EMERGENCY TRACHEOSTOMY IN A GASPING PARTURIENT WITH LUDWIGS ANGINA
: A BIRD IN HAND IS BETTER THAN TWO IN BUSH!
Background
Ludwig s angina is a potentially life-threatening infection of the neck and floor of mouth. We report
successful outcome of a near miss event term in a parturient with LUDWIG’S ANGINA presenting to
emergency with acute respiratory distress and fetal compromise.
Case Report
A 20 years young primigravida at 39 weeks of gestation reported with acute respiratory distress due
to painful swelling in the lower jaw following tooth extraction. