Ludwig's Angina: Symptoms, Causes, Treatment, Prognosis, Epidemiology, Complications


Ludwig's angina is a rare bacterial infection that affects the floor of the mouth. It usually occurs if a tooth infection is left untreated. If the condition is not promptly treated it can lead to serious complications and can be fatal.



What is Ludwig's Angina?
Ludwig's angina (also known as angina Ludovici) is a form of cellulitis or connective tissue disorder that affects the submandibular, sublingual and submental spaces i.e. the area under the tongue and the neck. It is an emergency condition which is characterised by sudden onset and rapid progress. If left untreated it can obstruct the airway and can cause death from breathlessness.


Signs and Symptoms of Ludwig's Angina
Ludwig's angina is primarily characterised by swollen tongue, bull neck appearance, and difficulty in breathing. Other signs and symptoms include:

  • Tenderness over floor of the mouth/underneath the tongue is a common symptom of Ludwig's Angina.
  • Swelling and inflammation of the neck
  • Pain under the chin and over the neck is also a symptom of Ludwig's Angina
  • Upwards displacement of the tongue caused by swelling in tongue
  • Difficulty swallowing
  • Speech difficulties
  • Uncontrolled drooling
  • Ear pain
  • Generalized weakness and fatigue
  • Fever and chills
  • Mental issues.


In advanced cases, as the swelling of the tongue progresses it may cause airway blockage leading to breathing difficulties. It is a life-threatening situation and can even lead to death.

Epidemiology of Ludwig's Angina
Ludwig's angina occurs mostly in healthy individuals. Certain systemic conditions act as predisposing factors. Odontogenic infection or oral cysts accounts for 90% of the cases of Ludwig's angina. With improvement in imaging techniques and advancement in surgical options, the mortality rate of Ludwig's angina has reduced from 50% to 8%. This condition is more common in adults than in children; and more common in males than in females. Most of the cases are seen in between the age of 20 to 60 years.

Reviewed By: Pramod Kerkar, MD, FFARCSI
ePainAssist