Maxillofacial Infections
Ludwig's Angina
Rapidly spreading bilateral cellulitis of the submandibular, sublingual and submental spaces — an airway emergency.
§ overviewOverview
Rapidly spreading bilateral cellulitis of the submandibular, sublingual and submental spaces — an airway emergency.
§ etiologyEtiology
- 01Odontogenic infection from mandibular molars (most common)
- 02Polymicrobial: streptococci, staphylococci, anaerobes
§ clinicalClinical Features
- 01Brawny bilateral submandibular swelling
- 02Raised, protruding, oedematous tongue ('woody floor of mouth')
- 03Trismus, dysphagia, drooling
- 04Stridor — impending airway obstruction
- 05Fever, toxicity
§ investigationsInvestigations
- 01CBC, CRP, blood culture
- 02CECT neck — extent and mediastinal spread
- 03Airway assessment
§ treatmentTreatment
- 01Airway management is priority — fibre-optic intubation or elective tracheostomy
- 02IV broad-spectrum antibiotics (Amoxi-clav + metronidazole; add clindamycin/vancomycin for MRSA suspicion)
- 03Incision & drainage of all involved spaces
- 04Removal of causative tooth
§ complicationsComplications
- 01Airway obstruction
- 02Descending necrotising mediastinitis
- 03Sepsis
- 04Cavernous sinus thrombosis
§ prognosisPrognosis
Mortality < 10% with prompt airway control and IV antibiotics.
§ pearlsClinical Pearls
- 01Airway first, antibiotics second, drainage third.
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.