Ludwig’s angina

Which of the following best describes Ludwig’s angina?

A) Substernal chest pain that radiates to the right arm.
B) An infection involving the sublingual and submaxillary space.
C) Abdominal pain secondary to an enlarging AAA.
D) A tonsillar infection that leads to chronic abscess formation.
E) Ischemic pain related to insufficient blood flow to an extremity.

Answer and Discussion
The answer is B. ( An infection involving the sublingual and submaxillary space.)

Ludwig’s angina usually develops from a periodontal or dental infection and is one of the most common neck space infections.

The condition is usually a rapidly developing, bilateral cellulitis that affects the sublingual and submaxillary space, without involvement of the lymph nodes or formation of abscesses.
The infection usually rapidly arises from the second and third mandibular molars as a result of poor dental hygiene, tooth extraction, or trauma.

Symptoms include:

•  edema and erythema of the upper neck (under the chin) and floor of the mouth,(see picture) 
• trismus, 
• drooling, 
• dysphonia, 
• dysphagia, and 
• dyspnea. 
• Fever, chills, and tachycardia are usually present.
• Tongue displacement upward may also occur and threaten the airway. 

In severe cases, the condition may be fatal.

Treatment includes protection of the airway in severe cases and intravenous antibiotics (e.g., penicillin, wide spectrum cephalosporins) in high doses to cover anaerobic organisms (Bacteroides). Incision and drainage may be required.