Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Submandibular Space Infection

(Ludwig's Angina; Ludwig Angina)


Clarence T. Sasaki

, MD, Yale University School of Medicine

Last full review/revision Jan 2020| Content last modified Jan 2020
Click here for the Professional Version

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.

Symptoms of Submandibular Space Infection

People with a submandibular space infection 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.

Diagnosis of Submandibular Space Infection

  • 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.

Treatment of Submandibular Space Infection

  • A breathing tube followed by surgery to drain the abscess

  • Antibiotics

Treatment for submandibular space infection 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.

Drugs Mentioned In This Article

Generic Name Select Brand Names
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
Test your knowledge
Loss of Smell
Anosmia is the total loss of smell. Most people with anosmia can taste sweet, sour, salty, and bitter substances but cannot distinguish among specific flavors. This is because the sense of smell makes it possible to distinguish among flavors, not taste receptors as many people erroneously believe. Which of the following is NOT a common cause of anosmia?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID