Signs, Symptoms, and Diagnosis of Ludwig's angina
- Severe cellulitis of the floor of the mouth
- Bilateral lower facial swelling and upper neck swelling
- Elevation of the floor of the mouth and posterior displacement of the tongue
- Painful neck swelling
- Symptoms may include drooling, tooth pain, dysphagia, shortness of breath, fever, and general malaise
- Dental X-ray can identify infections originating in the roots of teeth
- CT scan of the neck with contrast material is used to identify deep neck space infections
- Chest scan may be done if there is suspicion of chest cavity infection
- Other possible diagnoses such as angioneurotic edema, lingual carcinoma, and sublingual hematoma should be ruled out

Causes and Microbiology of Ludwig's angina
- Dental infections account for 75-90% of cases
- Infections of lower second and third molars are common
- Other causes include oral ulcerations, infections secondary to oral malignancy, mandible fractures, and penetrating injuries of the mouth floor
- Patients with systemic illness such as diabetes mellitus and compromised immune system are predisposed
- Incidence of Ludwig angina is higher in patients with diabetes mellitus, acquired immune deficiency syndrome, and human immunodeficiency virus (HIV)
- Ludwigs angina is most often polymicrobial and anaerobic
- Commonly found microbes include Viridans streptococci, Staphylococci, Peptostreptococci, Prevotella, Porphyromonas, and Fusobacterium
- Traditional culture samples are time-consuming and sometimes unreliable
- Microbiology can be determined through culture samples
- Culture and sensitivity results guide antibiotic therapy

Treatment and Surgical Techniques for Ludwig's angina
- Treatment plan should consider stage of infection, airway control, and comorbidities
- Four principles guide treatment: sufficient airway management, early and aggressive antibiotic therapy, incision and drainage if necessary, and adequate nutrition and hydration support
- Airway management is the primary therapeutic concern and can involve endotracheal intubation or tracheostomy
- Antibiotic therapy is empirical until culture and sensitivity results are obtained
- Incision and drainage may be performed for localised abscesses or if medical management fails
- Indications for incision and drainage include airway compromise, septicaemia, deteriorating condition, descending infection, and diabetes mellitus
- Surgical techniques for incision and drainage include bilateral submandibular incisions, blunt dissection through the mylohyoid muscle, placement of Penrose drains, and debridement of necrotic tissue and thorough irrigation
- Post-operative care includes extubation when airway is patent, monitoring cultures and sensitivity tests, observing for signs of further infection or sepsis, monitoring white blood cell count, and repeating CT scans to assess health status and extent of infection

Nutritional Support for Ludwig's angina
- Adequate nutrition and hydration support is essential
- Difficulties in eating or swallowing may reduce food and fluid intake
- Well-nourished and hydrated patients promote wound healing and fight off infection
- Particularly important in young children following surgery
- Pain and swelling in the neck region can affect eating and swallowing

Etymology, Complications, and Follow-up of Ludwig's angina
- The term 'angina' is derived from the Latin word 'angere' meaning choke
- The term 'Ludwig's angina' refers to the feeling of strangling and choking due to airway obstruction
- The most serious potential complication of this condition is airway obstruction
- Complications of Ludwig's angina include spread of infection to the chest or other deep neck structures, septicemia, pneumonia, and mediastinitis
- Follow-up visits are necessary to ensure complete resolution of the infection.