Effect of Surgical Versus Pharmacological Decompression of Ludwig’s Angina on Airway Compromise among Nigerian Patients

2020 ◽  
Author(s):  
Ekaniyere EB
Keyword(s):  
Length Of Hospital Stay ◽  
Surgical Decompression ◽  
Airway Compromise ◽  
Inclusion Criteria ◽  
Hospital Stays ◽  
Ludwig’S Angina ◽  
The Mean ◽  
The University ◽  
Ludwig's Angina ◽  
Gender Type

Background: Even though the decompression of the cellulitis phase of Ludwig’s angina (LA) by surgical or pharmacological approach is well documented, it is unclear which approach is more effective. Objective: We aim to compare the outcome of treatment between surgical versus pharmacological decompression in patients with LA. Subjects and Methods: A retrospective cohort study was designed. Data were collected from the case notes of patients that met the inclusion criteria from 2004 to 2018 at the University of Benin Teaching Hospital, Nigeria.The data were age, gender, type of decompression approach, length of hospital stay (LOS) and airway compromise. Result: A total of 62 patients comprising 37(59.7%) surgical decompression group and 25(40.3%) pharmacological decompression group were studied. Thirty-six (58.1%) males and 26 (41.9%) females were studied. Their mean age and standard deviation were 40.6 years and 11.9 years respectively. The mean length of hospital stays between the pharmacological and surgical decompression groups were 8.05 days and 13.8 days respectively. The incidence of airway compromise in the surgical decompression group was 19.9% lower than that of the pharmacological decompression group (P=0.47), which was not significant. The type of decompression approach also failed to influence the incidence of airway compromise (P = 0.41). Conclusion: The use of surgical versus pharmacological decompression does not significantly alter the incidence of airway compromise in the management of LA. The Patients that had surgical decompression had a shorter stay in the hospital as compared to those who had pharmacological decompression. This was not statistically significant.

scholarly journals Comparison of Outcomes in Conservative versus Surgical Treatments for Ludwig’s Angina

2018 ◽  
Vol 27 (4) ◽  
pp. 362-366 ◽  
Author(s):  
Benlance Ekaniyere Edetanlen ◽  
Birch Dauda Saheeb
Keyword(s):  
Early Stage ◽  
Statistical Tests ◽  
Surgical Decompression ◽  
Airway Compromise ◽  
Conservative Group ◽  
Intravenous Antibiotics ◽  
Cohort Study Design ◽  
Ludwig’S Angina ◽  
Level Of Significance ◽  
Ludwig's Angina

Objective: To compare the treatment outcomes in patients with early stage Ludwig’s angina who received intravenous antibiotics alone with those who received surgical decompression and intravenous antibiotics. Subjects and Methods: Individuals with early stage Ludwig’s angina were studied using a retrospective cohort study design from August 1997 to September 2017. Data were collected from case notes and logbooks. Appropriate statistical tests were chosen to analyze both the independent and outcome variables. Using 2-tailed test, a level of significance of 0.05 was chosen. Results: A total of 55 patients comprising 38 (69.1%) males and 17 (30.9%) females were studied. The conservative group had a higher number of cases that developed airway compromise (26.3%) when compared to those with surgical approach (2.9%). There was an association between the treatment approach and the development of airway compromise (χ2[1] = 4.83, p = 0.03). Conclusion: There was a higher incidence of airway compromise in patients treated with intravenous antibiotics alone than in those treated with surgical decompression and intravenous antibiotics.

scholarly journals Staged Bilateral Hip or Knee Arthroplasties

2007 ◽  
Vol 15 (2) ◽  
pp. 159-162 ◽  
Author(s):  
FR Hashmi ◽  
K Barlas ◽  
CF Mann ◽  
FR Howell
Keyword(s):  
Hospital Admission ◽  
Hospital Stay ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Complication Rates ◽  
Early Complication ◽  
Early Complications ◽  
Hospital Stays ◽  
The Mean

