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Ludwig’s angina

Definition

Ludwig's angina is an infection of the floor of the mouth under the tongue. It is due to bacteria.

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Alternative Names

Submandibular space infection; Sublingual space infection

Causes, incidence, and risk factors

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

This condition is uncommon in children.

Symptoms

The infected area swells quickly. This may block the airway or prevent you from swallowing saliva.

Symptoms include:

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

Other symptoms that may occur with this disease:

Difficulty swallowing
Drooling
Earache
Speech that is unusual and sounds like the person has a "hot potato" in the mouth

Signs and tests

Your health care provider will do an exam of your neck and head to look for redness and swelling of the upper neck, under the chin.

The swelling may reach to the floor of the mouth. Your tongue may be swollen or out of place.

You may need a CT scan of the neck. A sample of the fluid from the tissue may be sent to the lab to test for bacteria.

Treatment

If the swelling blocks the airway, you need to get emergency medical help right away. A breathing tube through your mouth or nose and into the lungs to restore breathing. You may need to have surgery called a tracheostomy that creates an opening through the neck into the windpipe.

Antibiotics 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 getting treatment to keep the airways open and taking antibiotic medicine.

Complications

Airway blockage
Generalized infection (sepsis)
Septic shock

Calling your health care provider

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

Call your health care provider if you have symptoms of your condition, or if symptoms do get better after treatment.

Prevention

Visit the dentist for regular checkups.

Treat symptoms of mouth or tooth infection right away.

References

Melio FR. Upper respiratory tract infections. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 73.

Christian JM. Odontogenic infections. In: Cummiongs CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 12.

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