Ludwig’s Angina


Ludwig’s angina which is also referred to as angina Ludovici is a severe type of bacterial skin infection that can be life-threatening. The infection often occurs under the tongue or on the floor of the mouth, commonly in adults who have concomitant dental infections. This infection rarely occurs in children.

ludiwg angina pictures

The bacterial infection is frequently followed by a tooth abscess which is the gathering of pus in the middle of a tooth or other mouth injury or infection. If the condition is not treated, it could block the passage airways which may necessitate an incision in the windpipe to ease the obstruction.

Ludwig’s angina is sometimes confused with angina pectoris, since it is also known as “angina”. The term angina comes from a Greek word “ankhon”, which means strangling. Therefore, Ludwig’s angina pertains to the strangling feeling instead of a chest pain, although it can also be present in the condition once the infection scatters into the retrosternal space.


Ludwig’s angina is a bacterial infection that is typically caused by the any of this bacterium:

  • Staphylococcus – It is a group of bacteria that can cause a large number of diseases. Under a microscope, they are bunched and rounded together. These bacteria can directly lead to illnesses by infection or secondarily through the products they create such as the toxins accountable for toxic shock syndrome and food poisoning.
  • Streptococcus – It is also a group of bacteria that results to a multitude of diseases. When they are observed under a microscope, streptococcus bacteria will appear to be a twisted cluster of round berries.

The bacterium is frequently followed by a mouth infection or injury like tooth abscess. Poor hygiene of the mouth, lacerations or trauma inside the mouth, or even the latest extraction of a tooth can contribute to Ludwig’s angina. Dental infections are responsible for about 80% of cases of the bacterial infection. This problem commonly develops in those individuals who are immunocompromised, though it can otherwise occur to healthy individuals.

Symptoms of Ludwig’s Angina

The infected region of Ludwig’s angina swells quickly. This could obstruct the airway or prevent the person from swallowing saliva. Symptoms may include:

  • Drooling
  • Pain in the neck
  • Redness of the neck
  • Inflammation of the neck
  • Problems with breathing
  • Difficulty swallowing
  • Tenderness or pain underneath the tongue or in the floor of the mouth
  • Inflamed tongue or protrusion of the tongue outside the mouth
  • Fatigue
  • Fever
  • Weakness
  • Problems with speech like the person has a hot potato inside the mouth when speaking
  • Earache
  • Confusion

Call the physician right away if any of the symptoms are suspected to be a Ludwig’s angina infection. Once it progresses, pain in the chest and difficulty breathing might also be experienced. If the passage airway is obstructed, an immediate medical attention is needed.


Successful treatment usually starts with a thorough diagnosis made by physicians with patients. The diagnosis is typically based on clinical observation. The tongue, head, and neck will look red and inflamed. If the diagnosis cannot be determined with a visual examination, it can be done through the following:

  • Computerized tomography (CT) scan – It is an imaging test with the aid of a computer to create three-dimensional or cross-sectional images of the structures and internal organs in the body. This test is needed to confirm the inflammation of the floor of the mouth or to get images of the neck.
  • Fluid cultures of tissue – A fluid sample from the tissue of the affected region might also be evaluated and tested to determine the specific bacterium that is giving rise to the infection.


If the swelling obstructs the passage airway, the patient must get an emergency medical help as soon as possible. A breathing tube might be required to be positioned through the nose or mouth, and directed into the lungs to reinstate breathing. The person may also be required by the physician to undergo a surgical procedure called a tracheostomy, which could make an opening through the neck into the trachea or the windpipe. If symptoms do not get better after treatment, call the physician right away.

Treatment options may involve:

Antibiotics – These medications are given to fight off the infection. There are frequently administered through a vein until the symptoms go away. Oral antibiotics may be taken continuously until examinations show that the bacteria have completely gone away.

Dental consultation – This is required for patients with tooth infections that lead to Ludwig’s angina.

Surgery – This may be needed in draining fluids that causes the swelling. An intraoral surgical cut and drainage method is often recommended if the infection is specifically affecting only the sublingual space. External surgical opening and drainage is done if infection includes the perimandibular spaces.

A person can lessen the risk of developing Ludwig’s angina by:

  • Seeking immediate treatment for infections of the mouth and tooth
  • Practicing good hygiene of the mouth
  • Having regular dental checkups

The prognosis of Ludwig’s angina varies on the severity of the infection and how quick the treatment is done. A delayed treatment can increase a person’s risk for the life-threatening complications. Ludwig’s angina is a deadly condition, and carries a mortality rate of approximately 5%.


Complications of Ludwig’s angina may include:

  • Obstruction of the airway passage
  • Septic shock which is a complication that resulted from an infection where toxins could trigger a full-body inflammatory response
  • Generalized infection (sepsis)


ludwigs angina ludwigs angina image


Rowe, Ollapallil. “Does surgical decompression in Ludwig’s angina decrease hospital length of stay?”. ANZ J Surg. Retrieved 2013-01-31.

Dhingra, PL; Dhingra, Shruti (2010) [1992]. Nasim, Shabina, ed. Diseases of Ear, Nose and Throat. Dhingra, Deeksha (5 ed.). New Delhi: Elsevier. pp. 277–278.

Zadik Yehuda, Becker Tal, Levin Liran (January 2007). “Intra-oral and peri-oral piercing”. J Isr Dent Assoc 24 (1): 29–34, 83.

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