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Year : 2021  |  Volume : 19  |  Issue : 3  |  Page : 191-193

Ludwig's angina – Is management possible in a resource-limited rural surgical setup?

1 Department of General Surgery, Gudalur Adivasi Hospital, The Nilgiris, Tamil Nadu, India
2 Department of Dental Surgery, Gudalur Adivasi Hospital, The Nilgiris, Tamil Nadu, India

Correspondence Address:
Dr. Royson Jerome Dsouza
Gudalur Adivasi Hospital, The Nilgiris - 643 212, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cmi.cmi_22_21

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Ludwig's angina is a rapidly progressive gangrenous cellulitis of the soft tissues of the neck and floor of the mouth which can cause airway compromise. The management involves a multidisciplinary approach consisting of intensivists, otolaryngologists, head-and-neck surgeons, and anesthesiologists. Consequently, the patients with Ludwig's angina are mostly managed at tertiary care centers. Although early surgical intervention for drainage of the abscess and securing the airway is recommended, many subsets of these patients can be managed conservatively. These include hemodynamically stable patients, without stridor and respiratory distress. A 41-year-old lady with no known comorbidities presented with a rapidly progressive swelling over the submandibular region following dental extraction. There were severe trismus and dysphagia but without clinical evidence of airway compromise. She was successfully managed in a rural secondary tribal health-care center with intravenous antibiotics, analgesics, and serial clinical examination. The patient improved symptomatically and recovered well. Through this case report, the authors would like to highlight that Ludwig's angina can be managed in resource-limited rural surgical centers through early intervention along with adequate monitoring and surgical drainage if required.

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