Anaesthetic management of case of Ludwig angina: Forewarned is forearmed

Abstract

Ludwig's angina and deep neck infections are potentially lethal entities because of their tendency to cause oedema, distortion, and obstruction of the airway and may arise as a consequence of airway management mishaps. In the early stages of the disease, patients may be managed with observation and intravenous antibiotics. Advanced infections, however, require the airway to be secured in addition to immediate surgical drainage. This is complicated by pain, trismus, airway oedema, and tongue displacement creating a compromised airway. Awake fibreoptic intubation under topical anaesthesia may be the ideal method to secure the airway in advanced cases of Ludwig's angina. Here we discuss the successful anaesthetic management with fibreoptic nasal intubation of a 20-year-old female with Ludwig's angina scheduled for emergency drainage with a brief review of airway management options