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BACKGROUND: Ludwig's angina is a potentially deadly condition that must not be missed in the emergency department (ED). OBJECTIVE: The purpose of this narrative review article is to provide a summary of the epidemiology, pathophysiology, diagnosis, and management of Ludwig's angina with a focus on emergency clinicians. DISCUSSION: Ludwig's angina is a rapidly spreading infection that involves the floor of the mouth. It occurs more commonly in those with poor dentition or immunosuppression. Patients may have a woody or indurated floor of the mouth with submandibular swelling. Trismus is a late finding. Computed tomography of the neck soft tissue with contrast is preferred if the patient is able to safely leave the ED and can tolerate lying supine. Point-of-care ultrasound can be a useful adjunct, particularly in those who cannot tolerate lying supine. Due to the threat of rapid airway compromise, emergent consultation to anesthesia and otolaryngology, if available, may be helpful if a definitive airway is required. The first line approach for airway intervention in the ED is flexible intubating endoscopy with preparation for a surgical airway. Broad spectrum antibiotics and surgical source control are keys in treating the infection. These patients should then be admitted to the intensive care unit for close airway observation. CONCLUSION: Ludwig's angina is a life-threatening condition that all emergency clinicians need to consider. It is important for clinicians to be aware of the current evidence regarding the diagnosis, management, and disposition of these patients.

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Sialolithiasis represents the most common issue of the salivary gland, ranging from asymptomatic to airway compromising. In rapidly progressing, completely obstructive salivary stones, the presentation can mimic emergent oropharyngeal diseases, primarily Ludwig's angina. We present a case of a large and obstructive sialolith with abscess whose initial presentation was concerning for Ludwig's angina with impending airway compromise. While a common complaint, emergency providers should be aware of the nefarious presentation of an everyday complaint.

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Ludwig angina remains a potentially lethal disease, rapidly spreading bilateral cellulitis of the submental, sublingual, and submandibular spaces, which bears the threat for rapid airway obstruction. Since the introduction of antibiotics in 1940s, the mortality was reduced significantly. This resulted in the rare occurrence of the disease, leaving many physicians with limited experience of Ludwig angina. Although the occurrence of Ludwig angina in adults is rare, its presence in the pediatric edentulous population is even more uncommon. Because the unfamiliarity with this disease is now increasing, unnecessary delaying diagnosis or inadequate management may occur and may result in serious complications. This presentation will consist of a historical review, discussion of pathophysiology, followed by clinical presentation, etiology, bacteriology, and management. With early diagnosis, airway observation and management, aggressive intravenous antibiotic therapy, and judicious surgical intervention, the disease should resolve without complications. In addition, the source of infection should be determined and eliminated if possible. A thoughtful, individualized management strategy seems to be the most reasonable approach to the disease.

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While the incidence of Ludwig angina is decreasing, this is an important disease process because failure to control the airway can have catastrophic consequences. Accurate diagnosis, airway control, antibiotic therapy, and, occasionally, surgical management are essential for patient safety. Ludwig angina is caused by a rapidly expanding cellulitis of the floor of the mouth and is characterized by hardened induration of the floor and suprahyoid region bilaterally with an elevation of the tongue potentially obstructing the airway. In the preantibiotic era, Ludwig angina was frequently fatal; however, antibiotics and aggressive surgical treatment have significantly lowered mortality.

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BACKGROUND: Ludwig's angina is a rapidly spreading cellulitis that may produce upper airway obstruction often leading to death. There is very little published information regarding this condition in the pregnant patient. CASE: A 24-year old black female was admitted at 26 weeks gestation with tooth pain, submandibular swelling, severe trismus, and dysphagea, consistent with Ludwig's angina. Her treatment included emergent tracheostomy, incision and drainage of associated spaces, teeth extraction, and antibiotic therapy. CONCLUSIONS: During a life threatening infectious situation such as the one described, risks of maternal and fetal morbidity include both septicemia and asphyxia. Furthermore, the healthcare provider must consider the risks that the condition and the possible treatments may cause the mother and her unborn child.

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Ludwig's angina is caused by a rapidly expanding cellulitis of the floor of the mouth and is characterized by a brawny induration of the floor and suprahyoid region (bilaterally), with an elevation of the tongue potentially obstructing the airway. In the pre-antibiotic era, Ludwig's angina was frequently fatal; however, antibiotics and aggressive surgical intervention have significantly reduced mortality. We reviewed nine patients with Ludwig's angina between July 1996 and June 2002, all of whom presented with fever, neck swelling, bilateral submandibular swelling and elevation of the tongue. In eight patients (89%) a dental infection appeared to be the underlying cause. High-dosage intravenous antibiotics directed towards the suspected causative microorganisms were given to all of the patients: two were treated successfully with conservative medical management, while seven underwent surgical drainage (a tracheotomy was necessary in one patient). Routine aerobic cultures were done on samples of drained material and the predominant microorganisms were Streptococcus species in two patients; there were none in the other five. Two patients had post-operative complications, but all recovered.

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A angina de Ludwig é um quadro infeccioso de curso agressivo, que se relaciona às regiões da mandíbula e do pescoço, podendo, inclusive, levar o paciente ao óbito. Os autores fazem uma breve revisão da literatura desta patologia, enfocando temas tais como etiologia, patogênese, diagnóstico, tratamento e possíveis complicações advindas da mesma. Um caso clínico é ralatado, a fim de que se possam ilustrar os aspectos clínicos da angina de Ludwig, bem como a importância de fazer-se um diagnóstico precoce e um tratamento efetivo

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A angina de Ludwig é um processo infeccioso, descrito pela primeira vez em 1836. Trata-se de um processo infeccioso que ocorre entre a face superior do músculo miloióideo e a mucosa do addoalho da boca, difundindo-se para a região sublingual e submentoniana, podendo chegar até o mediastino quando não tratada. Na maioria das vezes (80 por cento) inicia-se no ápice do segundo ou terceiro molar inferior, após ruptura de fina camada óssea existente no local, outras vezes por trauma com comprometimento do assoalho da boca. Os agentes bacterianos mais comuns são os da própria flora oral. Descrevemos um caso clínico para alertar os profissionais da saúde, pois a complicação maior poderá levar o paciente ao óbito

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