Ludwig's angina

Alternative names

Submandibular space infection; Sublingual space infection

Definition

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.

Symptoms

• 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.

Treatment

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.