Ludwig Angina

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

To view the entire topic, please or purchase a subscription.

Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:

Emergency Central

-- The first section of this topic is shown below --



  • 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

-- To view the remaining sections of this topic, please or purchase a subscription --