and Method Study was conducted in the department of maxillofacial surgery in a tertiary care teaching hospital from Jan 2011 to Dec 2022. Data of 17 patients who were clinically diagnosed as Ludwig's angina were included in the study. The comorbidity, source of odontongenic cause, mode of intubation and the outcome of the disease were evaluated. Result Comparison of categorical variables was done using Fishers exact test. A p-value of <0.7 was considered statistically significant. The results suggested that Out of 17 patients 12 patients (70.5%), 7 male and 5 females had comorbidities and four cases (23.5%) had complication of death, all having co-morbidities. Summary It concludes that associated comorbidity has a significant role in progress and outcome of the disease and incidence of death is more common in cases having associated comorbidity.
Collapse
Affiliation(s)
- N. K. Sahoo
- Present Address: Department of OMFS, Subharti Dental College and Hospital, Meerut, 250005 India
| | | | - Swati Pandey
- Present Address: Department of OMFS, Subharti Dental College and Hospital, Meerut, 250005 India
| | - Himani Vaswani
- Present Address: Department of OMFS, Subharti Dental College and Hospital, Meerut, 250005 India
| | - Sahil Vashisht
- Present Address: Department of OMFS, Subharti Dental College and Hospital, Meerut, 250005 India
| | - Isha Maheshwari
- Present Address: Department of OMFS, Subharti Dental College and Hospital, Meerut, 250005 India
| |
Collapse
|
3
|
Es Dawoud B, Kent S, Henry A, McDonald C, Kyzas P, McCaul J, Ng T, Kawalec A, Gowrishankar S, Grant J, Elledge R, Mohindra A, Madattigowda R, O'Connor R, Tudor-Green B, Tavakoli M, Garg M, Wareing J, Kulkarni R, Exley R, Wicks C, Mitchell O, Maarouf M, Chohan P, Otukoya R, Wu E, Farooq S, Uppal S, Shaheen S, Reedy N, Vithalani G, Underwood C, Swain A, Brewer E, Cairns M, Logan G, Cashman H, Wareing S, King H, Stevenson S, Collins T, Davies R, Baniulyte G, Watson M, Murray S, Stephanus Brandsma D, Stiles E, Davies L, Nandra B, King S, Regan A, Hennedige A, McCaul J. Predictors and risk factors for admission to critical care in cervicofacial infections: a Maxillofacial Trainee Research Collaborative (MTReC) study. Br J Oral Maxillofac Surg 2023; 61:78-83. [PMID: 36513528 DOI: 10.1016/j.bjoms.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022]
Abstract
Cervicofacial infections carry significant morbidity. Patients present on a broad spectrum of severity, with some requiring outpatient management and others admission to higher level care. Recognition of risk factors is helpful in decision making regarding the need for admission to higher level care. Prospective data were captured on 1002 patients in 25 centres across 17 regions of the United Kingdom (UK) by the Maxillofacial Trainee Research Collaborative (MTReC). Patients admitted to critical care were compared with those who received ward-level care. Multivariate and receiver operating characteristic curve analyses were used to identify predictors for critical care admission. Our results show that the best predictor for critical care admission is the presence of three or more features of airway compromise (AUC 0.779), followed by C-reactive protein (CRP) >100 mg/L (OR 2.70; 95% CI 1.59 to 4.58; p < 0.005), submandibular space involvement (OR 3.82; 95% CI 1.870 to 7.81; p = 0.003), white cell count (WCC) >12 × 109/ dl (1.05; 95% CI 1.01 to 1.10; p = 0.03), and positive systemic inflammatory response syndrome criteria (OR 2.78; CI 1.35 to 5.80; p = 0.006). Admission to critical care is multifactorial, however, the presence of three or more features of airway compromise is the best predictor. Awareness of this alongside other key clinical findings in cervicofacial infections may allow for the early recognition of patients who may require escalation to critical care.
Collapse
Affiliation(s)
- B Es Dawoud
- Maxillofacial surgery Trainees Research Collaborative, Manchester University Foundation NHS Trust, United Kingdom.