Purpose. To compare the operating time, amount of blood transfused, length of hospital stay, and early complications (within 6 months) between 2-week staged bilateral arthroplasties and matched randomised controls undergoing unilateral arthroplasties. Methods. From October 1992 to October 2000, 90 patients who underwent bilateral hip or knee arthroplasties with a 2-week interval were compared with matched randomised controls undergoing unilateral arthroplasties. A single surgeon performed all procedures. Results. After the match-up process, 30 pairs of patients were included in the analysis. There were no significant differences in the operating times, amount of blood transfused, and early complication rates. The mean difference in length of hospital stay was significant ( t= −3.552, df=29, p<0.001). Conclusion. Compared to staged procedures with an interval months apart, staged sequential arthroplasty with a 7- to 10-day interval during one hospital admission is more efficient, as it facilitates earlier rehabilitation without higher complication rates, and entails shorter hospital stays.

scholarly journals Ludwig's Angina: Report of 40 Cases and Review of Current Concepts in Emergency Management in a Rural Tertiary Facility Teaching Hospital

2017 ◽  
Vol 8 (1) ◽  
pp. 11-14
Author(s):  
S Kumar ◽  
M Ambikavathy
Keyword(s):  
Emergency Management ◽  
Teaching Hospital ◽  
Treatment Protocol ◽  
Underlying Disease ◽  
Surgical Decompression ◽  
Facial Trauma ◽  
Duration Of Symptoms ◽  
Submandibular Duct ◽  
Ludwig’S Angina ◽  
Ludwig's Angina

ABSTRACT Objective To review the current protocols and assess their efficacy in the emergency management of cases presenting with Ludwig's angina. Materials and methods A retrospective study of patients diagnosed with Ludwig's angina, admitted and treated in our institution between November 2007 and December 2012. Results There were 40 cases with 24 males (60%) and 16 females (40%), ages ranged between 16 and 80 years. Duration of symptoms was between 3 days and 2 weeks. The most common cause was dental infections seen in 23 cases (57.5%), one of them was a pregnant lady. Six were due to habitual tooth pricking with a broom stick (15%). In 3 patients it was due to submandibular duct stenosis secondary to calculi (7.5%). Five patients had diabetes as underlying disease (12.5%). Facial trauma contributed in 2 patients (5%) and in 1 patient it was due to carcinoma buccal mucosa (2.5%). All the patients were treated with systemic broad spectrum antibiotics, intravenous fluids, and analgesics. Twenty patients (50%) underwent tracheostomy with surgical decompression through small incisions under local/ general anesthesia. Ten patients (25%) were subjected to incision and drainage with subsequent removal of the diseased teeth. Ten patients (25%) were managed conservatively with antibiotics, analgesics, and under close supervision for airway compromise. There were no complications recorded and no mortality. Conclusion Ludwig's angina is a life-threatening surgical emergency. Early diagnosis and immediate surgical intervention can save lives. The appropriate use of parenteral antibiotics complemented with airway protection and surgical decompression remains the standard treatment protocol in advanced cases of Ludwig's angina. How to cite this article Ambikavathy M, Kumar S. Ludwig's Angina: Report of 40 Cases and Review of Current Concepts in Emergency Management in a Rural Tertiary Facility Teaching Hospital. Int J Head Neck Surg 2017;8(1):11-14.

scholarly journals “Air” on the side of caution: The importance of early recognition and intervention in Ludwig’s angina

2018 ◽  
Vol 5 (3) ◽  
pp. 40
Author(s):  
Sallie M. Long ◽  
Talha Demirci ◽  
Stacy R. Kruse
Keyword(s):  
Surgical Intervention ◽  
Early Recognition ◽  
Morbidity And Mortality ◽  
Deep Neck Infection ◽  
Airway Compromise ◽  
Significant Morbidity ◽  
Neck Infection ◽  
Ludwig’S Angina ◽  
Basic Treatment ◽  
Ludwig's Angina

Ludwig’s angina is a deep neck infection of the supramylohyoid and inframylohyoid spaces. Without prompt recognition and intervention, it can progress to airway compromise with significant morbidity and mortality. Although otolaryngologists and oral surgeons are well-versed in this condition, it is vital that physicians across all specialties are knowledgeable about the presentation and basic treatment of this potentially fatal condition. Here we report a case of Ludwig’s angina in a 29-year-old male that was successfully managed with both medical and surgical intervention. We also aim to describe the presentation and treatment of Ludwig’s angina in order to increase awareness in non-surgical fields.

