A Severe Case of Ludwig Angina

Introduction: Ludwig angina, although an uncommon disease, may result in respiratory distress, with a total possible airway obstruction. This is an often originated cellulite dental infection, occurring in patients with poor oral health. It affects the submandibular and sublingual spaces bilaterally, in addition to the submental space. The treatment is based on the use of appropriate antibiotics, airway maintenance, and drainage of the infection.

Resumed Report: A 47-year-old female patient without comorbidities presented with symptoms of cervical bulging, difficulty turning the neck, pain and difficulty in swallowing, muffled voice, and dyspnea when lying down. On physical exam bulging and bilateral submandiblar hyperemia and sublingual teeth fariem disrepair were noticed along with bulging of the sidewall of the left oropharynx and hypopharynx. Computed tomography of the cervical region showed a giant abscess in the left parapharyngeal region, involving the submandibular and sublingual regions. The diagnosis of angina Ludwig was confirmed during hospitalization, antibiotic therapy with meropenem and vancomycin, tracheostomy and surgical drainage of the abscess were administered. Uneventfully and with a good development, she was discharged from hospital after decannulation assisted by nasolaryngoscopy.

Conclusion: The authors presented a case of Ludwig angina, with a brief review of the literature. In such cases, the protection of the upper airway is mandatory and, in most cases, tracheostomy is the best option.

Keywords: Ludwig, drainage, tracheotomy, antibiotics.