Ludwig's Angina - An emergency: A case report with literature review

Abstract

Ludwig's angina is a form of severe diffuse cellulitis that presents an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a state of emergency. Early diagnosis and immediate treatment planning could be a life-saving procedure. Here we report a case of wide spread odontogenic infection extending to the neck with elevation of the floor of the mouth obstructing the airway which resulted in breathlessness and stridor for which the patient was directed to maintain his airway by elective tracheostomy and subsequent drainage of the potentially involved spaces. Late stages of the disease should be addressed immediately and given special importance towards the maintenance of airway followed by surgical decompression under antibiotic coverage. The appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection remains the standard protocol of treatment in advanced cases of Ludwig's angina.

Keywords: Ludwig's angina; odontogenic infection; surgical decompression; tracheostomy.

Figure 1

Preoperative appearance with bilateral involvement of the submandibular, sublingual, and the submental spaces showing brawny induration of the swelling

Figure 2

Postoperative view showing the tube drains and tracheostomy tube in place