Ludwig’s angina

• Alternative Names

  Submandibular space infection; Sublingual space infection

• Causes, incidence, and risk factors

  Ludwig's angina is a type of cellulitis that involves inflammation of the tissues of the floor of the mouth, under the tongue. It often occurs after an infection of the roots of the teeth (such as tooth abscess) or a mouth injury.

  This condition is uncommon in children.

• Symptoms

  Swelling of the tissues occurs rapidly and may block the airway or prevent swallowing of saliva.

  Symptoms include:

  • Breathing difficulty
  • Confusion or other mental changes
  • Fever
  • Neck pain
  • Neck swelling
  • Redness of the neck
  • Weakness, fatigue, excessive tiredness

  Additional symptoms that may be associated with this disease:

  • Drooling
  • Earache
• Signs and tests

  An examination of the neck and head shows redness and swelling of the upper neck, under the chin. The swelling may reach to the floor of the mouth. The tongue may be swollen or out of place.

  A CT scan of the neck may be recommended. Culture of fluid from the tissues may show bacteria.

• Treatment

  If the swelling blocks the airway, emergency medical help is needed to maintain an open airway. This may involve placing a breathing tube through the mouth or nose and into the lungs, or surgery called a tracheostomy that creates an opening through the neck into the windpipe.

  Antibiotics, usually penicillin or a penicillin-like medication, are given to fight the infection. They are usually given through a vein until symptoms go away. Antibiotics taken by mouth may be continued until tests show that the bacteria have gone away.

  Dental treatment may be needed for tooth infections that cause Ludwig's angina.

  Surgery may be needed to drain fluids that are causing the swelling.

• Expectations (prognosis)

  Ludwig's angina can be life threatening. However, it can be cured with proper protection of the airways and appropriate antibiotics.

• Complications
  • Airway blockage
  • Generalized infection (sepsis)
  • Septic shock
• Calling your health care provider

  Breathing difficulty is an emergency situation. Immediately go to the emergency room or call your local emergency number (such as 911).

  Call your health care provider if you have symptoms of this condition, or if symptoms do not improve after treatment.

• Prevention

  Regular visits to the dentist, and prompt treatment of mouth or tooth infections can prevent the conditions that increase the risk of developing Ludwig's angina.

Review Date: 3/2/2009

Reviewed By: Daniel Levy, MD, PhD, Infectious Diseases, Greater Baltimore Medical Center, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.