Ludwig's Angina: Treatment & Symptoms

Instructor: Ian Lord

Ian is a real estate investor, MBA, former health professions educator, and Air Force veteran.

Ludwig's angina is a very serious condition that can affect a patient's ability to breathe. Let's review the symptoms as well as the treatment of this emergency medical condition.

Ludwig's Angina

Terri is a newly trained emergency department nurse and is on her first shift. All of a sudden a patient presents with swelling underneath her tongue that is making it difficult to breathe. What is going on? Upon physical examination the doctor confirms a diagnosis of Ludwig's angina, a potentially life threatening bacterial infection on the floor of the mouth underneath the tongue. In this lesson we will review the treatment, symptoms, and complications associated with Ludwig's angina.


How will Terri and the rest of the treatment team take care of the patient's condition? The exact treatment depends on how severe the swelling is. The first treatment the team will attempt in this case is broad spectrum antibiotics, such as penicillin, clindamycin, or metronidazole, delivered into a vein. Interestingly, before the invention of antibiotic medications patients had a greater than 50% chance of dying due to a case of Ludwig's angina. Today, the mortality rate averages eight percent. If the condition has been caused by a tooth infection then dental treatment may also be necessary. Fortunately for the patient the antibiotic treatment works and doesn't move on to a more severe form.

If the swelling has progressed to the point where the patient's airway is blocked, airway management is necessary. This can take the form of inserting a tube in the patient's nose or throat down to the lungs so that oxygen can be passed to the bloodstream. In extreme cases a surgical procedure called a tracheostomy may be necessary; an opening is created in the neck through which a tube can be fed into the airway. Surgery is also an option to drain the fluids causing swelling from the floor of the mouth.


Now that the patient has been treated, Terri should be aware of some of the common symptoms of Ludwig's angina so she can recognize cases of it in the future. In the majority of cases patients are otherwise healthy and don't have a complicating condition. However, patients often complain of dental pain or swelling, and may have had recent dental treatment. The tongue could swell so much that it begins to protrude outside the mouth. The swelling of the floor of the mouth can cause a number of problems such as difficulty breathing or swallowing, drooling, or speech problems. The patient may have neck pain, redness, or swelling as well.

Swelling of the floor of the mouth
Swelling of the floor of the mouth

Other possible symptoms include weakness or fatigue. Earaches are also a possible symptom given all the swelling. Confusion and other mental changes may result as well. Ultimately, Ludwig's angina can be diagnosed by clinical exam and does not require testing.

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