Ludwig’s angina

  • Definition
    • Ludwig's angina is an infection of the floor of the mouth under the tongue. It is due to bacteria.

  • Alternative Names
    • Submandibular space infection; Sublingual space infection

  • Causes
    • Ludwig's angina is a type of skin infection that occurs on the floor of the mouth, under the tongue. It often develops after an infection of the roots of the teeth (such as tooth abscess) or a mouth injury.

      This condition is uncommon in children.

  • Symptoms
    • The infected area swells quickly. This may block the airway or prevent you from swallowing saliva.

      Symptoms include:

      • Breathing difficulty
      • Difficulty swallowing
      • Drooling
      • Unusual speech (sounds like the person has a "hot potato" in the mouth)
      • Tongue swelling or protrusion of the tongue out of the mouth
      • Fever
      • Neck pain
      • Neck swelling
      • Redness of the neck

      Other symptoms that may occur with this disease:

      • Weakness, fatigue, excess tiredness
      • Confusion or other mental changes
      • Earache
  • Exams and Tests
    • Your health care provider will do an exam of your neck and head to look for redness and swelling of the upper neck, under the chin.

      The swelling may reach to the floor of the mouth. Your tongue may be swollen or out of place.

      You may need a CT scan.

      A sample of the fluid from the tissue may be sent to the lab to test for bacteria.

  • Treatment
    • If the swelling blocks the airway, you need to get emergency medical help right away. A breathing tube may needed to be placed through your mouth or nose and into the lungs to restore breathing. You may need to have surgery called a tracheostomy that creates an opening through the neck into the windpipe.

      Antibiotics are given to fight the infection. They are most often given through a vein until symptoms go away. Antibiotics taken by mouth may be continued until tests show that the bacteria have gone away.

      Dental treatment may be needed for tooth infections that cause Ludwig's angina.

      Surgery may be needed to drain fluids that are causing the swelling.

  • Outlook (Prognosis)
    • Ludwig's angina can be life-threatening. It can be cured with getting treatment to keep the airways open and taking antibiotic medicine.

  • Possible Complications
  • When to Contact a Medical Professional
    • Breathing difficulty is an emergency situation. Go to the emergency room or call your local emergency number (such as 911) right away.

      Call your health care provider if you have symptoms of this condition, or if symptoms do not get better after treatment.

  • Prevention
    • Visit the dentist for regular checkups.

      Treat symptoms of mouth or tooth infection right away.

  • References
    • Christian JM, Goddard AC, Gillespie MB. Deep neck and odontotogenic infections. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 10.

      Melio FR, Berge LR. Upper respiratory tract infections. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 75.