Ludwig’s Angina


  • Infection of the submandibular or sublingual spaces
  • Named after German physician, Wilhelm Friedrich von Ludwig
  • Aggressive, rapidly spreading cellulitis with potential for airway obstruction, carries 5% fatality rate
  • Over 2/3 of Ludwig’s angina have a dental source of infection
  • Once infection established, tongue can swell to 3 times its size
  • Typically polymicrobial infection due to flora from the oral cavity – most common organisms include Streptococcus viridans, Fusobacterium, Bacteroides, Staph aureus, Actinomyces, etc
  • Presentation: tender swelling along mandible with oral pain, neck stiffness and swelling, drooling, and dysphagia
  • Diagnosis: made clinically, imaging by CT scan with contrast or MRI, and surgical drainage with cultures
  • Treatment: Secure airway (intubation or tracheostomy), antibiotics with surgical drainage