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

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.