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Submandibular space infections (Ludwig's angina)

Anthony W Chow, MD, FRCPC, FACP
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


Ludwig's angina is a bilateral infection of the submandibular space that consists of two compartments in the floor of the mouth, the sublingual space and the submylohyoid (also known as submaxillary) space (figure 1). It was first described by the German physician, Wilhelm Frederick von Ludwig in 1836. This infection most commonly arises from an infected second or third mandibular molar tooth. It is an aggressive, rapidly spreading cellulitis without lymphadenopathy with potential for airway obstruction and requires careful monitoring and rapid intervention for prevention of asphyxia and aspiration pneumonia.

The anatomy, microbiology, clinical manifestations, imaging, and treatment of submandibular space infections (Ludwig's angina) will be reviewed here. Other deep neck space infections are discussed separately. (See "Deep neck space infections".)


Although the term Ludwig's angina has been loosely applied to a heterogeneous array of infections involving the sublingual and submylohyoid (submaxillary) spaces, this diagnosis should be restricted to the following classical description:

The infection begins in the floor of the mouth. It is characteristically an aggressive, rapidly spreading "woody" or brawny cellulitis involving the submandibular space.

The infection is a rapidly spreading cellulitis without lymphatic involvement and generally without abscess formation.

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Literature review current through: Nov 2017. | This topic last updated: Jul 26, 2017.
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