| | - S Kent
- Maxillofacial surgery Trainees Research Collaborative, Morriston Hospital, Swansea, United Kingdom
| | - A Henry
- Maxillofacial surgery Trainees Research Collaborative, Morriston Hospital, Swansea, United Kingdom
| | - C McDonald
- Maxillofacial surgery Trainees Research Collaborative, Ninewells Hospital, Dundee, United Kingdom
| | - P Kyzas
- Maxillofacial surgery Trainees Research Collaborative, East Lancashire Teaching Hospital Trust, United Kingdom
| | - J McCaul
- Maxillofacial surgery Trainees Research Collaborative, Glasgow, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Osaghae IP, Adebola AR, Amole IO, Olaitan AA, Salami YA, Kuye O, Ayoub A. Ludwig's angina in Nigeria: The disease of the poor and health inequality! Surgeon 2021; 20:e129-e133. [PMID: 34187738 DOI: 10.1016/j.surge.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/23/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
AIM highlight the health inequality and identify opportunities to improve the care delivered to the patients who suffer from Ludwig's angina which could have national and international clinical impact. MATERIALS AND METHODS Data was collected from three major oral and maxillofacial centers, in Nigeria including Benin, Lagos and Kano. A protocol was developed for data collection which included demographic details, socio-economic status, management of the air way, the associated morbidities and mortalities. RESULTS Forty-nine were managed in Benin, 57 in Lagos and 66 in Kano. Diabetes was the most prevalent underlying systematic condition, affecting 21% of the Ludwig's angina patients in Lagos. Poverty was a common denominator, 90% of the patients from Kano were unemployed compared to 23% and 8% from Lagos and Benin respectively. For most of the patients, the airway was monitored. Incision and drainage were carried out in most of the cases at Benin and Lagos, but it was only considered in 50% of the cases in Kano. Mortality ranged from 4% in Benin to 12% in Lagos and it was as high as 19% in Kano. CONCLUSION poor access to oral healthcare, unemployment and low socio-economic status are important predisposing factors of Ludwig's angina.
Collapse
Affiliation(s)
| | | | - Ibiyinka Olusola Amole
- Oral & Maxillofacial Surgery, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ademola Abayomi Olaitan
- Oral & Maxillofacial Surgery, Lagos State University Teaching Hospital, Ikeja Lagos State, Nigeria
| | - Yussuf Ajibola Salami
- Oral & Maxillofacial Surgery, Lagos State University Teaching Hospital, Ikeja Lagos State, Nigeria
| | - Olasunkanmi Kuye
- Oral & Maxillofacial Surgery, Lagos State University Teaching Hospital, Ikeja Lagos State, Nigeria
| | - Ashraf Ayoub
- Oral & Maxillofacial Surgery, The University of Glasgow Dental Hospital & School, United Kingdom.
| |
Collapse
|
5
|
Bridwell R, Gottlieb M, Koyfman A, Long B. Diagnosis and management of Ludwig's angina: An evidence-based review. Am J Emerg Med 2021; 41:1-5. [DOI: 10.1016/j.ajem.2020.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 02/08/2023] Open
|
6
|
DELANTONİ A, SARAFOPOULOS A, TSİROPOULOS G, DENİZ A, ORHAN K. Ludwig’s Angina: Case series with description of the ultrasonographic features of the emergency conditions. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2020. [DOI: 10.33706/jemcr.800027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
7
|
Dawoud BES, Kent P, Ho MWS. Impacts of lockdown during the SARS-CoV-2 pandemic on patients presenting with cervicofacial infection of odontogenic origin: a comparative study. Br J Oral Maxillofac Surg 2020; 59:e109-e113. [PMID: 33349495 PMCID: PMC7485545 DOI: 10.1016/j.bjoms.2020.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 10/25/2022]
Abstract
The SARS-CoV-2 pandemic caused unprecedented disruption to primary and secondary healthcare services. Our aim was to explore whether the pandemic had had any impact on patients presenting with cervicofacial infections (CFI) of odontogenic origin to secondary care and management. Comparative analysis was carried out evaluating prospective and retrospective consecutively admitted patients with a diagnosis of CFI of odontogenic origin in the COVID-19 lockdown period from 15 March to 15 June 2020 and pre-COVID-19 during the same period of the previous year. Data included patients' demographics, comorbidities, systemic inflammatory response syndrome (SIRS) status on admission, clinical features, prior treatment in primary care, source of referral, SARS-COV-2 antigen status, treatment received in secondary care, intraoperative findings, and whether escalation of the level of care was required. Across both cohorts there were one hundred and twenty-five (125) patients admitted with CFI of odontogenic origin, with a 33% reduction (n=75 (2019) vs n=50 (2020)) in number of patients admitted during COVID-19 lockdown. There was no difference between the cohorts in terms of age (p=0.192), gender (p=0.609) or major comorbidities (p=0.654). Proportionally more patients in the COVID-19 group presented with SIRS (p=0.004). This group of patients persisted with symptoms for longer before presenting to secondary care (p=0.003), more delay from hospital admission to surgical intervention (p<0.005) and had longer hospital stays (p=0.001). More patients required extraoral surgical drainage during COVID-19 (p=0.056). This study suggests that the COVID-19 lockdown has had adverse effects on the presentation of CFI of odontogenic origin and its management within a Regional Acute Maxillofacial Service. Commissioners and clinicians should endeavour to plan for adequate primary and secondary care provision during any future local lockdowns to ensure that patient care is optimised.
