Presentation, Characteristics, and Management of Dysphagia in Patients with Ludwig's Angina

摘要

Ludwig's angina is a rare clinical condition characterized by bilateral swelling of the sublingual and submandibular spaces. Although dysphagia is reported to occur in 44% to 83% of patients with this condition, there are no reports in the literature describing the nature of the dysphagia or its management. Therefore, the aim of this study was to provide descriptive information regarding the presentation and characteristics of dysphagia in this clinical population. A retrospective chart audit of 26 patients with Ludwig's angina revealed that speech pathology was involved with only 42% of patients, specifically those patients with more severe infection. Dysphagia severity at initial assessment revealed mild to severe impairments, with 36% of patients placed nil per os at their first assessment. Patients present with oropharyngeal dysphagia caused by extensive edema, impacting on bolus control, mastication, bolus transit, and airway protection. The presence of a tracheostomy tube had further negative impact on swallowing for some individuals. Management involved repeated clinical swallow assessments and compensatory management techniques to maximize swallow safety and comfort. Recovery is rapid, although the majority of patients are discharged on modified food textures because of residual swelling. The current data provide the first descriptive information on dysphagia and its management in patients with this rare clinical condition.