A Severe Case of Ludwig's Angina with a Complicated Clinical Course

Abstract

Ludwig's angina is a cellulitis of the submandibular, sublingual, and submental spaces, which tends to spread rapidly along fascial planes. The most common cause is a dental infection, although any other oropharyngeal infection has the potential to develop into Ludwig's angina. The most feared complication of Ludwig's angina is airway obstruction. Treatment involves early recognition so that an airway can be secured, initiation of antibiotics, and, finally, potential surgical debridement. We describe the case of a 57-year-old male with multiple comorbidities who was seen by a provider three times for dental pain prior to his admission for Ludwig's angina. Upon his index admission, he was found to have Ludwig's angina with impending airway obstruction. He required an emergency surgical airway debridement and extraction of multiple teeth. Although the patient eventually recovered, his hospital stay was prolonged and marked by multiple complications. This case is an example of a severe presentation of Ludwig's angina and the difficulties faced by the medical team in managing this condition. Early recognition and rapid intervention are paramount in the management of this serious condition.

Keywords: ludwig's angina; necrotizing fasciitis; odontogenic infection; surgery; tracheostomy.

Figure 1. Contrast-enhanced computed tomography of the soft tissues of the neck showed rightward displacement of the hypopharyngeal airway (a, blue arrow, axial image). Also noted were abscesses of the left masticator muscle (b, blue arrow, axial image), medial and lateral pterygoids (b, red arrow, axial image), left stylomandibular canal (c, blue arrow, coronal image), and the sublingual space (d, blue arrow, sagittal image) with narrowing of airway to 4 mm (d, red arrow, sagittal image).