Collapse
Affiliation(s)
- B E S Dawoud
- Oral & Maxillofacial Surgery, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust.
| | - P Kent
- Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust
| | - M W S Ho
- Oral & Maxillofacial Surgery, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust
| |
Collapse
|
8
|
Abstract
Although relatively uncommon, Ludwig's angina is a potentially life-threatening infection of the floor of the mouth and neck. There is a danger of airway obstruction by swelling in the area and displacement of the tongue, and patients are at risk of deterioration. There are many factors thought to place patients at an increased risk of developing the condition. These include recent dental treatment, dental caries or generally poor dentition, chronic disease such as diabetes, alcoholism and malnutrition, and patients with compromised immune systems (eg AIDS, organ transplantation). This article examines the aetiology of Ludwig's angina and considers the presentation, diagnosis and treatment of a patient who presented to an out-of-hours streaming area of a local emergency department, with an emphasis on the importance of a multidisciplinary approach. It also considers the need for ongoing education and awareness of health professionals to ensure the successful diagnosis, management and treatment of this condition, particularly in the context of patients with poor access to dental care presenting first to the emergency department.
Collapse
Affiliation(s)
- Emma Parker
- Nurse Practitioner/Trainee Advanced Clinical Practitioner, Derby Health United Health Care
| | - Gerri Mortimore
- Lecturer, Faculty of Education Health and Sciences, University of Derby
| |
Collapse
|
9
|
De Silva S. Airway safety in a patient with submandibular swelling. J Perioper Pract 2018; 27:59-60. [PMID: 29328745 DOI: 10.1177/175045891702700305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/26/2016] [Indexed: 11/15/2022]
Abstract
A fifty-eight year old gentleman (CH) with a five-day history of toothache presented to the emergency department (ED) with increasing pain with associated submandibular swelling over the last 24-hours. He was an unkempt gentleman who had not consulted his general practitioner or dentist in many years, was unaware of any significant past medical history and was not on any regular medication. He was an obese gentleman with a BMI of 56.
Collapse
|
10
|
Siu AYC, Chung CH. X-Ray Quiz: Lower Jaw Swelling. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790501200310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
11
|
Case Study in Critical Care Transport: A 51-Year-Old Male With Ludwig Angina. Air Med J 2017; 36:45-48. [PMID: 28336009 DOI: 10.1016/j.amj.2016.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/24/2016] [Indexed: 11/23/2022]
|
12
|
Pandey M, Kaur M, Sanwal M, Jain A, Sinha SK. Ludwig's angina in children anesthesiologist's nightmare: Case series and review of literature. J Anaesthesiol Clin Pharmacol 2017; 33:406-409. [PMID: 29109646 PMCID: PMC5672514 DOI: 10.4103/0970-9185.214318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Ludwig's angina is potentially lethal, rapidly spreading cellulitis of the floor of mouth and neck. The anticipated difficult airway becomes even more challenging when it occurs in children. In children, the larynx is positioned relatively higher in the neck, and one does not have the option for blind nasal intubation or awake fiberoptic, which otherwise is the technique of choice in adult patients. We present the clinical course of 16 children and highlight various problems encountered during the anesthetic management of six children who required emergency surgical drainage under general anesthesia.
Collapse
Affiliation(s)
- Maitree Pandey
- Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India
| | - Manpreet Kaur
- Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India
| | - Manoj Sanwal
- Department of Anaesthesia and Intensive Care, MAX Hospital, New Delhi, India
| | - Aruna Jain
- Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India
| | - Sunil K Sinha
- Department of Anaesthesia and Intensive Care, Lady Hardinge Medical College, New Delhi, India
| |
Collapse
|
13
|
Diep J, Kam D, Kuenzler KA, Arthur JF. Emergent Airway Management of an Uncooperative Child with a Large Retropharyngeal and Posterior Mediastinal Abscess. ACTA ACUST UNITED AC 2016; 6:61-4. [PMID: 26599735 DOI: 10.1213/xaa.0000000000000267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Retropharyngeal abscesses are deep neck space infections that can lead to life-threatening airway emergencies and other catastrophic complications. Retropharyngeal abscesses demand prompt diagnosis and early establishment of a definitive airway when there is airway compromise. This can be difficult in an uncooperative patient. We present the case of a 12-year-old girl with mediastinitis and tracheal compression and anterior displacement from a large retropharyngeal and posterior mediastinal abscess secondary to traumatic esophageal perforation, who received successful awake nasal fiberoptic intubation. Anesthesiologists must be prepared for airway emergencies in uncooperative patients, especially children, but there is controversy concerning the use of sedation.
