Airway Management in a Patient with Ludwig's Angina

Abstract

Ludwig’s angina (LA) is a rare but life-threatening deep space neck infection that affects several combined potential spaces in the neck, namely the submental and submandibular spaces. Patients often present with signs and symptoms such as dysphonia, odynophagia, neck and thoracic pain, otalgia, sialorrhea, and cough. In later stages, the patient may present with dysphagia, trismus, cyanosis, dyspnea, and stridor which all may signal an impending airway collapse. This comprehensive review will set out to describe the definition, anatomy, and epidemiology of Ludwig’s angina, how it manifests, and how to diagnose and treat the infection that can be often difficult to recognize. Clinical features of the disease are discussed as well as different strategies for anesthesia and airway management. Two special situations in which Ludwig’s angina can occur—pregnancy and pediatric patients—are also covered. This review contains 5 tables, and 30 references. Keywords: Ludwig’s angina, management of the airway in Ludwig’s angina, conservative treatment in Ludwig’s angina, surgical management in Ludwig’s angina, antibiotic treatment for Ludwig’s angina, Ludwig’s angina in pediatrics, Ludwig’s angina in pregnancy, neck anatomy in Ludwig’s angina