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Clinical Challenges
May 1999

Ludwig Angina: A Review of Current Airway Management

Author Affiliations

From the Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas.



Arch Otolaryngol Head Neck Surg. 1999;125(5):596-599. doi:10.1001/archotol.125.5.596

Physical examination of a patient with Ludwig angina reveals a woody, tender floor of mouth and slight dyspnea (respiratory rate, 20/min). Monitoring in an intensive care unit setting with a pulse oximeter is a safe option.

Originally mentioned in writings dating back to Hippocrates, Ludwig angina was best described in 1836 by its namesake, Karl Friedrich Wilhelm von Ludwig, following years of detailed observation of the disease and its postmortem findings. He described this disease as a rapidly progressive gangrenous cellulitis originating in the region of the submandibular gland that extends by continuity rather than lymphatic spread and shows no special tendency to form abscesses.1 Despite attempts at treatment, the disease was frequently fatal, giving rise to mortality rates exceeding 50% during the preantibiotic era. The often very sudden manner of death was originally attributed to overwhelming sepsis, but in the early 1900s the deadly role of mechanical respiratory obstruction was realized.2

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