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Year: 2004  Vol. 8   Num. 3  - July/Sept Print:
Original Article
Texto Text in Portuguese
Ludwig.s Angina: Minimally Invasive Surgical Treatment Guided by Cervical Ultrasonography
Angina de Ludwig: Tratamento Cirrgico Minimamente Invasivo e Guiado por Ultra-sonografia Cervical
Author(s):
Marcelo Miguel Hueb*, Luiz Marcondes Borges **, Leonardo Rodrigues de Oliveira***.
Key words:
Ludwigs angina, surgical treatment, ultrasonography.
Abstract:

Introduction: Ludwigs angina is an infectious and inflammatory condition that involves the floor of the mouth and the neck, with marked tissue swelling, causing severe respiratory distress, trismus, dysphagia, toxemia and occasionally having a fatal evolution. The etiology is generally associated with root infecctions or extractions or oral traumas and the microbiology is usually of mixed flora. The diagnosis is eminently clinical and plain films and computed tomography are the image evaluations of choice; ultrasonography is less used. The treatment consists mainly of mantainance of a patent airway, early antibiotic therapy, fluid reposition and eventually, aggressive surgical procedures in cases of unfavorable evolution. Objective: Review the authors experience in the surgical treatment of 14 cases of Ludwigs angina complicated with cervical abscesses between 1998 and 2002 using a minimally invasive cervical drainage technique guided by ultrasonography. Methods: The image evaluation consisted of cervical ultrasonography and the surgical procedure consisted of drainage with minimal and localized incisions guided by the ultrasonography. Results: The results found showed an evident diagnostic and therapeutic effectiveness of the method in 13 patients. Tracheostomy was performed in only one patient. Conclusions: Ultrasonography was found to be a highly accessible, dynamic and reliable method of diagnosis, easily repeatable and without radiation. The minimally invasive surgical procedure guided by the ultrasonography was found not to be aggressive, cosmetic or functionally disfavorable, while being fast and safe, with a very low cost, without adding morbidity and mortality to this pathology.

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