Ludwigs angina (severe infection in the mouth)

Mouth | Otorhinolaryngology | Ludwigs angina (severe infection in the mouth) (Disease)


Ludwig’s angina is a life-threatening infection of the connective tissue of the submandibular or sublingual area (located on the floor of the mouth). It was named after Wilhelm Friedrich von Ludwig, a German physician who first knew about the disease in 1836. Ludwig’s angina is also known as angina ludovici, angina maligna or morbus strangularis because of the inflammation it causes in the floor of the mouth causing a strangulating feeling (from the word angina meaning “strangling”).

Ludwig’s angina is different from angina pectoris or chest pains. However, chest pains may be present in advanced cases of Ludwig’s angina, where the infection reaches the retrosternal space. Ludwig’s angina is simply known as submandibular and sublingual space infection.

Causes and Risk factors

Ludwig’s angina starts from a dental infection. Almost half of the patients suffering from Ludwig’s angina have existing or previous infections of the teeth and gums. Periodontal infections are commonly caused by streptococcus and staphylococcus organisms which are present in the mouth even when the person is healthy.

Once the bacteria travel and spread, it reaches the submandibular and sublingual areas causing inflammation and swelling. Because of the inflammatory response, the body produces chemical mediators responsible for pain, erythema and swelling, which are evident to a patient. The infection and inflammation extends to adjacent tissues such as the pharynx and neck. Patients typically breathe through the mouth as a result of swelling of the airways. Because of inflammation of the tongue, it falls back at the base which causes airway obstruction. Massive swelling also makes the upper airways constricted.

The infection further reaches the lungs and mediastinum. Retrosternal abscess develops and results in chest pains and chest heaviness. Descending infections in the lungs cause pneumonia and formation of pulmonary secretions that further aggravates the difficulty in breathing.

Diagnosis and Treatment

If the swelling blocks the airway, emergency medical help is needed to maintain an open airway. This may involve placing a breathing tube through the mouth or nose and into the lungs, or surgery called a tracheostomy that creates an opening through the neck into the windpipe.

Antibiotics, usually penicillin or a penicillin-like medication, are given to fight the infection. They are usually given through a vein until symptoms go away. Antibiotics taken by mouth may be continued until tests show that the bacteria have gone away.

Dental treatment may be needed for tooth infections that cause Ludwigs angina. Surgery may be needed to drain fluids that are causing the swelling. ...