The management of septic shock and Ludwig’s angina: A case report of a life-threatening condition

Abstract

Ludwig’s angina is a high severity infection because of the risk of airway obstruction due to the rapid spread of the abscess into the deeper spaces. Therefore, performing the correct treatment is one of the keys to a successful result. A 44-year-old male patient came to the Emergency Unit of Hasan Sadikin Hospital, complaining of shortness of breath, severe pain, and progressive swelling. Extraoral examination showed a localized-fluctuated swelling located at the right lower jaw that extended to the chin, left lower jaw, and the frontal region of the neck region while a sequential organ failure assessment revealed a score of 2. A diagnosis of Ludwig’s angina and septic shock was confirmed. Intravenous infusion of norepinephrine was administered and a tracheostomy was performed. The next treatment phase consisted of a drainage procedure, tooth extraction, and placement of the Penrose drain. The patient was discharged 10 days later with a satisfactory outcome.

Management of Odontogenic Infection of Primary Teeth in Child That Extends to the Submandibular and Submental Spaces

“…15 Treatment of stable fascial space infection is incision and drainage or space decompression accompanied by broadspectrum antibiotics and analgesics with pus collection for culture and sensitivity. 1,5,9 Specific antibiotics are given if culture and sensitivity results are available. 1 Empiric antibiotic therapy should be administered without waiting for the results of the pus culture while the patient is hospitalized.…”

“…Second or third-generation cephalosporins as primary empiric antibiotic therapy, together with metronidazole or ornidazole, are usually used. 5,7,13 In this case, the patient has been given the antibiotics Ceftraxone inj 325 mg IV and Metronidazole inf 170 mg IV. Indications for surgical incision and drainage, however, remain controversial (especially for cellulitis).…”

“…1,2 Odontogenic infections are one of the most common infections in the oromaxillofacial area, especially in developing countries. 2,3,4,5 Infections that affected the maxillofacial area in various parts of the world range from 50-89%. 6 The results of the Peking study showed that around 57,5% of odontogenic infections spread to the maxillofacial space.…”

Emergency Treatment of Severe Odontogenic Infection Extending to the Four Maxillofacial Spaces: Case Report

“…Odontogenic infections are the most common infections in the orofacial area, especially in developing countries. [1,2,3,4,5] This infection originates from the teeth and their supporting tissues, such as pulp necrosis, periodontal disease, pericoronal, apical lesions, or complications of dental procedures. Odontogenic infections can extend to the maxillofacial area around 50%-89%.…”

“…analgesia, incision drainage, and hospitalization to control the progression of the disease. [1,2,3,15] Immediate treatment considerations are if the airway becomes obstructed and other considerations such as respiratory rate, oxygen saturation, systolic blood pressure, pulse, and level of consciousness. Definitive interventions to secure the airway in odontogenic submandibular infections that have extended to the neck are often challenging, even for experienced anesthesiologists, because of trismus, tongue shift, airway edema, distortion, or obstruction.…”