Alternate Names: Cellulitis - neck; Neck abscess; Sublingual infection; Submandibular space infection; Neck infection

Causes and Risks: Ludwig’s angina is the most common infection of the neck and surrounding areas. It is a type of cellulitis that involves inflammation of the tissues of the neck, jaw, and below the tongue. It often occurs following infection of the roots of the teeth (such as tooth abscess) or after oral trauma. Swelling of the tissues occurs rapidly and may block the airway. This condition is uncommon in children.

Prevention: Prompt treatment of oral/dental infections reduces the risk of developing Ludwig’s angina.

Symptoms:

• neck pain
• neck swelling
• redness of the neck
• fever
• weakness, fatigue, excessive tiredness
• confusion or other mental changes
• difficulty breathing (This symptom indicates an emergency situation!)

• earache
• drooling

Signs and Tests: Inspection of the neck and head shows redness and swelling of the upper neck under the chin, which may extend to the floor of the mouth. The tongue may be swollen or displaced upward and backward because of the spread of inflammation.

A CT scan of the neck may be recommended to determine the extent of inflammation. Culture of fluid from the tissues may show bacteria, usually streptococcus or staphylococcus bacteria. Pus formation is unusual.

Treatment: Ludwig’s angina may involve swelling to the extent that it blocks the airway. This is an emergency situation!

The goal of emergency treatment is to maintain an open airway. This may involve intubation (breathing tube placed through the mouth or nose and into the lungs) or tracheostomy (direct opening to the lungs through surgical placement of a tube at the base of the neck).

The goal of treatment of the disorder is eradication of the infection.

Antibiotics, preferably penicillin or a penicillin-type, are given to treat the infection. Usually these are given intravenously (in a vein) until the symptoms reduce, then the antibiotics are continued as oral medications until cultures are negative.

Dental examination and intervention may be appropriate to treat tooth infections that cause Ludwig’s angina.

Surgery may be recommended, including drainage of the swelling through cuts (incisions) or placement of drain tubes in the neck.

Prognosis: Ludwig’s angina can be life threatening, however, it is usually cured with adequate antibiotic therapy.

Complications:

• airway blockage (life threatening--see CPR if necessary)
• generalized infection (sepsis)
• septic shock

Call your health care provider if symptoms indicate Ludwig’s angina may be present, of if Ludwig’s angina has been diagnosed and symptoms persist or do not improve after treatment.

Go to the emergency room or call the local emergency number (such as 911) if difficulty breathing occurs.