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Ludwig’s angina

Definition

Ludwig's angina is an infection of the floor of the mouth underneath the tongue that is due to bacteria.

Alternative Names

Submandibular space infection; Sublingual space infection

Causes, incidence, and risk factors

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

This condition is uncommon in children.

Symptoms

Swelling of the tissues occurs quickly. It may block the airway or prevent you from swallowing saliva.

Symptoms include:

  • Breathing difficulty
  • Confusion or other mental changes
  • Fever
  • Neck pain
  • Neck swelling
  • Redness of the neck
  • Weakness, fatigue, excess tiredness

Other symptoms that may occur with this disease:

  • Difficulty swallowing
  • Drooling
  • Earache
  • Speech that is unusual and sounds like the person has a "hot potato" in the mouth

Signs and tests

An examination of the neck and head shows redness and swelling of the upper neck, under the chin. The swelling may reach to the floor of the mouth. The tongue may be swollen or out of place.

A CT scan of the neck may be recommended. Culture of fluid from the tissues may show bacteria.

Treatment

If the swelling blocks the airway, emergency medical help is needed to maintain an open airway. This may involve placing a breathing tube through the mouth or nose and into the lungs, or surgery called a tracheostomy that creates an opening through the neck into the windpipe.

Antibiotics, usually penicillin or a penicillin-like medication, are given to fight the infection. They are usually 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.

Expectations (prognosis)

Ludwig's angina can be life threatening. However, it can be cured with proper protection of the airways and appropriate antibiotics.

Complications

Calling your health care provider

Breathing difficulty is an emergency situation. Immediately go to the emergency room or call your local emergency number (such as 911).

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

Prevention

Regular visits to the dentist, and prompt treatment of mouth or tooth infections can prevent the conditions that increase the risk of developing Ludwig's angina.

References

Melio FR. Upper respiratory tract infections. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 73.

Christian JM. Odontogenic infections. In: Cummiongs CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 12.


Review Date: 2/28/2011
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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