Ludwig's Angina

Ludwig's angina is a progressive cellulitis of the floor of the mouth that may lead to tongue displacement and airway obstruction. The infection begins in the submandibular space and may extend to the soft tissues of the mouth and neck. Ludwig's angina commonly originates from a dental infection after a recent dental procedure. Other causes include penetrating injury of the mouth floor, mandibular fracture, sialadenitis, and recent intravenous drug injection into neck veins. Diagnosis is primarily clinically based, and early recognition is important because the infection can rapidly lead to airway compromise.

Causes

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 includes an infection of the roots of the teeth. Swelling of the tissues occurs rapidly and may block the airway. This condition is uncommon in children.

Symptoms

• Dental pain ++++ (especially mandibular second or third molar)
• Neck swelling +++
• Dysphagia +++
• Neck pain +++
• Dyspnea and stridor ++
• Dysphonia ++
• Tongue swelling ++
• Sore throat ++

Signs

• Submandibular swelling with brawny induration +++++
• Elevated, protruding tongue +++++
• Fever ++++
• Trismus +++
• Generally no fluctuance or lymphadenopathy

Treatment

Treatment such as includs:

• Mantain the permeability of the airway- a tracheostomy is usually required.
• Intravenous antibiotics usual doses of penicillin plus metronidazol, clindamicin or selective cephalosporins are good initial choices until the results of culture and sensitivity arrives.
• Incision and drainage of the neck.
• 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 or placement of drains in the neck.