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E1516. Ludwig’s Angina and Other Complications of Dental Infections
Authors
  1. Anju Dubey; State University of New York Downstate Medical Center
  2. Alexandra Perez Perez; State University of New York Downstate Medical Center
  3. Rahul Lazarus; State University of New York Downstate Medical Center
Background
Dental infections can lead to soft tissue infections of the floor of the mouth and neck. For example, Ludwig’s Angina is a cellulitis of the floor of mouth and neck which often results from odontogenic infections. It can result in life-threatening airway compromise due to posterior displacement of the tongue base. Other complications of odontogenic infections include abscess formation, mandibular osteomyelitis, necrotizing fasciitis, and mediastinitis. The purpose of this exhibit is to show examples of the complications of odontogenic infections. After viewing this exhibit the radiologist should become more confident in assessing for these complications.

Educational Goals / Teaching Points
Ludwig’s Angina is a cellulitis of the sublingual space (floor of mouth), submental and submandibular spaces. The most common cause is odontogenic infection, but it can also be caused by peritonsillar abscesses, epiglottitis, and facial trauma. The classical description is cellulitis only, without abscess formation. It can result in fatal airway compromise due to posterior displacement of the tongue base. Signs and symptoms include swelling and induration of the floor of mouth and neck, dysphagia, trismus and respiratory distress. Other complications of odontogenic infections include abscess formation, mandibular osteomyelitis, necrotizing fasciitis, and mediastinitis. It is important to know the complications of odontogenic infections so that one can look carefully for them.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
CT scan with contrast is the preferred imaging modality in adults due to ease of acquisition. The sublingual space and submandibular space are separated by the mylohyoid muscle, but are contiguous posterior to the margin of the mylohyoid muscle. The submandibular space is also contiguous with the anterior aspect of the parapharyngeal space. Infection can spread easily between these spaces. The roots of the 2nd and 3rd molars insert inferior to the mylohyoid muscle, and so infections of these teeth can directly cause infections of the submandibular space. The classical findings of Ludwig's Angina are edema and swelling of the submandibular, sublingual and submental spaces. Abscess formation and lymphadenopathy are less common.

Conclusion
Many soft tissue infections of the face and neck can start with odontogenic infections. This review should make the radiologist more confident in assessing the findings of odontogenic infections and their complications.