Collapse
Affiliation(s)
- Jack Diep
- From the *Department of Anesthesiology and Perioperative Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; †New Jersey Medical School, Newark, New Jersey; ‡Division of Pediatric Surgery, Hackensack University Medical Center, Hackensack, New Jersey; and §Division of Pediatric Anesthesiology, Hackensack University Medical Center, Hackensack, New Jersey
| | | | | | | |
Collapse
|
14
|
Cho SY, Woo JH, Kim YJ, Chun EH, Han JI, Kim DY, Baik HJ, Chung RK. Airway management in patients with deep neck infections: A retrospective analysis. Medicine (Baltimore) 2016; 95:e4125. [PMID: 27399122 PMCID: PMC5058851 DOI: 10.1097/md.0000000000004125] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Securing the airway in patients undergoing surgical intervention to control a deep neck infection (DNI) is challenging for anesthesiologists due to the distorted airway anatomy, limited mouth opening, tissue edema, and immobility. It is critical to assess the risk of a potential difficult airway and prepare the most appropriate airway management method.We reviewed our anesthetic experiences managing patients with DNIs, focusing on the need for video-laryngoscope or awake fiberoptic intubation beyond a standard intubation from the anesthesiologist's perspective.When patients had infections in the masticatory space, mouth of floor, oropharyngeal mucosal space, or laryngopharynx, their airways tended to be managed using methods requiring more effort by the anesthesiologists, and more extensive equipment preparation, compared with use of a standard laryngoscope. The degree to which the main lesion influenced the airway anatomy, especially at the level of epiglottis and aryepiglottic fold was related to the airway management method selected.When managing the airways of patients undergoing surgery for DNIs under general anesthesia, anesthesiologists should use imaging with computed tomography to evaluate the preoperative airway status and a comprehensive understanding of radiological findings, comorbidities, and patients' symptoms is needed.
Collapse
Affiliation(s)
| | - Jae Hee Woo
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
- Correspondence: Jae Hee Woo, Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 158-710, Korea (e-mail: )
| | | | | | | | | | | | | |
Collapse
|
15
|
Fellini RT, Volquind D, Schnor OH, Angeletti MG, Souza OED. [Airway management in Ludwig's angina - a challenge: case report]. Rev Bras Anestesiol 2015; 67:637-640. [PMID: 26238960 DOI: 10.1016/j.bjan.2014.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 10/08/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ludwig's angina (LA) is an infection of the submandibular space, first described by Wilhelm Frederick von Ludwig in 1836. It represents an entity difficult to manage due to the rapid progression and difficulty in maintaining airway patency, a major challenge in medical practice, resulting in asphyxia and death in 8-10% of patients. OBJECTIVE Describe a case of a patient with Ludwig's angina undergoing surgery, with emphasis on airway management, in addition to reviewing the articles published in the literature on this topic. CASE REPORT Male patient, 21 years, drug addict, admitted by the emergency department and diagnosed with LA. Difficult airway was identified during the anesthetic examination. In additional tests, significant deviation from the tracheal axis was seen. Undergoing bilateral thoracoscopic pleural drainage, we opted for airway management through tracheal intubation using fiberoptic bronchoscopy, and balanced general anesthesia was proposed. There were no complications during the surgical-anesthetic act. After the procedure, the patient remained intubated and mechanically ventilated in the intensive care unit. CONCLUSIONS Airway management in patients with Ludwig's angina remains challenging. The choice of the safest technique should be based on clinical signs, technical conditions available, and the urgent need to preserve the patient's life.
Collapse
Affiliation(s)
- Roberto Taboada Fellini
- Propedêutica Cirúrgica e Anestésica da Universidade de Caxias do Sul, Unidade de Ensino Médico, Caxias do Sul, RS, Brasil; Clínica de Anestesiologia de Caxias do Sul, Caxias do Sul, RS, Brasil
| | - Daniel Volquind
- Propedêutica Cirúrgica e Anestésica da Universidade de Caxias do Sul, Unidade de Ensino Médico, Caxias do Sul, RS, Brasil; Clínica de Anestesiologia de Caxias do Sul, Caxias do Sul, RS, Brasil; Comissão Examinadora do Título Superior em Anestesiologia, Porto Alegre, RS, Brasil.
| | - Otávio Haygert Schnor
- Hospital Santa Rita, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Olívia Egger de Souza
- Propedêutica Cirúrgica e Anestésica da Universidade de Caxias do Sul, Unidade de Ensino Médico, Caxias do Sul, RS, Brasil; Clínica de Anestesiologia de Caxias do Sul, Caxias do Sul, RS, Brasil; Comissão Examinadora do Título Superior em Anestesiologia, Porto Alegre, RS, Brasil; Hospital Santa Rita, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil; Curso de Medicina da Universidade de Caxias do Sul, Caxias do Sul, RS, Brasil
| |
Collapse
|
16
|
Bali RK, Sharma P, Gaba S, Kaur A, Ghanghas P. A review of complications of odontogenic infections. Natl J Maxillofac Surg 2015; 6:136-43. [PMID: 27390486 PMCID: PMC4922222 DOI: 10.4103/0975-5950.183867] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Life-threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. Complications include airway obstruction, mediastinitis, necrotizing fascitis, cavernous sinus thrombosis, sepsis, thoracic empyema, Lemierre's syndrome, cerebral abscess, orbital abscess, and osteomyelitis. The incidence of these "space infections" has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur. This study reviews complications of odontogenic infections. The search done was based on PubMed and Google Scholar, and an extensive published work search was undertaken. Advanced MEDLINE search was performed using the terms "odontogenic infections," "complications," and "risk factors."
