As a result of current antibiotic therapies and surgical techniques, current mortality estimates are in the range of 8%. 7 Before the availability of antibiotics, oedema frequently led to upper airway obstruction, and a mortality rate of 50% was reported. 9 Early antibiotic treatment should be broad spectrum to cover oral cavity flora Gram-positive, Gram-negative and anaerobic organisms. The management of Ludwig’s angina involves maintenance of a secure airway with surgical tracheostomy or endotracheal intubation, antibiotics and surgical drainage, if necessary. 7 CT scan may demonstrate either a diffusely infiltrative process or a more discrete low-attenuation area, reflecting abscess. 6 Early imaging is important to determine the extension of tissue infection or necrosis or the presence of an abscess, which will help to decide the most appropriate approach to the patient. 3 4 The aetiology of Ludwig’s angina is primarily odontogenic 5 and diabetes mellitus has been recognised as the systemic disease most commonly associated with deep neck infection. 2 It is more frequent in male sex and in the fifth decade of life.

This type of infection is relatively uncommon in the postantibiotic era but is still an important and potentially life-threatening condition, primarily due to elevation and posterior displacement of the tongue causing airway obstruction unless early recognised and adequately treated. It was first described in 1836 by von Ludwig, and is still diagnosed by the criteria provided by Grodinsky in 1939 as a cellulitis originating in the floor of the mouth, invading bilaterally more than one compartment of the submandibular space that produces a serosanguinous infiltrate but little or no pus it involves connective tissue fascia and muscle but not glandular structures, and is able to spread by contiguity, not through the lymphatic system. Ludwig’s angina is a deep neck space infection defined as a rapidly progressive bilateral cellulitis of the submandibular space.

Ludwig angina