Ludwig's Angina: The Original Angina

Area of Science:

• Oral and Maxillofacial Surgery
• Anesthesiology
• Infectious Diseases

Background:

• Ludwig's angina is a rapidly progressing, bilateral cellulitis of the submandibular, sublingual, and submental spaces.
• Severe trismus and airway compromise are hallmark features, necessitating prompt airway management.
• Dental infections, particularly from mandibular third molars, are a common etiology.

Purpose of the Study:

• To present a case of Ludwig's angina managed with awake fiberoptic intubation.
• To illustrate the challenges in securing the airway in patients with severe trismus.
• To emphasize the importance of multidisciplinary care in managing deep neck space infections.

Main Methods:

• A case report detailing the clinical presentation, diagnosis, and management of Ludwig's angina.
• Awake fiberoptic intubation was performed due to anticipated difficult airway.
• Surgical incision and drainage of neck spaces and extraction of involved teeth were performed.

Main Results:

• Successful awake fiberoptic intubation was achieved despite severe trismus.
• The patient required prolonged mechanical ventilation in the Intensive Care Unit.
• The patient recovered and was discharged one week post-admission with outpatient follow-up.

Conclusions:

• Awake fiberoptic intubation is a crucial technique for securing the airway in Ludwig's angina with severe trismus.
• Prompt surgical intervention and intensive care are vital for favorable outcomes.
• Multidisciplinary management involving surgery, anesthesia, and critical care is essential.