Collapse
Affiliation(s)
- Rishi Kumar Bali
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Parveen Sharma
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Shivani Gaba
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Avneet Kaur
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| | - Priya Ghanghas
- Department of Oral and Maxillofacial Surgery, JN Kapoor DAV (C) Dental College and Hospital, Yamunanagar, Haryana, India
| |
Collapse
|
17
|
Management and maintenance of the airway in cervical necrotising fasciitis: a retrospective analysis of 15 cases. Br J Oral Maxillofac Surg 2015; 53:642-6. [PMID: 25981627 DOI: 10.1016/j.bjoms.2015.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 04/18/2015] [Indexed: 11/23/2022]
Abstract
Cervical necrotising fasciitis is a progressive deep infection of the neck associated with high mortality, and skillful management of the airway is critical for operations under general anaesthesia. Tracheostomy under local anaesthesia has been considered the gold standard of airway management in patients with deep neck infections, but it may be difficult or impossible in advanced cases. We report here our experience over 6 years (January 2008 and December 2013) during which a total of 15 patients was diagnosed with cervical necrotising fasciitis. Of 6 patients, admitted between January 2008 and March 2010, 5 had routine tracheostomy under local anaesthesia, 1 had direct laryngoscopy intubation, and 9 who were admitted between Spring 2010 and December 2013 were treated with nasotracheal intubation. Postoperatively all patients were given moderate sedation and analgesia. Nasotracheal intubation was continued until the infection had been controlled. During intubation patency of the endotracheal tube was maintained by humidification with a continuous pump of 0.45% sodium chloride and suction. All 15 patients (10 men and 5 women, mean age 62 years, range 36-93) required an emergency drainage procedure under general anaesthesia. Fourteen of the 15 had evidence of compromise of the airway, but emergency intervention was not required. Since Spring 2010, 9 consecutive patients had required nasotracheal intubation, including 7 video laryngoscopies and 2 fibreoptic bronchoscopies. No other interventions were required. Patients were intubated postoperatively from 3 to 14 days, and there were no problems with the airway. Advanced techniques for control of the airway have a high rate of success in patients with necrotising fasciitis and could be an appropriate alternative to a traditional airway. Postoperative sedation and analgesia should be considered as routine management of pain and anxiety.
Collapse
|
18
|
Severe Hyponatremia due to Phlegmonous Trismus. Case Rep Dent 2015; 2014:320438. [PMID: 25610664 PMCID: PMC4290655 DOI: 10.1155/2014/320438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/09/2014] [Indexed: 11/18/2022] Open
Abstract
We describe a patient with dysphagia and trismus associated with lower jaw inflammation due to phlegmon who developed severe hyponatremia from water intoxication due to excessive water intake after diaphoresis caused by abnormally hot weather. A 63-year-old woman presented with severe swelling of the floor of the mouth and trismus. As she had spasms and numbness of the extremities and restlessness and water intoxication caused by excessive water intake was suspected, she was hospitalized for the treatment of inflammation and electrolyte disorder. Although swelling of the floor of the mouth subsided over time after antimicrobial therapy, vomiting, diarrhea, and numbness of the extremities continued. On day 5 of hospitalization, severe vomiting and diarrhea recurred, and serum sodium levels decreased to 108 mEq/L. Decrease in water intake is essential in the treatment of hyponatremia. However, in patients with severe vomiting and diarrhea who can swallow only liquids because of hot weather and eating disorder, the risk of sodium depletion is high. It is important to restore electrolyte balance and fluid volume through supplementation with sodium, chlorine, potassium, and glucose among others, the reduction of intravenous fluid volume, and diuresis in order to correct the sodium level slowly.
