Ludwig Angina

Main risk factor is odontogenic infection, especially of the second and third molars (90% of all cases). Other factors include dental and gingival disorders, bacterial infection of the floor of the mouth, peritonsillar abscess, IV drug abuse, mandible fracture, tongue piercing, sialadenitis, and puncture wounds of the floor of mouth.

Infrequently encountered with contemporary oral hygiene practices and antibiotics.

Often occurs in otherwise healthy pts but predisposing factors include immunosuppressed states, diabetes mellitus, alcoholism, acute glomerulonephritis, systemic lupus erythematosus, and aplastic anemia.

Airway obstruction and respiratory distress, aspiration pneumonia secondary to inability to handle secretions, sepsis, descending mediastinitis, subphrenic abscess, empyema, and cervical or mandibular osteomyelitis

Airway obstruction, sepsis, jugular venous thrombosis, pneumothorax, pericardial/pleural effusions, infection of carotid sheath structures, descending necrotizing mediastinitis occurring via the retropharyngeal space and carotid sheath

Potentially lethal, rapidly spreading cellulitis of the bilateral submandibular space, which is comprised of the sublingual and submaxillary spaces. Five characteristics: Submandibular cellulitis; involvement of more than one space; progression of cellulitis to gangrene; extension of cellulitis to connective tissue, fascia, and muscles; and spread of cellulitis by continuity and not via the lymphatics. Infection often starts as a periapical dental abscess of the second and third mandibular molars (the roots of these teeth penetrate the mylohyoid ridge such that any abscess or dental infection has direct access to the submaxillary space) usually with elevation and posterior displacement of the tongue. Infection may spread to adjacent neck tissues and the thorax, causing airway obstruction and other serious complications, including mediastinitis.

Presents with painful neck swelling, laryngeal edema, tooth pain, dysphagia, dyspnea, fever, and malaise. Neck swelling and protruding or elevated tongue are seen in the vast majority. Stridor, trismus, cyanosis, and tongue displacement suggest impending airway crisis.

Most commonly results from bacterial infection: Usually polymicrobial but also Streptococcus viridans and Staphylococcus aureus. Less commonly from Bacteroides, Fusobacterium, Actinomyces, or Haemophilus influenzae.