Ludwig's angina

Ludwig's angina
Other names	Angina Ludovici
Swelling in the submandibular area in a person with Ludwig's angina.
Specialty	Otorhinolaryngology, oral and maxillofacial surgery
Symptoms	Fever, pain, a raised tongue, trouble swallowing, neck swelling[1]
Complications	Airway compromise[1]
Usual onset	Rapid[1]
Risk factors	Dental infection[1]
Diagnostic method	Based on symptoms and examination, CT scan[1]
Treatment	Antibiotics, corticosteroids, endotracheal intubation, tracheostomy[1]

Ludwig's angina (Latin: Angina ludovici) is a type of severe cellulitis involving the floor of the mouth^[2] and is often caused by bacterial sources.^[1] Early in the infection, the floor of the mouth raises due to swelling, leading to difficulty swallowing saliva. As a result, patients may present with drooling and difficulty speaking.^[3] As the condition worsens, the airway may be compromised and hardening of the spaces on both sides of the tongue may develop.^[4] Overall, this condition has a rapid onset over a few hours.

The majority of cases follow a dental infection.^[3] Other causes include a parapharyngeal abscess, mandibular fracture, cut or piercing inside the mouth, or submandibular salivary stones.^[5] The infection spreads through the connective tissue of the floor of the mouth and is normally caused by infectious and invasive organisms such as Streptococcus, Staphylococcus, and Bacteroides.^[6]

Prevention is by appropriate dental care including management of dental infections. Initial treatment is generally with broad-spectrum antibiotics and corticosteroids.^[1] In more advanced cases endotracheal intubation or tracheostomy may be required.^[1]

With the advent of antibiotics in 1940s, improved oral and dental hygiene, and more aggressive surgical approaches for treatment, the risk of death due to Ludwig's angina has significantly reduced. It is named after a German physician, Wilhelm Frederick von Ludwig, who first described this condition in 1836.^[7]