Angina is derived from the latin word angere which means to strangle. Patients may appear quite toxic, sitting upright, drooling and tachypneic. Further extension of the infection to lateral pharyngeal retropharyngeal and prevertebral spaces invariably produces severe trismus. Grodinsky proposed four criteria to distinguish Ludwig's angina from other forms of deep neck abscesses. The roots of these molars extend into the mylohyoid muscle thereby providing a roule to the three primary mandibular spaces.
Infection usually begins in the necrotic pulp of a tooth and then invades adjacent bony tissue.
Alter a period of intrabony spread the infection may erode the thinnest part of the bony cortex and thereby gain access to muscle and soft tissue. If this erosion occurs above the muscle attachment site, fascial space is entered. Submandibular and sublingual spaces freely communicate. The bacterial agents commonly isolated in order ol decreasing frequency include Streptococcus viridans, Staphylococcus aureus and Staphylococcus epidermidis . The free communication of potential spaces of the head and neck and the minimal resistance offered by cervical fascia can have devastating consequences.