Airway management in Ludwig's angina – a challenge: case report

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

“…Unfortunately, the patient did develop a septic shock on the sixth day and passed away due to the septic shock. 4 In another case report about the management of Ludwig's angina reported by Candamourty et al, 13 regardless of the similar symptoms to the patient in our case report, the medication given consisted "only" of intravenous cefotaxime, gentamicin, metrogyl, and decadron. No vasopressor was given, and the patient showed good improvement, and the recovery was satisfactory.…”

“…Another factor that increases the mortality rate is the difficulty in maintaining airway patency, which, in 8% to 10% of patients, resulted in asphyxiation and death. 4,15 In the case where a septic shock is present as a complication of Ludwig’s angina, the management is even more complicated as it might lead to death as reported by Chequetto et al, 16 and therefore, the management should be thorough and as early as possible. In the current case, the antibiotics given served as therapeutic tools for the odontogenic infection that caused Ludwig’s angina as well as the septic shock.…”

“…Ludwig's angina is a form of acute severe diffuse cellulitis of the maxillofacial region that has been described as bilateral involvement of the sublingual, submental, and submandibular spaces. [1][2][3] Because the location of these spaces is inferior to the tongue base, infections in these areas can result in elevation of the floor of the mouth and posterior displacement of the tongue base into the airway, 3,4 and could lead to death. This is one of the reasons why Ludwig's angina is considered a life-threatening condition.…”

“…Not to mention that there is another complication such as septic shock. 4 Septic shock, which is defined as "a subset of sepsis with particularly profound circulatory, cellular, and metabolic abnormalities associated with a greater risk of mortality than sepsis alone" has an in-hospital mortality rate as high as 40%. 5 The deep neck spaces can be potentially threatening because swelling in these spaces can readily displace, efface, or obstruct the airway.…”

“…1,9,10 When assessing the severity of an infection, one must consider the infection's rate of progression. 1,4 A case report of Ludwig's angina that required complex and immediate management due to the life-threatening condition of the patient is presented in the following section.…”