Collapse
|
19
|
Motahari SJ, Poormoosa R, Nikkhah M, Bahari M, Shirazy SMH, Khavarinejad F. Treatment and prognosis of deep neck infections. Indian J Otolaryngol Head Neck Surg 2014; 67:134-7. [PMID: 25621269 DOI: 10.1007/s12070-014-0802-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/13/2014] [Indexed: 11/28/2022] Open
Abstract
Deep neck infections could have serious threats for life of patients, if not noticed adequately. Early diagnosis and correct treatment planning can save the patient's lives and prevent complications of disease extension and also surgical procedures that in some instances may be performed in an emergent situation with higher complication rates. Herein, we have studied 815 cases of deep neck abscesses and infections with especial consideration to treatment and prognosis. In a retrospective case review, we studied 815 cases admitted in our medical center from 1998 until the year 2013. Only patients with abscesses or infections deeper than superficial layer of deep cervical fascia were included in this study, based on the review of their medical records. From 815 cases (485 males and 330 females) surgery was indicated and performed in 428 cases and the rest were treated medically. In cases with dental infections as the etiologic factor, dental procedures were performed as early as possible (extraction in almost all cases). Tracheostomy was performed in five cases. All of the patients in medical treatment group and most of the surgically managed patients were discharged while were stable with relative or complete resolution of their symptoms. One of our patients, a 15 year old boy died with symptoms suggestive for mediastinitis and air way compromise. Early diagnosis and medical management can be effective in treating deep neck infections. Dental infections and also procedures are the major cause in our patients, although tonsillitis and peritonsillar abscess also were important leading causes with almost equal numbers in our series. Extraction of the infected tooth as early as possible while medical treatment is continued can be very helpful. In some cases it may be necessary to perform surgical exploration of the neck more than once, and finally, malignant neoplasia, somewhere in the head and neck should be considered in some cases, as in one of our patients with left side submandibular abscess whose underlying disorder was tongue SCC with neck metastasis. Prognosis can be excellent in both medically and surgically managed groups if started and designed early and promptly.
Collapse
Affiliation(s)
| | - Rostam Poormoosa
- Department of Otolaryngology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Nikkhah
- Department of Otolaryngology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Milad Bahari
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | | |
Collapse
|
20
|
Candamourty R, Venkatachalam S, Babu MRR, Kumar GS. Ludwig's Angina - An emergency: A case report with literature review. J Nat Sci Biol Med 2012; 3:206-8. [PMID: 23225990 PMCID: PMC3510922 DOI: 10.4103/0976-9668.101932] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ludwig's angina is a form of severe diffuse cellulitis that presents an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a state of emergency. Early diagnosis and immediate treatment planning could be a life-saving procedure. Here we report a case of wide spread odontogenic infection extending to the neck with elevation of the floor of the mouth obstructing the airway which resulted in breathlessness and stridor for which the patient was directed to maintain his airway by elective tracheostomy and subsequent drainage of the potentially involved spaces. Late stages of the disease should be addressed immediately and given special importance towards the maintenance of airway followed by surgical decompression under antibiotic coverage. The appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection remains the standard protocol of treatment in advanced cases of Ludwig's angina.
Collapse
Affiliation(s)
- Ramesh Candamourty
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Mahatma Gandhi Medical College and Research Institute Campus, Pillaiyarkuppam, Pondicherry, India
| | | | | | | |
Collapse
|
21
|
Is surgical airway necessary for airway management in deep neck infections and Ludwig angina? J Crit Care 2011; 26:11-4. [DOI: 10.1016/j.jcrc.2010.02.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 02/23/2010] [Accepted: 02/27/2010] [Indexed: 11/20/2022]
|
22
|
Matzelle SJ, Heard AMB, Khong GLS, Riley RH, Eakins PD. A Retrospective Analysis of Deep Neck Infections at Royal Perth Hospital. Anaesth Intensive Care 2009; 37:604-7. [DOI: 10.1177/0310057x0903700411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Serious deep neck infections may result in life-threatening airway complications. The aim of this study was to review the management of patients requiring surgical drainage with deep neck infections and to identify possible factors that may predict a greater risk of airway complications. In this study the authors reviewed the notes of patients requiring surgical drainage of deep neck infections who were admitted to Royal Perth Hospital over a seven-year period (2000 to 2007). One hundred and twenty-nine suitable patients were identified, of whom 15.5% encountered airway complications including one death due to airway obstruction. Airway complications were more common if there was no consultant anaesthetist present (odds ratio 4.01 [confidence interval 1.20 to 13.46], P=0.02). Deep neck infections are still relatively common and are associated with significant morbidity and mortality. Patients with deep neck infections represent an anaesthetic challenge which should be managed by those with an appropriate level of experience.
Collapse
Affiliation(s)
- S. J. Matzelle
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth Western Australia, Australia
| | - A. M. B. Heard
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth Western Australia, Australia
| | - G. L. S. Khong
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth Western Australia, Australia
| | - R. H. Riley
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth Western Australia, Australia
| | - P. D. Eakins
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth Western Australia, Australia
| |
Collapse
|
23
|
Ling KU, Hasan MS, Ha KO, Wang CY. Superficial cervical plexus block combined with auriculotemporal nerve block for drainage of dental abscess in adults with difficult airways. Anaesth Intensive Care 2009; 37:124-6. [PMID: 19157359 DOI: 10.1177/0310057x0903700118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report our use of a superficial cervical plexus block to manage three adults who presented for drainage of dental abscesses. All patients had difficult airways related to severe trismus (preoperative inter-incisor distance < or = 1.5 cm). The first two patients, whose abcesses involved both the submandibular and submasseteric spaces, were managed with combined superficial cervical plexus and auriculotemporal nerve block. In a third patient, a superficial cervical plexus block alone was sufficient because the abscess was confined to the submandibular region. The blocks were successful in all three cases with minimal requirement for supplemental analgesia. We recommend the consideration of superficial cervical plexus block, and if necessary an auriculotemporal nerve block, for the management of selected patients with difficult airways who present for drainage of dental abcesses.