scholarly journals Ludwig’s Angina: Emergency Treatment

2017 ◽  
Vol 8 (1) ◽  
pp. 46-48
Author(s):  
KA Kamala, ◽  
Sankethguddad S ◽  
Sujith SG
Keyword(s):  
Early Diagnosis ◽  
Treatment Planning ◽  
Emergency Treatment ◽  
Acute Onset ◽  
Surgical Decompression ◽  
State Of Emergency ◽  
Life Saving ◽  
Ludwig’S Angina ◽  
Antibiotic Coverage ◽  
Ludwig's Angina

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 Ludwig’s angina successfully treated by surgical decompression under antibiotic coverage. How to cite this article Kamala KA, Sankethguddad S, Sujith SG. Ludwig’s Angina: Emergency Treatment. J Health Sci Res 2017;8(1):46-48.

scholarly journals Comparative study of the outcome of surgical decompression in Ludwig’s angina by conventional skin incision versus multiple interrupted skin incisions

2020 ◽  
Vol 6 (11) ◽  
pp. 2054
Author(s):  
Kulkarni Manik Rao ◽  
Navneeth T. P. ◽  
Vivek S. ◽  
Sonu S. Rathod
Keyword(s):  
Hospital Stay ◽  
Skin Incision ◽  
Conventional Group ◽  
Female Ratio ◽  
Life Threatening ◽  
Common Etiology ◽  
Ludwig’S Angina ◽  
The Mean ◽  
Male To Female ◽  
Ludwig's Angina

<p class="abstract"><strong>Background:</strong> Ludwig’s angina is a potentially life threatening infection characterized by a rapidly progressing, bilateral gangrenous cellulitis of all the three primary mandibular spaces namely submental, submandibular and sublingual. If left untreated the cellulitis can progress swiftly to produce obstruction of airway and death. Despite that, no specific guidelines exist and management is greatly dependent on clinical judgement and experience.</p><p class="abstract"><strong>Methods:</strong> Forty cases of patients with Ludwig’s angina, attending the department of otorhinolaryngology were included in this study and were randomly allocated into conventional incision (CI) and multiple incisions (MI) groups. Following informed written consent, either conventional incision or multiple small incisions were used for drainage and the outcomes analysed.  </p><p class="abstract"><strong>Results:</strong> The mean age of patients was 28.4 years and majority of the patients belonged to 20-40 years age group. Male to female ratio was 2.3:1.The most common etiology was odontogenic. The outcome of both the conventional group and multiple small incisions group were comparable. The mean hospital stay of the conventional group was 10.25 days and multiple incisions group was 5.31 days which was statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> Multiple small incisions for the drainage of Ludwig’s angina is a safe and less invasive alternative method, with the advantages being shorter hospital stay and better cosmesis without an increase in complications.</p>

scholarly journals Comparison between open and laparoscopic elective cholecystectomy in elderly, in a teaching hospital

2016 ◽  
Vol 43 (1) ◽  
pp. 2-5 ◽  
Author(s):  
Cássio Padilha Rubert ◽  
Roberta Alves Higa ◽  
Fabiano Vilas Boas Farias
Keyword(s):  
Hospital Stay ◽  
Conversion Rate ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Mato Grosso ◽  
Significant Difference ◽  
Stay Time ◽  
Hospital Stays ◽  
The Mean ◽  
Mato Grosso Do Sul

Objective: to analyze the differences in mortality rates, length of hospital stay, time of surgery and the conversion rate between elective open cholecystectomies (OC) and laparoscopic ones (LC) in elderly patients. Methods : we evaluated medical records of patients 65 years of age or older undergoing open or laparoscopic cholecystectomy at the Hospital Regional de Mato Grosso do Sul between January 2008 and December 2011. We excluded individuals operated in non-elective scenarios or who underwent intraoperative cholangiography. Results : we studied 113 patients, of whom 38.1% were submitted to the OC and 61.9%, to LC. Women accounted for 69% of patients and men, for 31%. The conversion rate was 2.9%. The mean age and duration of the procudure was 70.1 and 84 minutes, respectively, with no significant difference between OC and LC. Patients undergoing LC had shorter hospital stays (2.01 versus 2.95 days, p=0.0001). We identified operative complications in sixpatients (14%) after OC and in nine (12%) after LC, with no statistical difference. Conclusion : there was no difference in morbidity and mortality when comparing OC with LC. The laparoscopic approach led to shorter hospital stay. Operative time did not differ between the two access routes. The conversion rate was similar to other studies.

