From the Research
Ludwig's angina is a rapidly progressive, potentially life-threatening cellulitis of the floor of the mouth and neck, requiring immediate attention with securing the airway, administering broad-spectrum antibiotics, and surgical drainage when necessary, as emphasized in the most recent study 1.
Etiology
The etiology of Ludwig's angina is typically caused by dental infections, particularly from the second and third lower molars, where bacteria spread into the submandibular space. The most common causative organisms are mixed aerobic and anaerobic bacteria, including streptococci, staphylococci, and oral anaerobes, as reported in 2, 3, 4, 5.
Treatment
Treatment requires immediate attention and consists of:
- Securing the airway, with early consideration for intubation or tracheostomy in cases with respiratory distress or significant swelling, as highlighted in 3, 5, 1
- Administering broad-spectrum antibiotics, with a recommended combination of ampicillin-sulbactam or piperacillin-tazobactam plus metronidazole, as suggested in 2
- Surgical drainage when necessary, indicated for fluctuant collections, worsening symptoms despite antibiotics, or airway compromise, as emphasized in 2, 3, 4, 5
- Dental treatment of the underlying cause is essential once the acute infection is controlled to prevent recurrence, as noted in 2, 3, 4, 5
Key Considerations
- Airway management is critical, with early consideration for intubation or tracheostomy in cases with respiratory distress or significant swelling, as reported in 3, 5, 1
- Antibiotics should be continued for 2-3 weeks, transitioning to oral therapy once clinical improvement occurs, as suggested in 2
- The seriousness of Ludwig's angina stems from its potential to cause airway obstruction due to floor of mouth elevation and posterior displacement of the tongue, as emphasized in 2, 3, 4, 5, 1