CELLULITIS

• Diffuse inflammation of soft tissues which is not

circumscribed or confined to one area.

• It tends to spread through tissue spaces and along facial

planes.

• Large amount of Streptokinase, hyaluronidase and

fibrinolysins released by microorganisms cause breakdown of
tissue.

• Streptococci and staphylococci frequently give rise to

cellulitis.

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 Causes of face and neck cellulitis

1. Dental infection
2. Periodontal infection
3. Osteomyelitis
4. Pericoronitis

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 Clinical features
• Fever
• Local lymph nodes are palpable
• Diffuse swelling
• Swelling is painful

• In case of superficial tissue space involvement skin appears

inflamed and purplish.
• In case of deep tissue space involvement skin appears normal.
• Skin appears stretched and shiny.
• Firm and brawny on palpation
• Swelling may cause Facial asymmetry

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 Histologic features
• Diffuse spread of inflammatory cells.

• Polymorphonuclear leukocytes in majority and some

lymphocytes.

• Serous fluid which causes separation of fibrin and muscles.

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 Treatment

• Removal of the cause of the infection

• Administration of antibiotics

Complications
• Abscess formation
• Gangrene
• Toxemia and septicemia
• Cellulitis may precipitate ketoacidosis in diabetics.

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S. No. Characteristics Cellulitis Abscess
1. Duration Acute phase Chronic phase
2. Pain Severe and generalized Localized
3. Size Large Small
4. Localization Diffuse borders Well circumscribed
5. Palpation Doughy to indurated Fluctuant
6. Presence of pus No Yes
7. Degree of seriousness Greater Less
8. Bacteria Aerobic Anaerobic/mixed

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 LUDWIG’S ANGINA
• Is a serious, potentially life-threatening cellulitis

• Severe cellulitis, beginning usually in the submaxillary space

and secondarily involving the sublingual and submental space
as well.

• True ludwigs angina when all submandibular space are

involved.

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• This space is bounded superiorly by the floor of mouth
mucosa and inferiorly by the superficial layer of the deep
cervical fascia as it extends from the hyoid bone to the
mandible.

• This space is sub-divided by the mylohyoid muscle into two

spaces: the submaxillary space below the mylohyoid and the
sublingual space above.
• Cellulitis typically spreads superiorly from the submaxillary
space to the sublingual space producing firm induration of the
floor of mouth, elevation and posterior displacement of the
tongue, and insidious airway compromise.
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 Etiology
1. Chief source of infection is mandibular molars (2nd and 3rd)
• When an infection perforates bone to establish drainage, it seeks
the path of least resistance.
• Since the outer cortical plate of mandible is thick in the molar
region, the lingual plate is more commonly perforated.
• Root apices of mandibular 1st molar are above the mylohyoid ridge
– infection of sublingual space.
• Root apices of mandibular 2nd and 3rd molar are below the
mylohyoid ridge- infection of submaxillary space
2. Any penetration injury in the floor
of the mouth (gun shot, stab
wound)
3. Osteomyelitis from mandible
fracture.
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 Clinical features
• Rapidly developing swelling of the floor of the mouth.
• Swelling is firm, painful and diffuse.
• Elevation of tongue
• Board like swelling on palpation
• Difficulty in eating, swallowing (dysphagia), breathing
• Dysphonia – difficulty in speaking ("hot potato mouth"),
• Odynophagia
• Drooling
• Trismus

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• High fever

• Rapid pulse

• Fast respiration

• As the disease continues swelling involves neck and glottis.

• May cause of death by suffocation.

• Cavernous sinus thrombosis

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 Treatment

• Airway maintenance should be the primary concern in

Ludwig’s angina.
• Tracheotomy may have to be done in emergency cases.
• The cornerstone of medical management is antibiotic agents
active against streptococcus, staphylococcus, and anaerobic
species.
• Penicillin has been commonly used; however, various
combinations of penicillins, aminoglycosides,
chloramphenicol, and metronidizole have been employed.

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