Ludwig's angina

Revision as of 15:25, 11 September 2011 by Russellm77 (talk | contribs) (→‎Diagnosis)


  • Infection of submandibular and sublingual spaces
  • 85% of cases arise from an odontogenic source, usually mandibular molars
  • Patients usually 20-60 yrs old, male predominance
  • Streptococcus, Staphylococcus, and Bacteroides spp. are pathogens
  • Intubation may be very difficult


  • Mouth pain, drooling, trismus,brawny edema,tongue protrusion,stridor
  • Acute laryngospasm with airway compromise is biggest concern
    • Suggested by dyspnea or cyanosis
  • Clinical diagnosis, but CT with IVC can define abscess
    • May lose airway in scanner when pt lies flat
    • Weigh the risks and benefits


  • Abx
    • Must cover typical oral flora
    • Usually third gen cehpalosporin with clindamycin or flagyl
  • Steroids controversial


  • Admit, usually ICU for airway monitoring
  • Emergent ENT or OMFS consult


Tintinalli ER Atlas