Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPrognosisPrevention
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Prognosis
Prevention
Ludwig’s angina is a rare infection that affects the mouth, neck, and jaw. In severe instances, Ludwig’s angina can spread from the neck into themediastinum(the area located between the lungs, where the heart lies), causing some people to experience chest pain.Ludwig’s angina is more common in adults than in children.
The most common cause of Ludwig’s angina is a dental infection that spreads, with severe pain, tenderness, and swelling. Treatment is usually effective, but Ludwig’s angina can prove fatal in about 8% of cases, typically because of swelling that causes emergency airway obstruction.
This article discusses Ludwig’s angina symptoms, diagnosis, and treatment. It explains some of the complications that can arise, along with why prompt treatment is important to a full recovery.
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Ludwig’s Angina Symptoms
The inflammatory response leads to swelling of the neck and tissues of thesubmandibular(facial space of the head and neck), submaxillary (lower jawbone area), andsublingual(under the tongue) spaces.
Common symptoms of Ludwig’s angina include:
As the condition progresses, symptoms may include:
How Does Ludwig’s Angina Start?A tooth or gum infection that spreads in the mouth is the most common cause of Ludwig’s angina. As it spreads, it affects other tissue in the mouth, throat, neck, and chest. This may be more likely in people who have compromised immune systems due to an underlying health condition.
How Does Ludwig’s Angina Start?
A tooth or gum infection that spreads in the mouth is the most common cause of Ludwig’s angina. As it spreads, it affects other tissue in the mouth, throat, neck, and chest. This may be more likely in people who have compromised immune systems due to an underlying health condition.
Complications
As Ludwig’s angina progresses, there are some dangerous complications that could develop if the condition is left untreated, such as:
Airway compromise is the most common cause of death in people with Ludwig’s angina.
Is Ludwig’s Angina an Emergency?Symptoms of Ludwig’s angina require immediate medical attention. As the condition progresses, tongue swelling could obstruct the airway, causing it to be difficult or even impossible to breathe. Call 911 or seek immediate emergency medical attention for breathing problems.
Is Ludwig’s Angina an Emergency?
Symptoms of Ludwig’s angina require immediate medical attention. As the condition progresses, tongue swelling could obstruct the airway, causing it to be difficult or even impossible to breathe. Call 911 or seek immediate emergency medical attention for breathing problems.
Ludwig’s Angina Causes
The underlying cause of Ludwig’s angina is a bacterial infection. The common culprits are group A beta-hemolyticStreptococcusassociated with anaerobic germs (those that do not require oxygen to live) such as pigmentedBacteroides.
According to medical research studies, the most common causative organisms include:
Dental infections, often linked to poor dental hygiene, are the most common cause of Ludwig’s angina. The bacteria that cause Ludwig’s angina often originate from atooth infection. Other causes may include:
Seek prompt treatment for a dental infection or abscess to prevent complications such as Ludwig’s angina.
Diagnosing Ludwig’s Angina
If you have any symptoms of a tooth or mouth infection, see a healthcare provider. They will take your medical history and ask about your symptoms, as well as any recent dental problems. They will examine you to check for visible swelling of the jaw, neck, and other areas, as well as palpable (those that can be felt) areas of swelling.
The primary diagnostic measures used in the diagnosis of Ludwig’s angina include:
How Ludwig’s Angina is Treated
Airway compromise is so commonly linked with Ludwig’s angina that the condition warrants close observation to prepare for the possibility of impending airway obstruction. In fact, airway obstruction is the number one cause of death from the condition.
The most important immediate treatment for Ludwig’s angina is to secure the airway. This is done either with a breathing tube that’s inserted into the nose or mouth or with atracheostomy procedure(a surgical opening in the windpipe through the neck for insertion of a breathing tube).
Emergency Airway Management
Early Stage Treatment
Treatment is never administered at home.
Treatment for Advanced Stage Ludwig’s Angina
Surgical drainage may be necessary to remove fluid from secondary abscesses. Needle drainage is often performed to lower the risk of the infection spreading.
Discharge Instructions
Dental treatment may be necessary to treat any tooth abscesses or dental infections. This may require a dental specialist, called an endodontist, to do a root canal on the affected tooth. A root canal is a procedure involving the removal of the infected tissue in the tooth that has formed an abscess.
What to Expect During a Root Canal
What Is the Survival Rate for Ludwig’s Angina?
Before antibiotics were available, over half of all people with Ludwig’s angina died from the condition.
Today there is around an 8% mortality (death) rate for people diagnosed with Ludwig’s angina, though the survival rate drops if it remains untreated or people experience complications.
Preventing Ludwig’s Angina
Summary
Ludwig’s angina is an infection of tissues in the mouth, neck, and jaw. It can sometimes spread to the mediastinum at the center of your chest, causing chest pain, or cause an airway obstruction that can lead to life-threatening respiratory problems.