Collapse
Affiliation(s)
- K U Ling
- Department ofAnaesthesia, Faculty of Medicine, University Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | | | | | | |
Collapse
|
24
|
Raval C, Rashiduddin M. Nasal Endotracheal Intubation under Fibreoptic Endoscopic Control in Difficult Oral Intubation, Two Pediatric Cases of Submandibular Abscess. Oman Med J 2009; 24:51-3. [PMID: 22303512 DOI: 10.5001/omj.2009.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 11/03/2008] [Indexed: 11/03/2022] Open
Abstract
Securing an airway in children with trismus is challenging and dangerous. Sound clinical judgment is critical for timing and for selecting the method for airway intervention. We present two pediatric cases of submandibular abscess with difficult oral intubation who underwent incision and drainage. Large facial (jaw) swelling, trismus-limited mouth opening, edema, protruding teeth, and altered airway anatomy makes airway management more difficult. Chances of rupture of abscess intraorally and aspiration under General Anesthesia (GA) is a major threat. Loss of airway under muscle relaxation, difficult to ventilate, difficult to intubate and unwillingness for awake intubation in the pediatric age group makes these cases most challenging. On the basis of our experience, both cases were successfully intubated in anaesthetized, spontaneously breathing children with visual-guided fibreoptic intubation.
Collapse
Affiliation(s)
- Chetan Raval
- Department of Anesthesia, Al Nahdha Hospital, Muscat, Sultanate of Oman
| | | |
Collapse
|
25
|
Rajeev S, Panda NB, Batra YK. Anaesthetic management of Ludwig's angina in pregnancy. Int J Obstet Anesth 2008; 18:96-7. [PMID: 19046866 DOI: 10.1016/j.ijoa.2008.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 08/19/2008] [Indexed: 11/17/2022]
|
26
|
Tanguay J, Pollanen M. Sudden death by laryngeal polyp: a case report and review of the literature. Forensic Sci Med Pathol 2008; 5:17-21. [PMID: 19291432 DOI: 10.1007/s12024-008-9061-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Accepted: 09/26/2007] [Indexed: 11/28/2022]
Abstract
Sudden unexpected death in the context of bizarre or unusual behavior usually relates to acute drug intoxication or excited delirium. We report the case of a man who died suddenly while running naked on a public street. Although the initial death investigation was indicative of excited delirium or drug intoxication, autopsy revealed glottic obstruction by an inflammatory laryngeal polyp. Toxicologic studies were negative and investigation revealed presentation at a hospital the day before death with stridor. It is believed he developed airway obstruction while dressing at home and ran out on the street to find assistance. This case illustrates the importance of a thorough death investigation and a broad differential diagnosis when approaching a forensic autopsy.
Collapse
Affiliation(s)
- Jeff Tanguay
- Provincial Forensic Pathology Unit, Office of the Chief Coroner, Department of Laboratory Medicine and Pathobiology, University of Toronto, 26 Grenville Street, Toronto, ON, Canada M7A 2G9
| | | |
Collapse
|
27
|
Abstract
Ludwig angina remains a potentially lethal disease, rapidly spreading bilateral cellulitis of the submental, sublingual, and submandibular spaces, which bears the threat for rapid airway obstruction. Since the introduction of antibiotics in 1940s, the mortality was reduced significantly. This resulted in the rare occurrence of the disease, leaving many physicians with limited experience of Ludwig angina. Although the occurrence of Ludwig angina in adults is rare, its presence in the pediatric edentulous population is even more uncommon. Because the unfamiliarity with this disease is now increasing, unnecessary delaying diagnosis or inadequate management may occur and may result in serious complications. This presentation will consist of a historical review, discussion of pathophysiology, followed by clinical presentation, etiology, bacteriology, and management. With early diagnosis, airway observation and management, aggressive intravenous antibiotic therapy, and judicious surgical intervention, the disease should resolve without complications. In addition, the source of infection should be determined and eliminated if possible. A thoughtful, individualized management strategy seems to be the most reasonable approach to the disease.
