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Ludwig angina and sudden death.
Abbie Tu1, John D Gilbert1, Roger W Byard2
1School of Anatomy and Pathology, University of Adelaide and Forensic Science SA, South Australia, Adelaide, Australia.
Forensic Science, Medicine, and Pathology
|January 22, 2021
Summary
A fatal case of Ludwig's angina, a severe neck infection, led to airway obstruction and death after a tooth extraction. This rare but dangerous condition requires careful consideration in emergency airway management.
Area of Science:
- Forensic Pathology
- Emergency Medicine
- Oral Surgery
Background:
- Ludwig's angina is a rapidly progressing cellulitis of the floor of the mouth and sublingual/submylohyoid spaces.
- Dental infections, particularly from mandibular molars, are a common predisposing factor.
Observation:
- A 27-year-old male presented with neck swelling and dyspnea post-tooth extraction.
- Surgical drainage of the submandibular region was followed by acute respiratory collapse.
- Autopsy revealed diffuse cellulitis, edema, and significant submucosal edema of the glottic inlet.
Findings:
- Microbial cultures showed mixed Gram-positive and Gram-negative bacteria.
- The cause of death was airway obstruction due to severe glottic edema secondary to Ludwig's angina.
- Histopathology confirmed diffuse cellulitis and neutrophil infiltration.
Implications:
- Lethal Ludwig's angina, though rare, remains a critical differential diagnosis for acute upper airway obstruction.
- Prompt recognition and management of dental infections are crucial to prevent life-threatening complications.
- This case underscores the importance of considering odontogenic infections in unexplained airway compromise.
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