Airway Management of Ludwig’s Angina in a Paediatric Patient

Valsa Abraham, Narjeet K Osahan, Himani Garg, Elzeba Susan Varghese* and Harmanbir

Diffuse cellulitis affecting the bilateral submandibular, sublingual, and submental spaces characterizes Ludwig’s angina, a quickly developing, potentially fatal soft tissue infection. It is a medical emergency due to its sudden onset and rapid spread. In this report, we describe a case of a widespread odontogenic infection that spread to the cervical region with an elevated floor of the mouth and compromised airway. The affected spaces were drained. 

Case report: A 9-year-old female child with Ludwig’s angina was taken up for emergency incision and drainage. The airway management was anticipated to be difficult. Initial tracheal intubation was difficult, and an attempt at tracheostomy was made, which led to drainage of pus, but the trachea could not be identified due to inflammation. Following the drainage of pus, oral intubation was done with a smaller tube (4.5), and the airway was secured. 

Conclusion: In a case of Ludwig’s angina, difficult mask ventilation due to swelling of the soft tissues, difficult laryngoscopy due to swelling and inflammation of the floor of the mouth, and difficult intubation should be anticipated by the anaesthesiologists. Hence, there should be minimal airway manipulation with a trial of intubation by an experienced anaesthesiologist and tracheostomy is considered the mainstay of airway management. In the paediatric age group, tracheostomy could be associated with tracheal stenosis; hence, endotracheal intubation is usually preferred over tracheostomy as the first line of airway management.

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Published on: Feb 11, 2026 Pages: 1-5

Full Text PDF Full Text HTML DOI: 10.17352/2455-3476.000061
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