Information on Ludwig’s Angina

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What is Ludwig’s Angina?

Ludwig’s angina is a bacterial infection that infects the floor of the mouth, and is actually a type of cellulitis (an infection which affects the skin’s connective tissue). Most often caused by an infection with actinomyces, staphylococcus or streptococcus bacteria, Ludwig’s angina can occur after an infection in other parts of the mouth (such as a tooth abscess), or after a mouth injury (including piercing of the mouth floor).

Although Ludwig’s angina has become relatively rare since antibiotic use became widespread, people with compromised immunity are still at risk. In addition the infection can still develop in people who are otherwise healthy if a mouth infection is left untreated.

Ludwig’s angina should not be confused with angina pectoris, a condition which is characterized by chest pain and may indicate coronary disease. However, people with Ludwig’s angina may experience some chest pain if the infection spreads into the chest.

Symptoms and Diagnosis of Ludwig’s Angina

Ludwig’s angina symptoms develop as a result of the immune response to the bacterial infection. However, while many of the more common symptoms of bacterial infection are present, there are other symptoms which are more specific to the disease.

Symptoms of Ludwig’s angina may include:

  • Pain and swelling of the tongue, which may cause the tongue to raise from the floor of the mouth
  • The neck and jaw may become swollen and painful
  • Fever, fatigue, difficulty breathing
  • Inability to swallow or close the mouth
  • In severe cases the neck and jaw may swell so intensely the tissue becomes rigid. In these cases the airway may be severely compromised.

Treatment for Ludwig’s Angina

Ludwig’s angina can usually be cleared solely with antibiotics (usually penicillin or a penicillin analog), which are administered intravenously until symptoms are alleviated. People who are allergic to penicillin typically receive clindamycin and ciprofloxacin.

In severe cases where a patient’s airway is blocked by swollen tissue, emergency medical treatment may be needed. A breathing tube may be used to provide oxygen to the patient, or an emergency surgical technique called a tracheostomy may be performed in cases of extreme swelling.


Lemonick, D.M. Ludwig’s Angina: Diagnosis and Treatment.

Ludwig’s Angina at MedlinePlus

Ludwig’s Angina at the University of Maryland