Ludwig’s angina to retrosternal abscess: a complication of odontogenic infection

Ludwig's angina (LA) is a rapidly spreading cellulitis involving sublingual and submaxillary spaces. It arises most frequently from periapical and periodontal infection of the mandibular molars. Two major complications of LA are life-threatening upper airway obstruction and infectious seeding of the mediastinum, which are responsible for a high mortality rate. Other complications of LA include thrombophlebitis of the internal jugular vein, rupture of the carotid artery, metastatic abscesses and necrosis of the tongue. We have encountered two such cases, with a rapid spread of the inflammation resulting in various local and systemic complications. Awareness of such complications and early clinical as well as radiological diagnosis can lead to prompt surgical drainage, proper antibiotic therapy, and better survival chance. Recognised less often today, this rapidly progressive submaxillary cellulitis may still be fatal.