Definition of Ludwig's angina:

Ludwig's angina is a bacterial infection of the floor of the mouth. It involves swelling that may block the airway.

Causes, incidence, and risk factors:

Ludwig's angina is a type of cellulitis that involves inflammation of the tissues of the floor of the mouth, under the tongue. It often occurs after an infection of the roots of the teeth (such as tooth abscess) or a mouth injury.

This condition is uncommon in children.

Symptoms:

Swelling of the tissues occurs rapidly and may block the airway or prevent swallowing of saliva.

Symptoms include:

• Breathing difficulty
• Confusion or other mental changes
• Fever
• Neck pain
• Neck swelling
• Redness of the neck
• Weakness, fatigue, excessive tiredness

Additional symptoms that may be associated with this disease:

• Earache
• Drooling

Signs and tests:

An examination of the neck and head shows redness and swelling of the upper neck, under the chin. The swelling may reach to the floor of the mouth. The tongue may be swollen or out of place.

A CT scan of the neck may be recommended. Culture of fluid from the tissues may show bacteria.

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 penicillin-like drug, 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 has gone away.

Dental treatment may be needed to treat tooth infections that cause Ludwig's angina.

Surgery may be needed to drain fluids that are causing the swelling.

Expectations (prognosis):

Ludwig's angina can be life threatening. However, it can be cured with proper protection of the airways and appropriate antibiotics.

Complications:

• Airway blockage
• Generalized infection (sepsis)
• Septic shock

Calling your health care provider:

Breathing difficulty is an emergency situation. Immediately go to the emergency room or call your local emergency number (such as 911).

Call your health care provider if you have symptoms of this condition, or if symptoms do not improve after treatment.

Prevention:

Regular visits to the dentist, and prompt treatment of mouth or tooth infections can prevent the conditions that increase the risk of developing Ludwig's angina.