Ludwig's Angina

  • Ludwig's Angina is a rapidly spreading cellulitis of the floor of the mouth which involves submandibular space secondary to dental infection.
  • Submandibular space is divided into sublingual space (above the mylohyoid) and submaxillary space (below the mylohyoid muscle) 
Bacteriology: Mixed infections involving both aerobes and anaerobes are common like, alpha haemolytic streptococci, staphylococci bacteriodes and E. coll. H. influenzae is a rare cause.
  • Clinical features: In Ludwig's angina, there is usually cellulitis of the tissue rather than frank abscess.
  • Marked difficulty in swallowing (odynophagia).
  • Varying degrees of trisumus.
  • On involvement of sublingual space, floor of the mouth is swollen, edematous and tongue seems to be pushed up and back.
  • On involvement of the submaxillary space, the submental and submandibular regions become swollen and tender and impart woody-hard feel.Tongue is progressively pushed upward and backward threatening the airway.
  • Laryngeal edema may appear, if it spreads to parapharyngeal or retropharyngeal space.
Treatment: Systemic antibiotics
  • Incision and Drainage should be postponed as long as possible because pus is seldom found.
  • Tracheostomy is required if airway is endangered.
  • If incision and drainage for Ludwig's angina is done under GA-there are increased chances of aspiration and shock as tongue is pushed up and back in Ludwig angina.
Exam Question
  • Ludwig's angina is infection of submandibular space.
  • Ludwig's angina involves both submandibular and sublingual spaces and most common cause is dental infection.
  • Ludwigs angina is cellulitis of floor of mouth,infection can spread to retropharyngeal space and usually caused by both aerobic and anaerobic organisms.

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