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Ludwig’s Angina

Last reviewed by Dr. Raj MD on January 12th, 2022.

What is Ludwig’s angina?

This is an infection at the bottom of your mouth under your tongue. It If not treated quickly and properly it can develop into a serious infection. When some people think of the word “angina” they associate it with having pain in your chest but the general meaning of “angina” is to squeeze or strangle. With Ludwig’s angina one of the symptoms is swelling of your throat so if it becomes severe it can strangle a person by cutting off their air so this is why it is called Ludwig’s angina.

It is named after a German physician Wilhelm Friedrich von Ludwig in 1836. It is also known as sublingual space infection or submandibular. Although it is an infection that can happen to anyone regardless of age, race, or gender it is most commonly found in the elderly and adults who suffer from diseases. It is uncommon to find this infection in children.

Ludwig’s Angina Symptoms

The biggest symptom, or problem with this infection is that the tissues that are affected can begin to swell and cause your airway to be obscured which means your breathing becomes quickly inhibited. Before this serious symptom happens you will usually feel that your breathing is more challenging and you may find it a struggle to get air. Some of the other symptoms can include:

  • Excessive drooling
  • Noted redness and/or swelling around your neck
  • Pain in your neck
  • Earache which is a sign that the infection has now spread to your ears
  • Pain on your tongue
  • Difficulty in swallowing called dysphagia
  • Stridor which is a harsh sound that is heard when you take in breaths which usually signal an airway that is obstructed.
  • Speech that is unusual

There are some who may have a fever, have rapid mood changes, or appear to be confused. The infection can also cause flu-like symptoms in which a person might feel tired, very sleepy, and weak.


The most obvious cause of Ludwig’s angina is the failure to treat any infected teeth in your mouth. From these infected teeth bacteria can spread to the tissue under your tongue. This area of your mouth can also become infected if you have an injury in your mouth and it is not treated with antibiotics.

Ludwig’s Angina Treatment

If Ludwig’s angina is caught in the early stages the only treatment you might need would be a round of antibiotics to treat the infection along with a follow-up appointment with your dentist to treat any dental problems that might exist. The most common form of antibiotic that is prescribed is penicillin but the physician can prescribe other broad spectrum antibiotics to get rid of the bacterial infection. Your physician may also use steroid therapy for its anti-inflammatory effects to help reduce any inflammation you have from this infection along with helping you breathe easier.

If the swelling in your airway is so pronounced that your breathing is inhibited or labored you will need much greater treatment and intervention. There are many different choices to address the problem with inhibited or labored breathing such as:

  • Requiring intubation which is inserting a flexible tube down your trachea (windpipe) to secure your breathing
  • A breathing tube in your throat via your mouth
  • Oxygen support through your nose or with a mask

If the swelling is too great to allow passage of air from your nose or mouth to your lungs or you cannot be intubated, especially in severe cases, the physician may have to do a tracheotomy. A tracheotomy is a surgery that opens your windpipe and inserts a breathing tube into the opening so your lungs can get air. This is a treatment that is used as a last resort. Once the infection is cleared, the swelling has gone done, and you can breathe on your own the tube will be removed.

Because it can be such a serious infection with deadly consequences if not treated early you should see your physician at the first signs of this infection.

Ludwig’s Angina Pictures

Collection of pictures of Ludwig’s Angina…

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ludwigs angina pictures

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