Ludwig's angina involves infection of:

# Ludwig's angina is a severe and spreading infection that involves the:
A. Submental and sublingual spaces only
B. Submandibular, submental, and sublingual spaces unilaterally
C. Submandibular and sublingual spaces only
D. Submandibular, submental, and sublingual spaces bilaterally

The correct answer is: D. Submandibular, submental, and sublingual spaces bilaterally

Ludwig's angina often results from an odontogenic infection. As a result, the bacteriology of theses infections generally involves oral flora, particularly anaerobes. Other recognized etiologies of Ludwig's angina include poor oral hygiene, IV drug abuse, trauma, and tonsillitis.

It is characterized by:

• Rapid onset

• The three facial spaces are involved bilaterally

• Board-like swelling of floor of the mouth and no fluctuance is present

• Typical "open-mouthed" appearance

• Elevation of the tongue

• Drooling. trismus, and fever

• Difficulty eating, swallowing, breathing

• Tachycardia, increased respiration rate

• Can lead to glottal edema; asphyxiation

Airway management, massive antibiotic coverage (IV), and surgical incision and drainage are the mainstays of treatment.

Very important: The most serious complication of Ludwig's angina is edema of the glottis (which is a slit-like opening between the true vocal cords).