The management of septic shock and Ludwig's angina: A case report of a life-threatening condition

Abstract

Ludwig's angina is a high severity infection because of the risk of airway obstruction due to the rapid spread of the abscess into the deeper spaces. Therefore, performing the correct treatment is one of the keys to a successful result. A 44-year-old male patient came to the Emergency Unit of Hasan Sadikin Hospital, complaining of shortness of breath, severe pain, and progressive swelling. Extraoral examination showed a localized-fluctuated swelling located at the right lower jaw that extended to the chin, left lower jaw, and the frontal region of the neck region while a sequential organ failure assessment revealed a score of 2. A diagnosis of Ludwig's angina and septic shock was confirmed. Intravenous infusion of norepinephrine was administered and a tracheostomy was performed. The next treatment phase consisted of a drainage procedure, tooth extraction, and placement of the Penrose drain. The patient was discharged 10 days later with a satisfactory outcome.

Keywords: Ludwig’s angina; Ludwig’s angina management; Septic shock.

Figure 1.

(a) Side view clinical appearance, and (b, c) neck and soft tissue X-ray demonstrated air bubble appearance at the anterior part of the neck and the trachea has deviated to the left, an indication of right lateral pharyngeal space abscess.

Figure 2.

(a) Pus needle aspiration, (b) bilateral incision and drainage, (c) Penrose drain placement at submandibular and submental area, (d) Penrose drain placement at sublingual area, (e) postoperative condition—day 1, and (f) postoperative condition—day 5.