LUDWIG'S ANGINA: A CASE REPORT AND LITERATURE REVIEW

Abstract

Ludwig's angina is an aggressive and rapidly progressing cellulitis that affects the floor of the mouth, with the potential for airway obstruction. Maintaining an adequate airway should be the main concern and in more serious cases an emergency tracheostomy may be necessary. Mortality is reported to be up to 8%, however, progression to mediastinitis increases this rate to up to 50% of cases. Thus, the objective of the present work is to describe a case of Ludwig's angina that was diagnosed late, but which had a favorable outcome. A 56-year-old patient, with no known comorbidities or previous history of hospitalization, presented with fever, odynophagia and progressive submandibular edema over the course of a month, progressing with difficulty opening the oral cavity, trismus and hoarseness. A clinical diagnosis was made, supported by imaging examination, and given the airway was compromised, the patient underwent drainage of the collections, evolving, however, into acute respiratory failure requiring urgent tracheostomy. After a new approach and antimicrobial therapy, the patient showed progressive clinical and laboratory improvement. It is worth noting that, as in the case described, some patients can be initially treated with antibiotic therapy alone. The surgical indication is not consensual, but normally includes patients who do not improve with antibiotic therapy, in case of fluctuations in the clinical examination or if there are abscesses visible on the image. It becomes clear, therefore, that the therapeutic plan is not unique and requires a individualized assessment of the case, including risk factors, clinical manifestations and resources available at the health institution.