Transmigrated impacted mandibular canine: Cause of Ludwig’s angina

Abstract

Intraosseous migration of unerupted teeth across the midline is a rare phenomenon known as dental transmigration. The term transmigration was coined by Ando et al in 1964. Transmigration was defined as a phenomenon of the movement of unerupted canine through the midline by Tarsitano et al. Intraosseous migration involving the canine is commonly called transmigration because the affected canine moves mesially across the mandibular symphysis to the opposite side of the mandible. Impaction of maxillary canines is more prevalent, whereas transmigration is seen more commonly in the mandible.Transmigrated canines usually remain asymptomatic, or at times may be chronically infected, also causing pressure resorption of the roots of adjacent teeth. Transmigrated mandibular canine mostly occur unilaterally but some cases of bilateral occurrence also had been reported. It is more frequently found in females as compared to males in the ratio of 1.6:1. Due to its un-favourable position, repositioning by orthodontic means is rarely indicated and since transmigrated mandibular canine may also develop pathology associated with it, transalveolar extraction is mostly indicated. If the impacted tooth is chronically infected, the foci of odontogenic infection may also lead to diffuse cellulitis, in the form Ludwig’s angina. The condition bilaterally affects the submandibular, sublingual, and the submental spaces, causing elevation of the floor of the mouth, obstruction of the airway and stridor. It presents as a medical emergency, requiring immediate surgical intervention, under antibiotic coverage. The present study discusses a case of 63 years old patient presenting with Ludwig’s angina with an odontogenic cause of infection- being the transmigrated, impacted mandibular canine.