Clinical profile and management options in patients of Ludwig’s angina: a 5 year prospective study


  • Smruti Milan Tripathy Department of Otorhinolaryngology, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
  • Harikumar B. Department of Otorhinolaryngology, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India



Ludwig’s angina, Odontogenic, Diabetes mellitus, Pseudomonas


Background: The objective of the study was to study the etiology, clinical presentation, bacteriology and management options in 38 cases of Ludwig’s angina.

Methods: 38 patients of Ludwig’s angina admitted in ENT Department of Saveetha Medical College, between March 2012 to April 2017, were included in the study. Various parameters like etiological agents, clinical features and management options were analysed.  

Results: Ludwig’s angina was found to be more prevalent between age group of 41 to 70 years with a mean age group of (60.3yrs). Males were found to be more commonly affected (71%) as compared to females (29%). Odontogenic infections still accounted for majority (81%) of causes with uncontrolled type 2 diabetes mellitus emerging as the main associated comorbidity. Patients mainly presented with symptoms like submental and submandibular swelling (100%), dysphagia (67%), odynophagia (55%), and stridor (42%). Almost all the patients required intravenous antibiotics, analgesics and steroids (100%) with (82%) requiring tooth extraction and (74%) requiring incision and drainage. Among the patients who presented with stridor (29%) underwent tracheostomy for airway management. The culture of the discharge obtained after incision and drainage found pseudomonas (71%), staphylococcus aureus (34%) and beta hemolytic streptococcus (42%) as common microbial agents.

Conclusions: Ludwig’s angina is a serious and life threatening condition which can have fatal outcome if not treated aggressively, therefore a thorough understanding of the clinical presentation, common etiological factors, microbial agents and treatment methods is needed to manage these patients.


Author Biography

Smruti Milan Tripathy, Department of Otorhinolaryngology, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India

Department of ENT

Associate professor


Kulkarni AH, Pai SD, Bhattarai B, Rao ST, Ambareesha M. Ludwig’s angina and airway considerations: a case report. Case J. 2008;1:19.

Stanley RE, Liang TS: Acute epiglottitis in adults. J Otolaryngol. 1988;102:1017-21.

Braunwald E, Fauci AS, Kasper DL,Hauser S, Longo D, Jameson JL. McGraw-Hill Harrison's Principles of Internal Medicine. Volume 1. 16th edition. 2001:191-5.

Linder HH. The anatomy of the fasciae of the face and neck with particular reference to the spread and treatment of intraoral infections that have progressed into adjacent fascial spaces. Ann Surg. 1986;204:705-14.

Loughnan TE, Allen D:Ludwig’s angina:the anesthetic management of 9 cases. Anesth. 1985;40:295-7.

Schuman NJ, Owens BM. Ludwig’s angina following dental treatment of a five year old male patient: report of a case. J Clin Pediatr Dent. 1992;16:263-5.

Chen MK, Wen YS, Chang CC, Huang MT, Hsiao HC. Predisposing factors of life-threatening deep neck infections: logistic regression analysis of 214 cases. J Otolaryngol. 1998;27(3):141-4.

Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterisation of life-threatening deep cervical space infections:a review of 196 cases. Am J Otolaryngol. 2003;24(2):111-7.

Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS. Deep neck infection: analysis of 185 cases. Head Neck. 2004;26(10):854-60.

Parhiscar A, Har-El G. Deep neck abscess:a retrospective review of 210 cases. Ann Otol Rhinol Laryngol. 2001;110(11):1051-4.

Marioni G, Rinaldi R, Staffieri C, Marchese-Ragona R, Saia G, Stramare R. Deep neck infection with dental origin: analysis of 85 consecutive cases (2000-2006). Acta Otolaryngol. 2008;128(2):201-6.

Eftekharian A, Roozbahany NA, Vaezeafshar R, Narimani N. Deep neck infections:a retrospective review of 112 cases. Eur Arch Otorhinolaryngol. 2009;266(2):273.

Saifeldeen K, Evans R. Ludwig’s angina. Emerg Med J. 2004;21:242-3.

Iwu CO. Ludwig’s angina:a report of seven cases and review of current concepts in management. Br J Oral Maxillofac Surg. 1990;28(3):189-93.

Ovassapian A, Tuncbilek M, Weitzel EK, Joshi CW. Airway management in adult patients with deep neck infections: A case series and review of the literature. Anesth Analg. 2005;100:585-9.

Barakate MS, Jensen MJ, Hemli JM, Graham AR. Ludwig’s angina: report of a case and review of management issues. Ann OtoRhinol Laryngol. 2001;110:453-6.

Rowe DP, Ollapallil J. Does surgical decompression in Ludwig’s angina decrease hospital length of stay? ANZ J Surg. 2011;81(3):168-71.






Original Research Articles