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Case Reports
. 2025 Jul 28;21(4):1-5.
doi: 10.5152/iao.2025.241804.

Intraoperative Finding of Potential Ludwig's Angina Resulting from the Spread of Middle Ear Cholesteatoma Following Head Trauma: A Case Report

Xuecheng Song  1 , Jing Fei  1 , Leiji Li  1
Affiliations
Case Reports

Intraoperative Finding of Potential Ludwig's Angina Resulting from the Spread of Middle Ear Cholesteatoma Following Head Trauma: A Case Report

Xuecheng Song et al. J Int Adv Otol. .

Abstract

Ludwig's angina is a cellulitis involving multiple spaces in the floor of the mouth. It is mainly associated with odontogenic infections and head or facial trauma, which may result in death by asphyxiation due to sudden airway obstruction. By presenting a case of Ludwig's pharyngitis second- ary to middle ear cholesteatoma, it was aimed to alert otolaryngologists to the potential risks and management of this disorder. The patient was a 49-year-old woman with a 40-year history of middle ear cholesteatoma. Ten days prior to her admission, she sustained an ipsilateral punch injury to the tempo-lateral region, which was followed by postauricular erythematous swelling, pain, and postauricular subperiosteal abscess forma- tion. Sudden mandibular swelling was found during postoperative extubation from middle ear cholesteatoma surgery. In order to prevent the occurrence of sudden acute asphyxia in the postoperative period, an immediate prophylactic tracheotomy was carried out to establish an artifi- cial airway. The patient was subsequently treated with antibiotics and had an uneventful recovery. Prompt diagnosis and aggressive therapeutic interventions are essential for successfully managing Ludwig's angina.

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Figures

Figure 1.
Figure 1.
Image of the patient exhibited right-sided postauricular subperiosteal abscess.
Figure 2.
Figure 2.
Imaging reveals a lesion filling the right middle ear with destruction of the mastoid bone and communication with the ethmoid sinus. The lesion extends into the external auditory canal and periauricular skin, accompanied by abscess formation.
Figure 3.
Figure 3.
MRI displayed a right middle ear mass with a high mixed signal.
Figure 4.
Figure 4.
MRV revealed a lack of visualization of the right sigmoid sinus.
Figure 5.
Figure 5.
The above images display the patient’s intraoperative picture.
Figure 6.
Figure 6.
A follow-up maxillofacial CT on the second postoperative day revealed persistent submandibular swelling in the patient.
See this image and copyright information in PMC

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