Repeated Perioperative Airway Management in Odontogenic Deep Neck Space Infection Managed Clinically as Ludwig's Angina: An Anaesthesia- and Intensive Care Unit-Focused Case Report
Abstract
Ludwig's angina and odontogenic deep neck space infections represent high-risk scenarios for anaesthesiologists, as airway compromise may develop despite initially preserved spontaneous breathing. We report a 41-year-old woman with no relevant comorbidities who presented with a five-day history of odontogenic right-sided neck swelling, fever, odynophagia, dysphagia, muffled voice, and mild discomfort in the supine position. She was breathing spontaneously on room air with an oxygen saturation of 98%. CT neck demonstrated a right submandibular collection measuring 3 × 0.6 cm, multiple right sternocleidomastoid (SCM) intramuscular collections, and bilateral deep cervical lymphadenopathy. Leftward tracheal deviation was identified on clinical imaging review. On Day 0, emergency drainage was performed under general anaesthesia. C-MAC video laryngoscopy revealed a Cormack-Lehane grade 1 view; the trachea was intubated on the first attempt with rocuronium 1.2 mg/kg, without complication. The patient was maintained intubated in the ICU for approximately 24 hours and extubated following cuff-leak testing, corticosteroid pre-treatment, and multidisciplinary team reassessment. On Day 5, a second general anaesthetic was required for repeat drainage; again, grade 1 direct laryngoscopy, first-attempt intubation, and immediate post-procedure extubation were achieved. The pus culture grew Streptococcus agalactiae, susceptible to levofloxacin, vancomycin, and amoxicillin/clavulanate. Total…
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