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March 21, 1980

Ludwig's Angina

Author Affiliations

From the Division of Infectious Diseases, Department of Medicine (Dr Finch), and the Division of Otolaryngology, Department of Surgery (Drs Snider and Sprinkle), West Virginia University Medical Center, Morgantown. Dr Finch is now with the Department of Microbial Diseases, City Hospital, Nottingham, England.

JAMA. 1980;243(11):1171-1173. doi:10.1001/jama.1980.03300370045027

LUDWIG'S angina is a life-threatening infection of the sublingual and submandibular spaces, first described by Von Ludwig in 1836. Before the widespread use of antibiotics, the disease seems to have occurred relatively frequently, as evidenced by several large series.1,2 In recent years, scattered case reports make up most of the available information,3,4 suggesting that the disease is now either less commonly seen or recognized.

Mortality has exceeded 50%,2 and fatalities are still reported.5 Our recent experience with six cases of Ludwig's angina seen over a 32-month period has prompted this review. Despite the critical nature of their illness, all of our patients showed a prompt and complete response to treatment. Table 1 summarizes some clinical features present on admission, while Table 2 outlines the roentgenographic, surgical, and antibiotic aspects of the management of these six cases.

Pathogenesis  Ludwig's angina may arise de novo, but this is