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Submandibular Space Infection

(Ludwig's Angina; Ludwig Angina)

By Clarence T. Sasaki, MD, The Charles W. Ohse Professor of Surgery and Director, Yale Larynx Lab, Yale University School of Medicine

A submandibular space infection is a bacterial infection of the floor of the mouth.

Bacteria can spread from an infected lower tooth to the tissue under and around the tongue. People with poor dental hygiene and people who have had a tooth pulled or a jaw fracture are at higher risk. The infection causes swelling that can block the airway causing difficulty breathing and sometimes death.


People have pain and tenderness under the tongue, and/or under the jaw. The pain is worse with opening the mouth or swallowing.

Fever and chills are common.

Later, swelling worsens, which may cause drooling and noisy breathing. Once swelling occurs, blockage of the airway and death may occur within hours.


  • A doctor's evaluation

  • Sometimes computed tomography

Doctors usually can diagnose submandibular space infection by examining the mouth.

If the examination is unclear, doctors do a computed tomography (CT) scan. However, if an airway blockage appears to be developing or may occur soon, they initiate treatment quickly and postpone the CT scan.


  • A breathing tube followed by surgery to drain the abscess

  • Antibiotics

Treatment must be done quickly to prevent blockage of the airway.

Doctors take the person to the operating room and use a fiberoptic scope to help guide a plastic breathing tube through the nose into the windpipe (trachea) to keep the airway open. Then doctors surgically open the infected area to allow the infection to drain.

Antibiotics such as clindamycin are given by vein.