Ludwig's angina in pregnancy and puerperium: Case series in an academic hospital, Sokoto, Northwest Nigeria

Abstract

Ludwig's angina (LA) otherwise known as angina ludovici is a potentially life-threatening diffuse cellulitis of the neck, the floor of the mouth and submandibular regions bilaterally leading to airway obstruction. This condition during pregnancy and puerperium is rare. Many physiological changes occur through pregnancy and puerperium that place the mother at a higher risk of infection or deteriorating condition once infected. This change includes, reduced immune response resulting in potential faster progression of an infection. We report two cases of LA in third trimester of pregnancy and two cases during peurperium within 5 months at the Departments of Dental and Maxillofacial Surgery and Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Treatment modalities and challenges involved in their management were also discussed. Overall, three patients survived the disease, two cases of LA in pregnancy and one case of LA in the puerperium, one patient in the puerperium died due to overwhelming sepsis. The babies of both patients in the puerperium survived, although they came in with very low birth weight and failure to thrive. They were managed in the special care baby unit of the hospital. Management of LA in a resource and personnel scarce setting is demanding especially in special group of patients such as pregnancy and puerperium. Multidisciplinary approach in management is essential, especially in the antenatal period of the patient.