gangrenous pharyngitis
gan·gre·nous phar·yn·gi·tis
acute necrotising ulcerative gingivitis
A condition characterised by progressive necrosis of intraoral tissues and upper respiratory abscesses, which is seen in those with poor oral hygiene and suboptimal nutrition, often linked to herpes simplex and anaerobic flora—e.g., Fusobacterium spp, spirochetes.Acute necrotizing ulcerative gingivitis (ANUG) appears to be the most appropriate for a polymicrobial (‘fusospirochetal’) gingival infection that most commonly occurs in a back-group of malnutrition, stress and poor oral hygiene; with time the ulcerating or ulceromembranous lesions may spread to the rest of the oral cavity.
It is also a more accurate term for the antiquated Vincent's angina, in which the infection is seated on the soft palate and tonsils.
The microbiological analysis of the lesions of ANUG, given that certain bacteria may cause acute (eg Streptococcus spp) and/or ulceromembranous (eg Corynebacterium diphtheriae) lesions.
“Trench mouth” is a coinage of World War I vintage which attributed ANUG to living in close quarters—i.e., “the trenches”.
Clinical findings
Pain, oedema, punched-out ulcers, pseudomembrane formation, halitosis.
DiffDx
Erythema multiforme, lichen planus, pemphigus, bullous pemphigoid.
Management
H2O2, antibiotics (e.g., tetracycline, if fever or lymphadenopathy), saline mouth rinse, local anaesthetics.