Ludwig's angina

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A potentially life-threatening, rapidly expanding, diffuse inflammation of the submandibular, submental and sublingual spaces that occurs most often in young adults with dental infections.

Description

Ludwig's angina is a potentially life-threatening, rapidly expanding, diffuse inflammation of the submandibular, submental and sublingual spaces. The presenting infection descends down the great vessels of the neck to the mediastinum. If the person does not die from airway obstruction, the pericardial infection and pulmonary empyema will result in death. It occurs most often in young adults with dental infections.

Causative bacteria include streptococci, staphylococci, gram-negative and anaerobic organisms. Symptoms include severe neck pain and swelling, fever, malaise and dysphagia. Examination may reveal carious molar teeth, neck rigidity or drooling. The presence of stridor, dyspnea, decreased air movement or cyanosis suggests impending airway compromise. Treatment includes protection of the airway, parenteral antibiotics (e.g., high-dose penicillin G or clindamycin with or without metronidazole) immediate surgical consultation and possible operative drainage.

Wilhelm Friedrich von Ludwig in 1836 described five patients with marked swelling of the neck that progressed rapidly to involve the tissues covering the muscles between the larynx and the floor of the mouth. His first patient was Queen Catherine of Württemberg.

Angina is from anchone, the Greek word for strangulation, and was taken to connote throat pain and infection. At that time, the condition was almost always fatal.

We thank Carl Dahlberg and Lonnie M. Sibley for information submitted.

Bibliography

  • W. F. Von Ludwig:
    Über eine in neuerer Zeit wiederholt hier vorgekommene Form von Halsentzündung.
    Medicinisches Correspondenzblatt des Württembergischen ärztlichen Vereins, Stuttgart, 1836, 6: 21-25.
    English translation and biographical note in the Bulletin of the History of Medicine, 1939, 7: 1115-1126. The title is usually referred to as just: Ueber eine Form von Halsentzündung.

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