Ludwig's Angina

Ludwig's Angina

Jessica Mason, MD, and Jennifer Farah, MD

Background

• Called “angina” because, like cardiac angina, it causes a choking sensation
• Due to cellulitis of the mouth floor
• Usually caused by dental infection or trauma; often the patient will report a recent dental visit
• Polymicrobial, rapidly progressive, likely Streptococcus and anaerobic
• Tends to spread quickly and bilaterally; can spread into the mediastinum
• Complications
• Sepsis
• Airway compromise

Clinical Findings

• Sickly appearance; oral mucosa has a brawny, meaty appearance
• Drooling
• Dysphagia
• Elevated tongue
• Firm mouth floor

Management

• Manage airway
• Administer broad-spectrum antibiotics

How You Will Be Tested

• Expect to see a picture of someone with recent dental work 
• Picture will likely show a large swollen tongue
• Airway management is key to management
• Patient will need broad-spectrum antibiotics and ear/nose/throat evaluation