Symptoms of Ludwig's Angina
Ludwig's angina is characterized by rapidly progressive cellulitis of the floor of the mouth and neck that can lead to life-threatening airway compromise if not diagnosed and treated promptly. 1
Key Clinical Presentations
- Bilateral neck swelling - diffuse, brawny induration of the submandibular, submental, and sublingual spaces 1, 2
- Fever - present in nearly all patients 1, 2
- Neck pain - significant discomfort in the affected areas 1
- Elevation and posterior displacement of the tongue - characteristic finding due to floor of mouth involvement 3
- Dysphagia - difficulty swallowing due to swelling 3
- Drooling - inability to swallow saliva 3
- Trismus - restricted mouth opening 3
- Respiratory distress - including dyspnea and stridor in advanced cases 3, 4
- Restricted neck movement - due to swelling and pain 3
- Floor of mouth edema - firm, tender swelling 1
- Foul-smelling discharge - may be present if abscess has formed 1
Warning Signs of Airway Compromise
- Stridor - high-pitched sound during breathing indicating airway narrowing 3
- Breathlessness - progressive difficulty breathing 5
- Hypoxia - decreased oxygen levels 4
- Inability to lie flat - patients often prefer sitting position to maintain airway 3
- Tongue displacement - upward and backward displacement creating airway obstruction 1
Associated Factors and Etiology
- Dental infections - most common cause (80-90% of cases), including dental caries, pericoronitis, and complications from dental procedures 1, 2
- Poor dental hygiene - significant predisposing factor 1
- Systemic conditions - diabetes mellitus, malnutrition, immunocompromised states (including AIDS) increase risk and severity 1
Clinical Course
- Acute onset - symptoms develop rapidly, often over hours to days 1, 5
- Rapid spread - infection spreads quickly through fascial planes 3
- Potential complications - include necrotizing fasciitis, septicemia, and death if not treated promptly 1
Key Considerations
- The classic triad of bilateral submandibular swelling, tongue elevation, and fever should raise immediate suspicion for Ludwig's angina 2
- Symptoms may progress rapidly from mild discomfort to life-threatening airway obstruction within hours 5, 4
- Early recognition is critical as mortality rates increase significantly once airway compromise develops 1, 5
- The condition represents a true medical emergency requiring immediate intervention to secure the airway and provide appropriate antibiotic therapy 4
Ludwig's angina should be considered in any patient presenting with bilateral submandibular swelling, especially in the context of recent dental infection or procedures, as prompt diagnosis and management are essential to prevent potentially fatal complications 1, 2.