Two cases of
Ludwig's angina treated successfully led us to review the main English language literature from 1945 to January 1979. The most common cause of
Ludwig's angina is dental, and the organism cultured most often is streptococcus. However, other avenues of
infection and numerous pathogens have been implicated in this disease.
Penicillin remains the preferred primary
antibiotic, with combinations of this
drug and other
antibiotics being used by various authors. In both the pre-
antibiotic and
antibiotic era, the airway remains the prime concern of the surgeon in the management of this potentially life-threatening disease. Of the 75 cases reviewed, there were seven deaths, but four of these patients had pre-existing fatal systemic problems and
Ludwig's angina was not the cause of death. The other three deaths were due to
Ludwig's angina, yielding a 4% mortality rate. Thus, aggressive management of
Ludwig's angina, with respect to airway,
antibiotics, and early surgical intervention, has resulted in a significant drop in the mortality rate of this disease which once led "almost uniformly to a fatal ending."