Did Ludwig's angina kill Ludwig?

Abstract

Wilhelm Frederick von Ludwig first described in 1836 a potentially fatal, rapidly spreading soft tissue infection of the neck and floor of the mouth. The condition was later named 'Ludwig's angina', a term which persists in medicine to this day. A gold medallist at 19 and professor at 25, Ludwig also served as president of the Württemberg Medical Association and chief physician to the royal family. His outstanding contribution to medicine was rewarded with the title Excellence upon retiring in 1855. Ludwig died at the age of 75, ironically, days after developing an inflammation of the neck. Could it be that Ludwig died of his own condition? This article combines a biography of Wilhelm Frederick von Ludwig with an overview of his eponymous condition and its management.

Controversies in the management of deep neck space infection in children: an evidence‐based review

“…Ludwig's angina is a severe and rapidly spreading bilateral cellulitis of the submandibular, sublingual and submental spaces with an odontogenic cause in 85% of cases . Hence, it is rare in the paediatric population but may also occur as a complication of a peritonsillar or parapharyngeal infection.…”

“…Symptoms include toothache, mouth and neck pain and in more advanced cases odynophagia, dysphagia and drooling. Clinical signs include fever, tender induration of the submandibular space with a so‐called characteristic brawny appearance to the skin and floor of the mouth oedema that may lead to tongue elevation and protrusion . Dyspnoea, tachypnea and stridor indicate progressive supraglottic oedema.…”

Angina de Ludwig. Experiencia en 29 pacientes Ludwig’s angina.

“…Aunque esta infección, descrita por Von Ludwig en 1836, presentó elevada mortalidad en la era preantibiótica, ha disminuido de forma importante en las últimas décadas. La inflamación de los tejidos del espacio submandibular y sublingual es el evento clásico de presentación de la misma, que, anecdóticamente, se encontró en la autopsia del médico alemán que la describió (3).…”

“…La línea y el músculo milohioideos cumplen una función importante en la fisiopatología de la enfermedad, ya que se disemina a través de su borde posterior hacia los espacios submaxilar (sublingual-submilohioideo) y submentoniano (figura 1). Comienza como una celulitis, avanza hacia una fascitis y finaliza como un verdadero absceso (3).…”

Ludwig angina

“…4 If the patient is sufficiently stable to allow radiologic investigations, CT is useful to evaluate deep neck and mediastinal conditions. 5 The most common cause of Ludwig angina is infection in odontogenic tissue. 1,3 In this case, however, we presumed that the condition originated from submandibular sialadenitis caused by sialolithiasis.…”