Life-Threatening Airway Obstruction and Septic Shock Due to Submandibular Space Infection: A Case Report

Abstract

Submandibular space infection, a rare and aggressive form of cellulitis, affects the floor of the mouth and neck, potentially leading to life-threatening complications. Although commonly associated with oral trauma and contiguous abscesses, the severity of these odontogenic infections often escalates due to underlying comorbidities. This report presents a unique case of a 74-year-old man who developed severe complications following an outpatient oral procedure. The patient exhibited fever and mouth swelling within a short time, which quickly advanced to impending airway compromise and septic shock. Diagnostic imaging revealed extensive swelling from the left submandibular region extending to the anterior neck and parapharyngeal space, effacing the airway. This necessitated immediate nasotracheal intubation and mechanical ventilation. Medical management comprised emergent antibiotic administration, airway protection, and admittance to the intensive care unit. This case underscores the potential severity of complications arising from an odontogenic infection in the presence of multiple comorbidities following an oral procedure. It emphasizes the need for prompt symptom recognition, emergency airway management, and the initiation of antibiotic therapy. Furthermore, this case illustrates the critical role of various imaging modalities and the choice of intubation technique in patients with an anticipated difficult airway. Despite the severity of submandibular space infection, a timely, effective, and multidisciplinary approach can mitigate fatal outcomes and improve patient prognosis.

Keywords: airway obstruction; ludwig’s angina; nasotracheal intubation; septic shock; submandibular space infection.

Figure 1. Images of the patient’s oral cavity and neck

Panel A shows a view of the patient’s mouth, highlighting the protrusion of the tongue and significant drooling. Panel B presents the patient’s neck, demonstrating significant swelling.

Figure 2. Soft tissue neck CT scans in sagittal (A) and axial (B) views, without contrast, revealing extensive soft tissue swelling extending from the left side of the face and the left submandibular region into the anterior neck

There is notable swelling in the parapharyngeal space resulting in effacement of the airway. CT, computed tomography

Figure 3. Images illustrating improvements in the patient’s condition

Panel A shows a reduction in neck swelling, and panel B displays an improved state of the patient’s oral cavity.