FROM FRACTURE TO AIRWAY THREAT: A CASE OF LUDWIG’S ANGINA FOLLOWING MANDIBULAR FRACTURE

Background: Ludwig’s angina is a rapidly progressive, potentially fatal cellulitis of the floor of the mouth and
neck, often arising from odontogenic or mandibular infections. Prompt surgical intervention and appropriate
antimicrobial therapy are critical for successful outcomes.
Case Presentation: A 53-year-old male presented to the emergency department with severe facial swelling, trismus,
dysphagia, and signs of airway compromise. Clinical and radiographic evaluation revealed an untreated, intraorally
open mandibular fracture complicated with Ludwig’s angina, necessitating urgent surgical intervention.
Management and Outcome: Under general anesthesia, bilateral submandibular stab incisions were made for
Surgical Decompression, debridement, and irrigation with gentamicin and metronidazole, followed by placement of
corrugated drains, and then ORIF of mandibular and maxillary fractures was performed. Postoperatively, the patient
received intravenous antibiotics, corticosteroids, NSAIDs, and fluid support. Microbiology report revealed
diphtheroids on POD-4, and Gentamicin was added to drug regimen. Drains were removed on POD-5, surgical
closure of the stab incisions was done on POD-12 following the resolution of infection, and the patient was
discharged.
Conclusion: This case underscores the importance of early surgical intervention, multidisciplinary care, and
adaptive antimicrobial strategies for managing complex facial trauma complicated by deep space infections, such as
Ludwig’s angina.