Ludwig's Angina: A Systematic Review and Meta-Analysis of Clinical Characteristics, Management Patterns, Complications, and Mortality

Authors

• Kambiz Ebrahimi, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.Follow
• Mekhaeel Shehata Fakhry Mekhaeel, Department of Operative Surgery and Clinical Anatomy named after I.D. Kirpatovsky, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Sameh Mohamed Ahmed Eissa Salem, Department of Operative Surgery and Clinical Anatomy named after I.D. Kirpatovsky, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Tahoura Talebidelooei, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Parsa Javidimomtaz, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Mohammad Pouya Javdani Golparvar, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Azin Nemati, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Mohammad Salar Khodabakhshian Naeini, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Reyhaneh Jahanshahi, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Erfan Kazemi, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Maedeh Bahmani, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Masoume Miraveysi, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Arian Safi Esfahani, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Kiyana Khodabandehloosoltani, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.
• Mohammadjavad Bahmani, Department of Oral and Maxillofacial Surgery and Surgical Dentistry, Medical Institute, Peoples' Friendship University of Russia named after Patrice Lumumba (RUDN University), Moscow, Russian Federation.

Abstract

Background: Ludwig's angina is a rapidly progressive odontogenic and deep neck infection that may lead to airway compromise, severe complications, and death. This systematic review and meta-analysis aimed to synthesize clinical evidence on mortality, etiology, comorbidities, complications, and management patterns in patients with true Ludwig's angina.
Methods: Published human studies reporting true Ludwig's angina were included. Multi-patient studies with extractable event and denominator data were eligible for quantitative synthesis. The outcomes were mortality, odontogenic source, diabetes mellitus, tracheostomy, surgical drainage, necrotizing fasciitis, and mediastinitis or deep neck mediastinitis. Random-effects meta-analyses of proportions were performed.
Results: Eighteen studies including 649 patients were included. Among studies reporting mean age, the weighted mean age was 43.8 years (range: 0.5–82 years). Twelve studies with 453 patients contributed to the mortality analysis. The pooled mortality proportion was 7.1% (95% confidence interval, 4.0%-12.2%). The pooled proportions of odontogenic source, diabetes mellitus, tracheostomy, surgical drainage, necrotizing fasciitis, and mediastinitis or deep neck mediastinitis were 83.1%, 27.9%, 13.7%, 85.3%, 10.8%, and 5.3%, respectively.
Discussion: The evidence indicates that Ludwig's angina remains predominantly odontogenic and is commonly managed with surgical drainage, whereas tracheostomy use varies across clinical settings. Interpretation is limited by heterogeneity and inconsistent reporting of disease severity, airway management, surgical timing, complications, and mortality.
Conclusion: Ludwig's angina remains associated with measurable mortality and clinically important complications. Standardized reporting is needed to improve future evidence synthesis.

Recommended Citation

Kambiz E. , Mekhaeel Shehata Fakhry M. , Sameh Mohamed Ahmed Eissa S. , Tahoura T. , Parsa J. , Mohammad Pouya Javdani G. , Azin N. , Mohammad Salar Khodabakhshian N. , Reyhaneh J. , Erfan K. , Maedeh B. , Masoume M. , Arian Safi E. , Kiyana K. , & Mohammadjavad B. (2026) "Ludwig's Angina: A Systematic Review and Meta-Analysis of Clinical Characteristics, Management Patterns, Complications, and Mortality," Journal of Dentomaxillofacial Science: Vol. 11: Iss. 4, Article 1.
DOI: https://doi.org/10.65844/2503-0825.1517
Available at: https://scholarhub.unhas.ac.id/jdmfs/vol11/iss4/1

Pages

317-332

DOI

10.65844/2503-0825.1517