A 45 year old male comes in with swelling of the tongue, fever to 102F, and O2 sat of 92% at triage. Patient states he has been having dental pain for the past two days.

 

Ludwig's Angina

What is it?
Ludwig’s angina, coined after German physician, Wilhelm Friedrich von Ludwig who first described the condition in five patients in 1836, is a deep soft tissue infection of the submandibular space with indurated, non-fluctuant swelling, often bilateral with some asymmetry.

How does it kill?
Patients often exhibit trismus and tachypnea. In addition, the tongue is often elevated and posteriorly displaced. Airway obstruction is the leading cause of death with a mortality of up to 50% in untreated patients.  Mortality is 8% overall and 19% in diabetics.

How do we treat?
In patients who need airway management, fiberoptic intubation is the preferred method. Tracheostomy can also be performed. Along with needle abscess drainage, IV penicillin G or ampicillin/sulbactam and clindamycin or metronidazole are recommended agents for the often mixed flora of the infection. Steroids have also been given in some case reports, though still controversial. ENT should be consulted for potential OR candidates.

J Nat Sci Biol Med. 2012 Jul;3(2):206-8. doi: 10.4103/0976-9668.101932.
Med Clinics of N. Am. 2012 NOv;96(6): 1107-1126. DOI: 10.1016/j.mcna.2012.08.002