A Severe Case of Ludwig's Angina with a Complicated Clinical Course.

Vitaley Kovalev

doi:10.7759/cureus.7695

Abstract

Ludwig's angina is a cellulitis of the submandibular, sublingual, and submental spaces, which tends to spread rapidly along fascial planes. The most common cause is a dental infection, although any other oropharyngeal infection has the potential to develop into Ludwig’s angina. The most feared complication of Ludwig’s angina is airway obstruction. Treatment involves early recognition so that an airway can be secured, initiation of antibiotics, and, finally, potential surgical debridement. We describe the case of a 57-year-old male with multiple comorbidities who was seen by a provider three times for dental pain prior to his admission for Ludwig's angina. Upon his index admission, he was found to have Ludwig’s angina with impending airway obstruction. He required an emergency surgical airway debridement and extraction of multiple teeth. Although the patient eventually recovered, his hospital stay was prolonged and marked by multiple complications. This case is an example of a severe presentation of Ludwig's angina and the difficulties faced by the medical team in managing this condition. Early recognition and rapid intervention are paramount in the management of this serious condition.

Highlights

Ludwig's angina is a potentially life-threatening cellulitis of the floor of the mouth and was first described by the German army physician Wilhelm Frederick von Ludwig in 1836 [1]
The patient is a 57-year-old male with a medical history of chronic obstructive pulmonary disease, congestive heart failure, hypertension, morbid obesity, and stage III breast cancer with the last chemotherapy completed three weeks before the index admission. He initially presented to our Emergency Department (ED) with left lower dental pain for four days
Just as with our patient, most deep space neck infections are of odontogenic origin, especially the second and third molars [9]

Summary

Introduction

Ludwig's angina is a potentially life-threatening cellulitis of the floor of the mouth and was first described by the German army physician Wilhelm Frederick von Ludwig in 1836 [1]. The patient is a 57-year-old male with a medical history of chronic obstructive pulmonary disease, congestive heart failure, hypertension, morbid obesity, and stage III breast cancer with the last chemotherapy completed three weeks before the index admission He initially presented to our Emergency Department (ED) with left lower dental pain for four days. An otolaryngologist was consulted and the patient was taken to the operating room for mass excision and biopsy on hospital day 16. Two days after the nasopharyngeal mass excision, the patient began having intermittent minor bleeding from the mouth, as noted by the nursing staff. His aspirin and unfractionated heparin doses were stopped.

Discussion

Conclusions

Disclosures

Chow AW