52. Ludwig’s Angina
Definition
Ludwig’s angina is cellulitis of the mouth floor. It expands very rapidly and can spread to other areas of the body, such as the mediastinum or the coccyx, via the myriad tissue planes found within the neck. Ludwig’s angina is potentially fatal.
Incidence
Currently there is no accurate estimate for the frequency at which this severe form of cellulitis occurs.
Etiology
For 100 years after the original description, Ludwig’s angina was generally viewed as a complication of a local anesthetic agent infiltration given for extraction of mandibular molars. The actual pathogenesis is the extension and expansion of a dental abscess into the submandibular space(s). Even today, the majority of Ludwig’s angina cases are initiated by an odontogenic source.
Possible Sources of Ludwig’s Angina
• Brachial cleft anomalies
• Cervical lymphadenitis
• Compound mandibular fracture
• Dental abscesses/infections
• Foreign body aspiration
• Infected malignancy
• IV drug use/abuse
• Lymphalocele
• Mastoiditis with apicitis of the petrous part of the temporal bone and Bezold’s abscess (abscess in the neck with pus tracts deep to the superior portion of the sternocleidomastoid muscle and along the posterior belly of the digastric muscle)
• Necrosis and suppuration of a malignant cervical lymph node or mass
• Oral surgical procedures
• Otitis media
• Penetrating trauma to the oral cavity pharynx
• Salivary gland infection/obstruction
• Sialadenitis
• Thyroiditis
• Tonsillar and pharyngeal infections
Infectious Organisms Associated with Ludwig’s Angina
• Bacteroides melaninogenicus
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