From the Guidelines
Ludwig's angina is a severe and potentially life-threatening bacterial infection of the neck and floor of the mouth, requiring immediate medical attention and treatment with intravenous antibiotics, such as penicillin or clindamycin, and possibly surgery to prevent airway obstruction and other serious complications.
Key Characteristics
- The infection typically starts in the teeth or gums and spreads to the soft tissues, causing rapid swelling under the tongue and in the neck.
- Symptoms include neck swelling, pain, difficulty swallowing, and fever, and in severe cases, difficulty breathing.
- Ludwig's angina is a medical emergency that can occur in anyone, but is most common in adults with poor dental hygiene or recent dental procedures.
Diagnosis and Treatment
- The diagnosis of Ludwig's angina is based on clinical signs and symptoms, such as severe neck swelling, pain, and difficulty swallowing, and may be confirmed by imaging studies or laboratory tests 1.
- Treatment typically involves intravenous antibiotics, such as penicillin or clindamycin, and may also include surgery to drain the infection or a breathing tube to protect the airway 1.
- Prompt recognition and treatment are crucial to prevent serious complications, such as airway obstruction, and to reduce the risk of morbidity and mortality.
Importance of Prompt Treatment
- Delayed treatment can lead to serious complications, including airway obstruction, which can be life-threatening.
- Prompt treatment with intravenous antibiotics and surgery, if necessary, can help to reduce the risk of complications and improve outcomes 1.
- It is essential to seek medical attention immediately if symptoms of Ludwig's angina occur, as prompt treatment can make a significant difference in preventing serious complications and improving quality of life.
From the Research
Definition and Characteristics of Ludwig's Angina
- Ludwig's angina is a severe diffuse cellulitis that presents with an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual, and submental spaces, resulting in a state of emergency 2, 3.
- It is a potentially deadly condition that must not be missed in the emergency department (ED) 4.
- The infection can cause elevation of the floor of the mouth, obstructing the airway, and resulting in breathlessness and stridor 2, 3.
Causes and Risk Factors
- Ludwig's angina often results from an odontogenic infection, which can be caused by various aerobic and anaerobic microorganisms, including oral flora such as streptococci and staphylococci 5.
- It occurs more commonly in those with poor dentition or immunosuppression 4.
Symptoms and Diagnosis
- Patients may present with a woody or indurated floor of the mouth, submandibular swelling, trismus, and respiratory distress 4, 6.
- Computed tomography of the neck soft tissue with contrast is preferred for diagnosis, and point-of-care ultrasound can be a useful adjunct 4.
- Early recognition and diagnosis are crucial to prevent mortality and morbidity 5.
Treatment and Management
- The standard protocol of treatment in advanced cases of Ludwig's angina includes the appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection 2, 3.
- Emergent consultation to anesthesia and otolaryngology may be helpful if a definitive airway is required, and the first line approach for airway intervention is flexible intubating endoscopy with preparation for a surgical airway 4.
- Early accurate diagnosis with conservative surgical decompression can be vital to avoiding mortality 6.