An Unusual Presentation of Ludwig's Angina Complicated by Cervical Necrotizing Fasciitis: A Case Report and Review of the Literature

Abstract

Ludwig's angina can seldom be complicated by necrotizing fasciitis. Due to the rapidly progressing nature of this infection and the potential for airway compromise and death, it is important to be aware of different ways in which this disease process can present in order to recognize and treat it emergently. We report here an unusual presentation of a case of Ludwig's angina complicated by necrotizing fasciitis in an elderly patient. The clinical features, diagnosis, and treatment are discussed in detail as well as a brief literature review on craniocervical necrotizing fasciitis.

Figure 1

Sagittal CT image of patient preoperatively. Note the classic “sniffing” position of patient to maximize air entry in the presence of an upper airway obstruction. White arrows point to significant gas formation in anterior cervical space.

Figure 2

Axial CT image of patient preoperatively at level of hyoid. Note again presence of gas in anterior cervical space and stranding of fat suggestive of acute infection.

Figure 3

Postoperative CT scan at level of the hyoid. Note: the extensive loss of soft tissue in the anterior neck compartment (arrow).

Figure 4

Intraoperative image taken after repeat debridement. Note: exposed submandibular gland on right side (single arrow) and exposed hyoid bone (double arrow).