Awake tracheostomy and caesarian section for full term female with Ludwig’s angina

Abstract

Pregnancy is associated with physiologic and immunologic changes that increase the risk of odontogenic infections and their progression to life-threatening conditions such as Ludwig’s angina. Ludwig’s angina, a rapidly progressive cellulitis of the floor of mouth and contiguous spaces, can compromise the airway and requires urgent multidisciplinary management. We present the case of a 32-year-old woman at 36 weeks of gestation who presented with progressive neck swelling, trismus, and dyspnea due to Ludwig’s angina. Given acute airway compromise and inability to tolerate supine positioning, an awake tracheostomy was performed under local anesthesia in a semi-seated position. After securing the airway, urgent cesarean section was completed with delivery of a healthy infant, followed by incision and drainage of the neck abscess. The patient recovered well on intravenous antibiotics, resumed breastfeeding on postoperative day one, and was decannulated by postoperative day 14. This case highlights the elevated risk of severe odontogenic infections in pregnancy, the physiologic changes that further compromise airway reserve, and the importance of prompt multidisciplinary decision-making. Awake tracheostomy, though rarely reported in pregnancy, may be lifesaving when fiberoptic intubation is unavailable, and can facilitate subsequent obstetric and surgical interventions to achieve successful maternal and neonatal outcomes.