EXTRA-CARDIAC MANIFESTATIONS OF LUDWIG'S ANGINA

Abstract

Introduction: Ludwig's angina is a serious soft tissue infection of the neck, often caused by a dental or oropharyngeal infection that spreads to the submandibular and sublingual spaces. This condition is characterized by bilateral edema, which can rapidly progress to life-threatening airway obstruction. Extensive tissue involvement and the potential for serious complications, such as sepsis and neurological impairment, make Ludwig's angina a significant challenge for healthcare professionals. An effective therapeutic approach requires a combination of intensive antibiotic treatment, respiratory support, and often surgical intervention to manage complications. Objective: The objective of this systematic literature review was to analyze the clinical approach and management strategies for Ludwig's angina, focusing on clinical manifestations, treatment, and associated complications. We sought to identify effective practices and outcomes of interventions, highlighting recent advances and evidence-based recommendations. Methodology: The methodology followed the PRISMA checklist to ensure transparency and quality of the review. The PubMed, Scielo and Web of Science databases were used to search for relevant articles published in the last 10 years. The five descriptors selected were "Ludwig's angina", "cervical infection", "respiratory complications", "antibiotic treatment" and "abscess drainage". The inclusion criteria were: peer-reviewed articles, studies that focused on the treatment and management of Ludwig's angina and publications in English or Portuguese. Articles that did not specifically address Ludwig's angina, case studies with few participants and research published before the 10-year period were excluded. Results: The results revealed that Ludwig's angina remains a highly serious medical condition, with a prognosis highly dependent on the speed and effectiveness of treatment. Airway obstruction, extensive cervical edema and the risk of systemic dissemination were identified as the main challenges. Effective treatment usually includes broad-spectrum antibiotics, immediate respiratory support and, when necessary, surgical drainage of abscesses. Recent studies have emphasized the importance of early intervention to improve prognosis and reduce mortality. Conclusion: The systematic review highlighted the severity of Ludwig's angina and the need for a multidisciplinary therapeutic approach. Effective management requires a combination of antibiotic treatment, respiratory support, and surgical interventions to resolve complications such as airway obstruction and systemic infection. Evidence suggests that early detection and prompt treatment are crucial to improve clinical outcomes and reduce associated mortality. Therefore, Ludwig's angina requires urgent attention and a well-established treatment protocol to ensure successful recovery of patients.