An acute bacterial infection of the floor of the mouth with swelling that may block the airway.
Alternative Names
Submandibular space infection; Sublingual space infection
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 infection of the roots of the teeth (such as tooth abscess ) or after mouth trauma. Swelling of the tissues occurs rapidly and may block the airway or prevent swallowing of saliva. This condition is uncommon in children.
Signs and tests
Inspection of the neck and head shows redness and swelling of the upper neck under the chin, which may extend to the floor of the mouth. The tongue may be swollen or displaced upward and backward because of the spread of 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
Ludwig's angina may involve swelling to the extent that it 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 goal of treatment of the disorder is eradication of the infection. Antibiotics, usually penicillin or penicillin-like drug, are given to treat the infection. Usually these are given intravenously (in a vein) until the symptoms diminish, then the antibiotics are continued as oral medications until cultures are negative. Dental examination and intervention may be appropriate 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.
Expectations (prognosis)
Ludwig's angina can be life threatening, but can be cured with proper protection of the breathing passages and adequate antibiotic therapy.
Calling your health care provider
Call your health care provider if symptoms indicate Ludwig's angina may be present, of if Ludwig's angina has been diagnosed and symptoms persist or do not improve after treatment. Go to the emergency room or call the local emergency number (such as 911) if difficulty breathing occurs.
Prevention
Regular visits to the dentist, and prompt treatment of oral/dental infections can prevent the conditions that increase the risk of developing Ludwig's angina.