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Ludwig Angina

Ludwig Angina is a topic covered in the 5-Minute Emergency Consult.

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  • Named for German physician Wilhelm Friedrich von Ludwig, who 1st described this in 1836 as a rapidly progressive, gangrenous cellulitis and edema of soft tissues of the neck, floor of the mouth
  • Gangrene is serosanguineous infiltration with little or no frank pus or primary abscesses
    • Contiguous spread may encircle the airway or involve the mediastinum
    • Emergent interventions rarely include surgical or aspiration techniques
  • Most deaths are due to airway compromise, occlusion, and resultant asphyxia
    • Mortality exceeded 50% in preantibiotic era, currently <8%


  • Odontogenic in 90% of adult cases, usually from 2nd, 3rd mandibular molars
  • Less commonly: Mandibular fractures, oral lacerations, contiguous infections, errant drug injections, tongue piercings
  • Polymicrobial: β-hemolytic strep commonly associated with anaerobes such as peptostreptococcus, pigmented bacteroides
    • Microbiologic analyses may guide therapy

Pediatric Considerations
  • Frequently no clear etiology or site of origin
  • Ideally, a destination facility will have specialty expertise available (surgery and subspecialties, anesthesia) and be properly equipped to provide emergent intervention

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Rosen, Peter, et al., editors. "Ludwig Angina." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307651/all/Ludwig_Angina.
Ludwig Angina. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307651/all/Ludwig_Angina. Accessed April 23, 2019.
Ludwig Angina. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307651/all/Ludwig_Angina
Ludwig Angina [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307651/all/Ludwig_Angina.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Ludwig Angina ID - 307651 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307651/all/Ludwig_Angina PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -