Ludwig’s angina
Overview
Ludwig’s angina is a rapidly progressive, often bilateral cellulitis of the floor of the mouth involving the submandibular (submaxillary), sublingual and submental spaces. It is most commonly odontogenic (≈60-70%) and can quickly produce tongue elevation and posterior displacement, causing life‑threatening upper airway obstruction.
Although uncommon, it is time‑critical: immediate airway planning, early senior and surgical escalation, and prompt source control are essential.
Aetiology and microbiology
- Most cases arise from infected mandibular molar teeth that spread into the sublingual and submandibular spaces. Other causes include extension from parapharyngeal or peritonsillar infections, mandibular trauma, salivary duct obstruction (sialolithiasis), oral penetrating trauma or post‑procedural infection.
- The infection is typically polymicrobial with mixed aerobic and anaerobic oral flora (streptococci, anaerobes, staphylococci and some Gram‑negative organisms).
- Culture of pus and blood where possible informs definitive therapy; empiric treatment must cover anaerobes as well as common oral aerobes.
Clinical features
Presentation reflects local soft‑tissue infection and evolving airway compromise.
Local symptoms
- Severe tooth or oral pain (often lower molars).
- Progressive submandibular and submental swelling.
- Dysphagia, odynophagia, drooling and trismus.