scholarly journals Comparison of surgical vs. non-surgical closure procedures for secundum atrial septal defect

2013 ◽  
Vol 53 (2) ◽  
pp. 108 ◽  
Author(s):  
Mazdar Helmy ◽  
Mulyadi M. Djer ◽  
Sudung O. Pardede ◽  
Darmawan B. Setyanto ◽  
Lily Rundjan ◽  
...  
Keyword(s):  
Transcatheter Closure ◽  
Length Of Hospital Stay ◽  
Surgical Closure ◽  
Lower Complication ◽  
Hospital Stays ◽  
Transcatheter Devices ◽  
The Mean ◽  
Asd Closure ◽  
Diopulmonary Bypass ◽  
Mean Cost

Backgi-ound Surgery has been the standard therapy for secundumatrial septa! defect (ASD) closure, but it has significant associatedmorbidities related to st ernotomy, car diopulmonary bypass,complications, residual scars, and trauma. A less invasive nonsurgicalapproach with transcatheter devices was developed toocclude ASD. Amplatzer® septa! occluder (ASO) is a commondevice in transcatheter closure.Objective To compare two secundum ASD closure procedures,transcatheter closure by ASO and surgical closure, in terms ofefficacy, complications, length of hospital stay, and total costs.Methods A retrospective analysis was performed on childrenwith secundum ASD admitted to the Cardiology Center ofCipto Mangunkusumo Hospital from January 2005 to December2011. Patients received either transcatheter closure with ASOor surgical closure procedures. Data was obtained from patients'medical records.Results A total of 112 secundum ASD cases were included in thisstudy, consisting of 42 subjects who underwent transcatheter closureprocedure by ASO and 70 subjects who underwent surgical closureprocedure. Procedure efficacies of surgery and ASO were not significantlydifferent (98.6% vs 95.2%, respectively, P= 0.555). However,subjects who underwent surgical procedures had significantly morecomplication s than subjects who underwent transcatheter closureprocedure (60% vs 28.6%, respectively, OR 1.61; 95%CI 1.19 to2.18; P= 0.001). Hospital stays were also significantly longer forsurgical patients than for transcatheter closure patients (6 days vs2 days, respectively, P< 0.0001). In addition, all surgical subjectsrequired intensive care. Transcatheter closure had a mean total costof 52.7 (SD 6.7) million Rupiahs while the mean cost of surgery was47 (SD 9.2) million Rupiahs (P< 0.0001) . Since the ASO devicecost represented 58% of the total cost of transcatheter closure, themean cost of transcatheter closure procedure without the deviceitself was less costly than surgery.Conclusion Transcatheter closure using ASO has a similar efficacyto that of surgical closure procedure. However, subjects whounderwent transcatheter closure have lower complication ratesand shorter length ofhosp ital stays than subjects who had surgery,but transcatheter closure costs are higher compared to the surgicalprocedure.

scholarly journals An Unusual Presentation of Ludwig’s Angina Complicated by Cervical Necrotizing Fasciitis: A Case Report and Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Kristelle Chueng ◽  
David J. Clinkard ◽  
Danny Enepekides ◽  
Yousef Peerbaye ◽  
Vincent Y. W. Lin
Keyword(s):  
Elderly Patient ◽  
Case Report ◽  
Literature Review ◽  
Necrotizing Fasciitis ◽  
Disease Process ◽  
Unusual Presentation ◽  
Airway Compromise ◽  
Review Of The Literature ◽  
Ludwig’S Angina ◽  
Ludwig's Angina

Ludwig’s angina can seldom be complicated by necrotizing fasciitis. Due to the rapidly progressing nature of this infection and the potential for airway compromise and death, it is important to be aware of different ways in which this disease process can present in order to recognize and treat it emergently. We report here an unusual presentation of a case of Ludwig’s angina complicated by necrotizing fasciitis in an elderly patient. The clinical features, diagnosis, and treatment are discussed in detail as well as a brief literature review on craniocervical necrotizing fasciitis.

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