The most common cause of Ludwig’s angina is a tooth infection that spreads, although other conditions (including tongue piercings) can lead to strep and staph bacteria entering the tissue. In most cases, Ludwig’s angina is successfully treated with antibiotics unless complications arise.
Prevention includes good dental hygiene and seeking medical care at the first sign of symptoms.
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.McKellop J, Mukherji K.Emergency head and neck radiology, Neck infections.Applied Radiology: Journal of Practical Medical Imaging and Management.Bridwell R, Gottlieb M, Koyfman A, Long B.Diagnosis and management of Ludwig’s angina: An evidence-based review.Am J Emerg Med. 2021 Mar;41:1-5. doi:10.1016/j.ajem.2020.12.030.Vallée M, Gaborit B, Meyer J, et al.Ludwig’s angina: a diagnostic and surgical priority.Int J Infect Dis. pii:S1201-9712(20)30030-8. doi:10.1016/j.ijid.2020.01.028Penn Medicine.Gas gangrene.Romero J, Elkattawy S, Romero A, Latif A, Al-Fiky E, Al-Nasseri A,et al.Ludwig’s Angina.Eur J Case Rep Intern Med. 2022 Jun 1;9(6):003321. doi:10.12890/2022_003321.Parker E, Mortimore G.Ludwig’s angina: a multidisciplinary concern.Br J Nurs. 28(9):547-551. doi:10.12968/bjon.2019.28.9.547
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.McKellop J, Mukherji K.Emergency head and neck radiology, Neck infections.Applied Radiology: Journal of Practical Medical Imaging and Management.Bridwell R, Gottlieb M, Koyfman A, Long B.Diagnosis and management of Ludwig’s angina: An evidence-based review.Am J Emerg Med. 2021 Mar;41:1-5. doi:10.1016/j.ajem.2020.12.030.Vallée M, Gaborit B, Meyer J, et al.Ludwig’s angina: a diagnostic and surgical priority.Int J Infect Dis. pii:S1201-9712(20)30030-8. doi:10.1016/j.ijid.2020.01.028Penn Medicine.Gas gangrene.Romero J, Elkattawy S, Romero A, Latif A, Al-Fiky E, Al-Nasseri A,et al.Ludwig’s Angina.Eur J Case Rep Intern Med. 2022 Jun 1;9(6):003321. doi:10.12890/2022_003321.Parker E, Mortimore G.Ludwig’s angina: a multidisciplinary concern.Br J Nurs. 28(9):547-551. doi:10.12968/bjon.2019.28.9.547
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
McKellop J, Mukherji K.Emergency head and neck radiology, Neck infections.Applied Radiology: Journal of Practical Medical Imaging and Management.Bridwell R, Gottlieb M, Koyfman A, Long B.Diagnosis and management of Ludwig’s angina: An evidence-based review.Am J Emerg Med. 2021 Mar;41:1-5. doi:10.1016/j.ajem.2020.12.030.Vallée M, Gaborit B, Meyer J, et al.Ludwig’s angina: a diagnostic and surgical priority.Int J Infect Dis. pii:S1201-9712(20)30030-8. doi:10.1016/j.ijid.2020.01.028Penn Medicine.Gas gangrene.Romero J, Elkattawy S, Romero A, Latif A, Al-Fiky E, Al-Nasseri A,et al.Ludwig’s Angina.Eur J Case Rep Intern Med. 2022 Jun 1;9(6):003321. doi:10.12890/2022_003321.Parker E, Mortimore G.Ludwig’s angina: a multidisciplinary concern.Br J Nurs. 28(9):547-551. doi:10.12968/bjon.2019.28.9.547
McKellop J, Mukherji K.Emergency head and neck radiology, Neck infections.Applied Radiology: Journal of Practical Medical Imaging and Management.
Bridwell R, Gottlieb M, Koyfman A, Long B.Diagnosis and management of Ludwig’s angina: An evidence-based review.Am J Emerg Med. 2021 Mar;41:1-5. doi:10.1016/j.ajem.2020.12.030.
Vallée M, Gaborit B, Meyer J, et al.Ludwig’s angina: a diagnostic and surgical priority.Int J Infect Dis. pii:S1201-9712(20)30030-8. doi:10.1016/j.ijid.2020.01.028
Penn Medicine.Gas gangrene.
Romero J, Elkattawy S, Romero A, Latif A, Al-Fiky E, Al-Nasseri A,et al.Ludwig’s Angina.Eur J Case Rep Intern Med. 2022 Jun 1;9(6):003321. doi:10.12890/2022_003321.
Parker E, Mortimore G.Ludwig’s angina: a multidisciplinary concern.Br J Nurs. 28(9):547-551. doi:10.12968/bjon.2019.28.9.547
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