Ludwig’s Angina – a cellulitis of the face and mouth
- usually occurring in adults
- May obstruct airways
- Might need a tracheotomy
- Can require surgical management and ICU
Ludwig’s Angina is also called:
- Angina Ludovici
- Cellulitis of the floor of the mouth
- Angina Maligna
- Morbus Strangularis
History of the name Ludwig’s Angina
Named after Wilhelm Friedrich von Ludwig who is a German physician who first described this condition in 1836. He died in 1865 of a unspecified neck infection.
Causes of Ludwig’s Angina
- Dental infections
- Infection of the gums
- Immunocompromised patients
- Tongue piercing
- Infections from other procedures on the face. Side note, see my other webpage: Botox and Juvederm injections in Modesto – sterile technique is important. Note: Botox and Dermal Fillers have not had any reports of association with Ludwig’s Angina. But infection prevention and knowledge is always on my mind.
Symptoms and signs of Ludwig’s Angina
- Cellulitic facial infection (side note: facial peels in Modesto, CA)
- Bilateral lower facial swelling around the lower jaw and upper neck.
- Spread to involve submandibular, sublingual, and submental spaces of the face.
- Difficulty swallowing
- There may be stridor or difficulty breathing.
- Can extend into the anterior mediastinum – with some patients presenting with chest pain.
- diverse in presentation ranging from enlargement of lymph nodes to necrotizing fasciitis.
- Tongue can be posteriorly displaced – airway concerns.
Radiographic appearance of Ludwig’s Angina
arrow shows multiple abscess in the sublingual space
Treatment of Ludwig’s Angina
- Getting prescription antibiotic medications
- Monitoring and protecting the airway
- Urgent facial surgery or dental consultation to incise and drain infection collections.
- Fatality rate is about 5%
