Ludwig’s angina

Alternative names
Submandibular space infection; Sublingual space infection

Ludwig’s angina is a bacterial infection of the floor of the mouth. It involves swelling that may block the airway.

Causes, incidence, and risk factors
Ludwig’s angina is a type of cellulitis that involves inflammation of the tissues of the floor of the mouth, under the tongue. It often occurs following an infection of the roots of the teeth (such as Tooth abscess) or after a mouth injury. Swelling of the tissues occurs rapidly and may block the airway or prevent swallowing of saliva. This condition is uncommon in children.


  • neck pain  
  • neck swelling  
  • redness of the neck  
  • fever  
  • weakness, fatigue, excessive tiredness  
  • confusion or other mental changes  
  • difficulty breathing (this symptom indicates an emergency situation!)

Additional symptoms that may be associated with this disease:

  • earache  
  • drooling

Signs and tests
An examination of the neck and head shows redness and swelling of the upper neck, under the chin. The swelling may extend to the floor of the mouth. The tongue may be swollen or displaced upward and backward because of the inflammation.

A CT scan of the neck may be recommended to determine the extent of inflammation. Culture of fluid from the tissues may show bacteria, usually streptococcus or staphylococcus bacteria.


If the swelling blocks the airway, this is an emergency situation!

The goal of emergency treatment is to maintain an open airway. This may involve intubation (breathing tube placed through the mouth or nose and into the lungs) or tracheostomy (direct opening to the lungs through surgical placement of a tube at the base of the neck).

The next major goal is to cure the infection. Antibiotics, usually penicillin or penicillin-like drug, are often given intravenously (in a vein) until the symptoms diminish. Then, the antibiotics are continued as oral medications until the person no longer tests positive for the bacteria.

Dental treatment may be needed to treat tooth infections that cause Ludwig’s angina.

Surgery may be recommended, including drainage of the swelling through cuts (incisions) or placement of drains (tubes) in the neck.

Expectations (prognosis)
Ludwig’s angina can be life threatening, but can be cured with proper protection of the breathing passages and adequate antibiotic therapy.


  • airway blockage (life-threatening - see CPR if necessary)  
  • generalized infection (sepsis)  
  • septic shock

Calling your health care provider
Call your health care provider if symptoms indicate Ludwig’s angina may be present, or if Ludwig’s angina has been diagnosed and symptoms do not improve after treatment.

Go to the emergency room or call the local emergency number (such as 911) if difficulty breathing occurs.

Regular visits to the dentist, and prompt treatment of oral/dental infections can prevent the conditions that increase the risk of developing Ludwig’s angina.

Johns Hopkins patient information

Last revised: December 4, 2012
by Janet G. Derge, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.