From the Guidelines
Ludwig's angina is a severe infection of the submandibular space that presents with rapidly progressive cellulitis of the floor of the mouth and submandibular space, often beginning with dental infection, particularly of the second and third mandibular molars, and can lead to life-threatening airway compromise if not promptly treated. The clinical presentations of Ludwig's angina include:
- Bilateral submandibular swelling
- Elevation and posterior displacement of the tongue
- Drooling
- Dysphagia
- Dysphonia
- Trismus
- Fever
- Malaise
- Neck pain As the infection progresses, patients may develop respiratory distress with stridor and cyanosis due to airway compromise, which constitutes a medical emergency 1. On examination, the floor of the mouth is typically indurated, tender, and elevated, and the submandibular area feels woody or board-like on palpation, and the skin may appear erythematous. Laboratory findings often show leukocytosis, and imaging (CT with contrast) can help define the extent of infection and potential airway compromise. Ludwig's angina has been reported as a complication of tongue piercing, and treatment involves maintaining an adequate airway, the administration of systemic antibiotic agents, and surgical drainage of abscesses 1.
The condition is dangerous because rapid progression can lead to complete airway obstruction, sepsis, and death if not promptly treated. Immediate treatment with broad-spectrum IV antibiotics, airway management, and surgical drainage if necessary is crucial to prevent morbidity and mortality. It is essential to prioritize the patient's airway, breathing, and circulation (ABCs) and to seek immediate medical attention if symptoms persist or worsen.
Key points to consider in the management of Ludwig's angina include:
- Prompt recognition and treatment of the infection
- Maintenance of a patent airway
- Administration of broad-spectrum IV antibiotics
- Surgical drainage of abscesses if necessary
- Monitoring for signs of respiratory distress and sepsis
- Consideration of the patient's overall health status and potential underlying conditions that may affect treatment.
From the Research
Clinical Presentations of Ludwig's Angina
The clinical presentations of Ludwig's angina include:
- Acute onset and rapid spread of infection, bilaterally affecting the submandibular, sublingual, and submental spaces 2, 3, 4, 5
- Diffuse cellulitis with odontogenic origin 3
- Trismus, jaw and neck swelling, mild respiratory distress with tachypnea, hyperthermia, and panic 3
- Elevation of the floor of the mouth obstructing the airway, resulting in breathlessness and stridor 2
- Impending airway obstruction, which is the most feared complication of Ludwig's angina 6, 4, 5
Symptoms and Signs
Symptoms and signs of Ludwig's angina may include:
- Dental pain 4
- Airway distress 3
- Respiratory distress with tachypnea 3
- Hyperthermia 3
- Panic 3
- Jaw and neck swelling 3
- Trismus 3
Complications
Complications of Ludwig's angina may include: