Submandibular space infection, also known as Ludwig's angina, is caused by dental infections in 80% of cases. The submandibular space lies between structures in the floor of the mouth and the superficial cervical fascia. Symptoms include difficulty swallowing, trismus, and swelling of the sublingual space or submaxillary space. Treatment involves systemic antibiotics and incision/drainage of abscesses either intraorally or externally depending on the location of the infection. Complications can include spread of infection to other spaces, airway obstruction, sepsis, or aspiration pneumonia.

1. By
Jini P. Abraham

2. Definition
 Infection of the submandibular space
 Submandibular space lies between the mucous
membrane of floor of mouth and tongue on one
side and superficial layer of deep cervical fascia
extending between the hyoid bone and mandible
on the other.
 It is divided into 2 compartments –
 Sublingual compartment
 Submaxillary and submental compartment

4. Etiology
 Dental infections – Accounts for 80% cases. Roots
of premolars cause sublingual space infection
while roots of molar teeth causes submaxillary
space infection.
 Submandibular sialadenitis
 Injuries to oral mucosa
 Fractures of the mandible

6. Bacteriology
 Mixed infections
 Common – Alpha hemolytic Streptococci
Staphylococci
 H. influenzae, E. coli and Pseudomonas

7. Clinical Features
 Marked difficulty in swallowing (odynophagia)
 Trismus
 Infection localized to sublingual space –
structures in floor of the mouth are swollen and
tongue seems to be pushed back
 Infection spreads to submaxillary space -
submental and submandibular regions become
swollen and tender and gives a woody feel
 Laryngeal edema may occur

9. Treatment
 Systemic antibiotics
 Incision and drainage
of the abscess
 Intraoral – Infection
is localized to
sublingual space
 External – Infection
involves
submaxillary space
 Tracheostomy, if
airway is endangered

10. Complications
 Spread of infection to parapharyngeal and
retropharyngeal spaces and hence to the
mediastinum
 Airway obstruction due to laryngeal edema
 Septicaemia
 Aspiration pneumonia