Ludwig′s angina - An emergency: A case report with literature review

Abstract

Ludwig's angina is a form of severe diffuse cellulitis that presents an acute onset and spreads rapidly, bilaterally affecting the submandibular, sublingual and submental spaces resulting in a state of emergency. Early diagnosis and immediate treatment planning could be a life-saving procedure. Here we report a case of wide spread odontogenic infection extending to the neck with elevation of the floor of the mouth obstructing the airway which resulted in breathlessness and stridor for which the patient was directed to maintain his airway by elective tracheostomy and subsequent drainage of the potentially involved spaces. Late stages of the disease should be addressed immediately and given special importance towards the maintenance of airway followed by surgical decompression under antibiotic coverage. The appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection remains the standard protocol of treatment in advanced cases of Ludwig's angina.

A woman with swelling of the neck

“…CT or MRI might be helpful in defining the extent and location of infection, including the abscess. Ludwig's angina can be life-threatening in leading to asphyxia, and mortality rates of 50% have been reported, if treatment is not provided immediately 3. Maintenance of the airway is crucial, and drainage and antimicrobial therapy are indicated.…”

Epidemiology and resource utilization of ludwig's angina ED visits in the United States 2006–2014

“…Ludwig's angina is a rare and potentially life‐threatening cellulitis of the submandibular space and floor of mouth. Over 90% of cases are secondary to disease of the lower molars, but additional etiologies include peritonsillar abscess, parapharyngeal abscess, mandibular fracture, sialadenitis, and other oral lacerations . Early recognition and airway management are crucial because this infection can progress rapidly to airway obstruction, mediastinitis, and sepsis, causing significant morbidity and mortality .…”

“…Over 90% of cases are secondary to disease of the lower molars, 1 but additional etiologies include peritonsillar abscess, parapharyngeal abscess, mandibular fracture, sialadenitis, and other oral lacerations. 2 Early recognition and airway management are crucial because this infection can progress rapidly to airway obstruction, mediastinitis, and sepsis, causing significant morbidity and mortality. 3 The leading cause of death in cases of Ludwig's angina is airway obstruction due to the rapidly expanding cellulitis in the submandibular, sublingual, and parapharyngeal spaces, causing the elevation of the floor of the mouth.…”

A Case Report on Ludwig’s Angina: An Ent Emergency

“…Ludwig's angina is diffuse cellulitis in the submandibular, sublingual, and submental spaces, characterized by its propensity to spread rapidly to the surrounding tissues which are a collection of pus in the center of a tooth. It is named after the Stuttgart physician Karl Friedrich Wilhelm von Ludwig, who first described the condition in 1836 [1].…”