Maxillofacial Infections
Ludwig's Angina
Rapidly spreading bilateral cellulitis of the submandibular, sublingual and submental spaces — an airway emergency.
§ figuresFigures (3)
Fig. 1Swelling in the submandibular area in a patient with Ludwig's angina. This made it difficult for the assessment of neck extension.
“Ludwig angina” · Anand H Kulkarni, Swarupa D Pai, Basant Bhattarai, Sumesh T Rao and M Ambareesha · CC BY 2.0 · Wikimedia Commons
Fig. 2Sexe du patient : inconnu. Âge du patient : inconnu. Année de prélèvement : 1931. Hôpital : Saint-Michel Archange. Pathologiste : inconnu.
“Macro Langue - Angine de Ludwig 55-o.apatho-260-langue” · Denis Desaulniers et Bernard Têtu · CC BY-SA 4.0 · Wikimedia Commons
Fig. 3Elevated tongue due to Ludwig's angina
“ElevatedTongueLA” · Doc James · CC BY-SA 4.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Ludwig's Angina figures pending faculty review.
§ 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.
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L4 · Research — 1
- L6 · Textbook — 3
2 linked sources were published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Key Research
R MN, R H, M V et al.. Cureus · 2024 · 16(10):e72337
Review of airway assessment and management strategies in deep neck space infection.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Draft — pending faculty review. Educational use only; verify against current guidelines and primary sources before clinical application.