Ludwig's angina: need for including airways and larynx in ultrasound evaluation

Ludwig's angina is a deep neck space infection. Unlike other abscesses elsewhere in the body, rapid progression of the disease results in serious complications such as airway oedema, distortion, total obstruction with loss of airway and death. Thus, early diagnosis and skilful airway management is necessary. For safe airway management, fibreoptic intubation or tracheostomy under local anaesthesia is recommended.1 We describe a case report where an initial attempt at fibreoptic intubation failed and subsequently bleeding ensued causing difficulty in viewing the larynx by fibreoptic bronchoscopy. Radiological investigations such as ultrasound and computer tomography (CT) are commonly ordered by surgeons and emergency physicians to know the extension of disease, but airways and larynx are seldom included. We discuss the role of ultrasound in airway assessment in such critical cases to ensure safe and uncomplicated airway access.