Ludwig’s Angina

This post is an answer to the case – Swelling in the Neck, Sore Throat, Chills, and Chest Pain

On examination, the floor of his oral cavity was indurated and woody, and he had marked tenderness and adenopathy throughout his neck.

He had erythema spreading from his neck down over his anterior chest wall where his chest pain was localized. He did not have appreciable stridor or trismus, and he was able to swallow his own secretions.

Ludwig’s angina is an infectious process involving the submental, sublingual, and submandibular spaces. It can rapidly progress to hemodynamic instability and airway obstruction; in rare cases, it spreads into the mediastinum.

Compromise of the airway can progress rapidly, with lethal consequences; therefore, immediate consideration should be given to surgical débridement of the infected areas and antimicrobial therapy. In addition, options for surgical management of the airway should be available.

The patient was admitted and underwent extensive surgical débridement. He recovered after a stay in the intensive care unit.