Ludwig’s Angina in a Parturient: A Case Report

Abstract

Introduction: Ludwig’s angina is a rare but life threatening cellulitis of the soft tissue involving the floor of the mouth. Although Ludwig’s angina is a rare condition, it must be kept as a differential in the clinical setup when a patient presents with a neck swelling. Case Report: A 28 year old multigravida with 31 weeks 4 days gestational age presented with a swelling over the right side of the neck since 8 days. Patient also complains of toothache since past 5 days. The swelling was sudden in onset and progressed to attain the present size. It was associated with breathing difficulty since past 1 day. It was also associated with pain over the region. She had difficulty in eating solid food due the restriction in mouth opening due to the swelling. She was on liquid diet since past 7 days. She was diagnosed with hypothyroidism and was on Tab. Thyroxine 50 mcg. On physical examination, she is a moderately built and nourished female, vitals were stable. Examination of the head and neck revealed a diffuse swelling of size 10x10 cm over the right side of face extending from the right mastoid till the right oral commissure. Superiorly it extended up to 1 cm below right eye and inferiorly till the sternocleidomastoid origin. Total leucocyte count of 5.59 thousand/mm3. After admission, antibiotics were started. Incision and drainage was planned for the patient. Intraoperatively, patient was tracheostomized due to restricted mouth opening and difficult intubation. After induction, vertical incision was made and about 100 ml of pus was drained from the swelling on the right side. Post-operative period was uneventful. The patient was discharged on antibiotics and tracheostomy care. Conclusion: Ludwig’s angina should be kept in mind with this type of presentation. It can be life threatening if the treatment is improper, but intervention and subsequent correction can clear the symptoms completely.