Bedside emergency tracheostomy in Ludwig neck- a dilemma: case report

Authors

  • Manish Munjal Department of ENTHNS, Dayanand Medical College Ludhiana, Punjab, India
  • Sandeep Kundra Department of Anaesthesia, Dayanand Medical College Ludhiana, Punjab, India
  • Amit Berry Department of Medicine, Dayanand Medical College Ludhiana, Punjab, India
  • Shubham Munjal Department of ENTHNS, Medical College Ludhiana, Punjab, India
  • Salony Sharma Department of ENTHNS, Medical College Ludhiana, Punjab, India
  • Swati . Department of Anaesthesia, 3Department of Medicine, Dayanand Medical College Ludhiana, Punjab, India
  • Shivam Talwar Department of ENTHNS, Dayanand Medical College Ludhiana, Punjab, India
  • Deeksha Chawla Department of ENTHNS, Dayanand Medical College Ludhiana, Punjab, India
  • Hardeep Kaur Department of ENTHNS, Dayanand Medical College Ludhiana, Punjab, India
  • Lovleen Sandhu Department of ENTHNS, Dayanand Medical College Ludhiana, Punjab, India
  • Dhruv Gupta Department of ENTHNS, Dayanand Medical College Ludhiana, Punjab, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20223050

Keywords:

Ludwig's angina, Odontogenic, Stridor, Fasciotomy, Surgical decompression, Tracheostomy

Abstract

A stony hard rigid neck is the typical presentation in the angina of Von Ludwig. Suddenly with excruciating pain generalized severe cellulitis of the neck is noticed. It flares up quickly and extends on either side, in the submandibular, sublingual and submental triangles thereby manifesting as a medical emergency. This necessitates a prompt diagnosis and intervention medical or surgical as the case maybe, lest a life maybe lost. A neck swelling secondary to self-manipulation of a loose dental plate with impacted wire is being reported. This odontogenic infection had accessed the deeper tissues of a neck with elevation of the floor of the mouth obstructing the airway with consequent breathlessness and stridor; with need to regain his airway by emergency tracheostomy. At the same time a cervical fasciotomy was undertaken to drain the potentially involved spaces.

 

Author Biography

Manish Munjal, Department of ENTHNS, Dayanand Medical College Ludhiana, Punjab, India

Prof hod ORLHNS

References

Saifeldeen K, Evans R. Ludwig’s angina. Emerg Med J. 2004;21(2):242-3.

Bansal A, Miskoff J, Lis RJ. Otolaryngologic critical care. Crit Care Clin. 2003;19(1):55-72.

Moreland LW, Corey J, McKenzie R. Ludwig's angina: report of a case and review of the literature. Arch Int Med. 1988;148(2):461-6.

Spitalnic SJ, Sucov A. Ludwig's angina: case report and review. J Emerg Med. 1995;13(4):499-503.

Fischmann GE, Graham BS. Ludwig's angina resulting from the infection of an oral malignancy. J Oral Maxillofac Surg. 1985;43(10):795-6.

Owens BM, Schuman NJ. Ludwig's angina. General dentistry. 1994;42(1):84-7.

Owens BM, Schumann NJ. Ludwig's angina: historical perspective. J Tennessee Dent Assoc. 1993;73(1):19-21.

Lejeune HB, Amedee RG. A review of odontogenic infections. J Louisiana State Med Soc. 1994;146(6):239-41.

Finch RG, Snider GE, Sprinkle PM. Ludwig's angina. JAMA. 1980;243(11):1171-3.

Britt JC, Josephson GD, Gross CW. Ludwig’s angina in the pediatric population: report of a case and review of the literature. Int J Pediatric Otorhinolaryngol. 2000;52(1):79-87.

Britt JC, Josephson GD, Gross CW. Ludwig’s angina in the pediatric population: report of a case and review of the literature. Int J Pediatric Otorhinolaryngol. 2000;52(1):79-87.

Har-El G, Aroesty JH, Shaha A, Lucente FE. Changing trends in deep neck abscess: a retrospective study of 110 patients. Oral Surg Oral Med Oral Pathol. 1994;77(5):446-50.

Kurien M, Mathew J, Job A, Zachariah N. Ludwig's angina. Clin Otolaryngol Allied Sci. 1997;22(3):263-365.

Bross-Soriano D, Arrieta-Gómez JR, Prado-Calleros H, Schimelmitz-Idi J, Jorba-Basave S. Management of Ludwig's angina with small neck incisions: 18 years experience. Otolaryngol Head Neck Surg. 2004;130(6):712-7.

Shockley WW. Ludwig angina: a review of current airway management. Arch Otolaryngol Head Neck Surg. 1999;125(5):600.

Marple BF. Ludwig angina: a review of current airway management. Arch Otolaryngol Head Neck Surg. 1999;125(5):596-9.

Neff SP, Merry AF, Anderson B. Airway management in Ludwig's angina. Anaesth Intens Care. 1999;27(3):659-61.

Parhiscar A, Har-El G. Deep neck abscess: a retrospective review of 210 cases. Ann Otol Rhinol Laryngol. 2001;110(11):1051-4.

Irani BS, Martin-Hirsch D, Lannigan F. Infection of the neck spaces: a present day complication. J Laryngol Otol. 1992;106(5):455-8.

Sethi DS, Stanley RE. Deep neck abscesses–changing trends. J Laryngol Otol. 1994;108(2):138-43.

Busch RF, Shah D. Ludwig's angina: improved treatment. Otolaryngol Head Neck Surg. 1997;117(6):S172-5.

Har-El G, Aroesty JH, Shaha A, Lucente FE. Changing trends in deep neck abscess. A retrospective study of 110 patients. Oral Surg Oral Med Oral Pathol. 1994;77:446-50.

Kurien M, Mathew J, Job A, Zachariah N. Ludwig's angina. Clin Otolaryngol Allied Sci. 1997;22:263-5.

Bross-Soriano D, Arrieta_Gómez JR, Prado-Calleros H, Schimelmitz-ldi J, Jorba-Basave S. Management of Ludwig's angina with small neck incisions: 18 years experience. Otolaryngol Head Neck Surg. 2004;130:712-7.

Shockley WW. Ludwig's angina: A review of current airway management. Arch Otolaryngol Head Neck Surg. 1999;125:600.

Marple BF. Ludwig's angina: A review of current airway management. Arch Otolaryngol Head Neck Surg. 1999;125:596-9.

Neff SP, Merry AF, Anderson B. Airway management in Ludwig's angina. Anaesth Intens Care. 1999;27:659-61.

Parhiscar A, Har-El G. Deep neck abscess: A retrospective study of 210 cases. Ann Otol Rhinol Laryngol. 2001;110:1051-4.

Irani BS, Martin-Hirsch D, Lannigan F. Infection of the neck spaces: A present day complication. J Laryngol Otol. 1992;106:455-8.

Sethi DS, Stanley RE. Deep neck abscesses – changing trends. J Laryngol Otol. 1994;108:138-43.

Busch RF, Shah D. Ludwig's angina: Improved treatment. Otolaryngol Head Neck Surg. 1997;117:S172-5.

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Published

2022-11-24

Issue

Vol. 8 No. 12 (2022): December 2022

Section

Case Reports