STRUCTURED AIRWAY MANAGEMENT AND EVIDENCE-BASED EXTUBATION STRATEGY FOR LUDWIG’S ANGINA

Ludwig’s angina is a rapidly advancing infection affecting the submandibular, sublingual, and submental spaces,
posing a significant risk of airway obstruction. Prompt airway management and an appropriate extubation strategy
are essential to prevent life-threatening complications. We report on a 20-year-old male patient who developed
worsening neck swelling, swallowing difficulties, and respiratory issues as a result of untreated dental cavities. Upon
examination, submandibular cellulitis and posterior tongue displacement were observed. Laboratory results showed
leukocytosis, thrombocytopenia, and hypoalbuminemia, indicating a systemic inflammatory response. Based on the
clinical and laboratory evidence, a diagnosis of Ludwig’s angina complicated by sepsis was established. To ensure
airway patency, awake fiber-optic intubation was conducted, followed by the commencement of mechanical
ventilation. Intravenous administration of ceftriaxone and metronidazole was employed as empirical therapy to
address both aerobic and anaerobic bacterial infections. The patient received care in the intensive care unit (ICU),
where continuous monitoring and sedation were maintained. On the eighth day, extubation was successfully
performed after confirming a positive cuff leak test, the absence of further edema, and stable respiratory function.
The patient achieved full recovery without necessitating a tracheostomy or additional corticosteroid treatment. This
case study demonstrates the successful conservative management of Ludwig’s angina in a young adult, facilitated by
prompt airway intervention, comprehensive multidisciplinary care in the intensive care unit (ICU), and a carefully
planned extubation strategy. It emphasizes the critical role of personalized, evidence-based protocols in addressing
complex airway infections and supports the application of non-surgical methods when guided by objective criteria.