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
- CT enhanced with contrast shows swelling of the floor of the mouth frequently with streaky changes in the adjacent subcutaneous fat and thickening of the overlying platysmus muscle. Pus or gas formation present in late cases. Enlargement of submental or submandibular lymph nodes may also be seen. http://www.wjgnet.com/1949-8470/full/v2/i3/91.htm
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%