What is Ludwig's angina?

From the Guidelines

Ludwig's angina is a severe and potentially life-threatening bacterial infection of the floor of the mouth and neck, characterized by rapidly spreading cellulitis that can cause severe swelling and airway obstruction. This condition is listed as a potential complication of mouth piercings, along with other issues such as airway compromise, gingival trauma, and infection 1. The infection typically starts from an infected lower tooth and can quickly progress to obstruct the airway, making prompt treatment crucial. Key symptoms include pain, swelling of the floor of the mouth, difficulty swallowing, drooling, and voice changes.

Important Considerations

• The infection spreads through the fascial planes rather than forming a discrete abscess, which makes it particularly dangerous.
• Patients with diabetes, immunocompromised conditions, or poor dental hygiene are at higher risk.
• Treatment requires immediate hospitalization for intravenous antibiotics, surgical drainage of any abscesses, and possibly emergency airway management if breathing is compromised.
• The mortality rate has decreased significantly with modern antibiotics and surgical techniques, but Ludwig's angina remains a medical emergency requiring immediate attention. Some of the key points to consider in the management of Ludwig's angina include:
• Prompt recognition and treatment to prevent airway obstruction and other complications
• The use of intravenous antibiotics, such as penicillin G or clindamycin, to treat the underlying infection
• Surgical drainage of any abscesses to help reduce swelling and promote healing
• Close monitoring of the patient's airway and respiratory status, with emergency intervention if necessary to ensure adequate oxygenation and ventilation.

From the Research

Definition and Characteristics of Ludwig's Angina

• Ludwig's angina is a severe cellulitis that involves the submandibular space, submental space, and sublingual space 2.
• It is characterized by brawny induration of the submental region and floor of mouth, with the potential for rapid airway obstruction 3.
• The condition presents with symptoms such as bilateral diffuse neck swelling, edema of the floor of the mouth, pain, fever, trismus, foul-smelling pus discharge, difficulty in swallowing, airway edema, and tongue displacement 2.

Causes and Risk Factors

• The main causative factors of Ludwig's angina include dental infections, such as dental caries with atypical periodontitis, pericoronitis, and dental procedures 2.
• Other predisposing conditions include poor dental hygiene, dental caries, malnutrition, diabetes mellitus, AIDS, and various other immunocompromised states 2.
• The condition can also be associated with other factors, such as COVID-19 infection 4, and can lead to complications like necrotizing fasciitis, septicemia, and acute myocardial infarction 2, 5.

Diagnosis and Treatment

• Early diagnosis and aggressive management are crucial in treating Ludwig's angina 2.
• Treatment options include airway management, antibiotics, and judicious surgical intervention 3.
• In some cases, tracheostomy may be required to maintain the airway 2.
• The use of corticosteroids and surgical intervention may also be considered in certain cases, such as those with COVID-19 infection 4.
• Prompt recognition and treatment of the condition are essential to reduce morbidity and mortality 2, 6.