Collapse
|
28
|
Darshane S, Groom P, Charters P. Responsive Contingency Planning: a novel system for anticipated difficulty in airway management in dental abscess. Br J Anaesth 2007; 99:898-905. [DOI: 10.1093/bja/aem302] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
29
|
Karkos PD, Leong SC, Beer H, Apostolidou MT, Panarese A. Challenging airways in deep neck space infections. Am J Otolaryngol 2007; 28:415-8. [PMID: 17980775 DOI: 10.1016/j.amjoto.2006.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Revised: 10/21/2006] [Accepted: 10/27/2006] [Indexed: 10/22/2022]
Abstract
Skilful airway management is critical in deep neck space infections. Although relatively uncommon, this spectrum of disease presents a clinical challenge for otolaryngologists and anesthetists. There is currently no universal agreement on the ideal method of airway control for these patients because this depends on various factors including available local expertise and equipment. We review the literature and discuss the available options of airway management in these head and neck emergencies. Special consideration is given to awake fiberoptic intubation and tracheotomy under local anesthesia. Relevant anatomy, route of spread and microbiology of deep neck space infections are also briefly discussed.
Collapse
|
30
|
Ovassapian A, Tuncbilek M, Weitzel EK, Joshi CW. Airway management in adult patients with deep neck infections: a case series and review of the literature. Anesth Analg 2005; 100:585-589. [PMID: 15673898 DOI: 10.1213/01.ane.0000141526.32741.cf] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Patients with deep neck infections, especially those with Ludwig's angina, may die as a result of airway management mishaps. Skillful airway management is critical, but a safe method of airway control in these patients is yet to be established. We subjected patients with deep neck infections to fiberoptic tracheal intubation by using topical anesthesia to provide general anesthesia for surgical interventions. Patient characteristics and techniques for intubations were recorded on a special data-collection form. Of the 26 patients, 17 had Ludwig's angina, and 9 had other types of deep neck infections. Three patients were tracheally intubated while in the sitting position, 2 in Fowler's position, and 21 in the supine position with the head up 10 degrees-15 degrees. Tracheal intubations were successful in 25 patients: 19 nasally and 6 orally. After surgery, seven patients were kept tracheally intubated, and five patients had tracheostomies. Complications were limited to three cases of mild epistaxis and four oversedations with transient hypoxemia. Twelve patients remembered part of the procedure, and two considered it unpleasant. Tracheal intubation with a flexible bronchoscope by using topical anesthesia is highly successful in adult patients with deep neck infections. Tracheostomy using local anesthesia is recommended if fiberoptic intubation is not feasible, if the clinician is not skillful in the use of awake fiberoptic intubation, or if intubation attempts have failed.
Collapse
Affiliation(s)
- Andranik Ovassapian
- *Department of Anesthesia and Critical Care, the University of Chicago, Chicago Illinois; †Department of Anesthesiology, Northwestern University, Chicago, Illinois, and ‡Department of Otolaryngology and Communication Sciences, Baylor College of Medicine, Houston, Texas
| | | | | | | |
Collapse
|
31
|
Abstract
Ludwig's angina is a serious, often fatal infectious disease process that requires prompt intervention of life-saving therapies. The critical care nurses caring for a patient with Ludwig's angina must be able to recognize subtle changes in the patient's status and intervene quickly to prevent death by airway edema or profound sepsis.
Collapse
Affiliation(s)
- Cindy Little
- AnMed Health, 112 James Lawrence Orr Drive, Anderson, SC 29621-1808, USA
| |
Collapse
|
32
|
Abstract
PURPOSE To discuss the causative factors, clinical course, and current treatment modalities for Ludwig's angina, a submandibular cellulitis, and to raise nurse practitioners' (NPs') awareness of this condition. DATA SOURCES Recent clinical articles, research, case studies, and medical texts. CONCLUSIONS Ludwig's angina may be fatal. Early diagnosis, aggressive antibiotic therapy, and management involving a multidisciplinary team approach are imperative for the patient to progress without complications. IMPLICATIONS FOR PRACTICE Education and awareness are crucial for successful diagnosis of and management of treatment for Ludwig's angina. Although NPs have a limited role in the treatment of Ludwig's angina, their ability to recognize the signs and symptoms will prompt emergency care and treatment and facilitate better outcomes for their clients.
Collapse
|
33
|
Doyle DJ, Arellano R. Upper airway diseases and airway management: a synopsis. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2002; 20:767-87, vi. [PMID: 12512262 DOI: 10.1016/s0889-8537(02)00019-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article summarizes some of the more important upper airway conditions likely to affect airway management. A number of upper airway conditions may present difficult challenges to the anesthesiologist. For instance, infected airway structures may lead to partial airway obstruction, stridor, or even complete airway obstruction. Partial airway obstruction may be mild, as in snoring or nasal congestion, or may be more severe, perhaps requiring the use of airway adjuncts, such as a nasopharyngeal airway. Complete airway obstruction is usually managed by prompt intubation, but surgical airways are sometimes needed as a last resort.
Collapse
Affiliation(s)
- D John Doyle
- Department of General Anesthesiology E31, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | | |
Collapse
|