- Definition: Ludwig’s angina is a rapidly progressive cellulitis of the floor of the mouth, involving the sublingual, submandibular, and submental spaces.
- Most commonly originates from dental infections (especially 2nd and 3rd mandibular molars).
- Airway obstruction occurs due to swelling, elevation of the tongue, and soft tissue distortion.
???? Common Causes
- Dental infections (most common)
- Oral trauma or recent dental procedures
- Mandibular fractures
- Submandibular gland infections
- Immunocompromised states (e.g., diabetes)
???? Common Organisms
- Polymicrobial, including:
- Streptococcus spp.
- Staphylococcus aureus
- Anaerobes (e.g., Fusobacterium, Bacteroides)
???? Clinical Features
- Bilateral neck swelling, firm and tender
- Elevated, protruding tongue
- Drooling, dysphagia, trismus
- Muffled or “hot potato” voice
- Pain in the floor of mouth or jaw
- Stridor, dyspnea (late and life-threatening sign)
- Fever, tachycardia, toxic appearance
❗ Obvious oral findings may not be present early — always examine under the tongue.
???? Diagnosis
- Clinical diagnosis is key — do not delay treatment.
- CT neck with contrast: Shows extent of infection and airway compromise.
- Flexible nasopharyngolaryngoscopy: To assess airway narrowing and edema (if patient stable).
- Labs: CBC, CRP, lactate, blood cultures.
????️ Management
???? 1. Secure the Airway
- Involve anesthesia, ENT, and surgery early
- Anticipate a difficult airway:
- Awake fiberoptic intubation (if feasible)
- Surgical airway (tracheostomy) if anatomy distorted
- Avoid blind or forceful intubation — may cause total obstruction
???? 2. Medical Therapy
- IV broad-spectrum antibiotics:
- Ampicillin-sulbactam, or
- Clindamycin + ceftriaxone, or
- Piperacillin-tazobactam
- IV steroids: Dexamethasone to reduce edema
- IV fluids and supportive care
- Analgesia and monitoring
???? 3. Surgical Intervention
- I&D (incision and drainage) of abscess if present
- Dental extraction for source control
- May require multiple surgical teams (ENT, oral-maxillofacial, anesthesia)
???? Disposition
- Admit to ICU
- Continuous
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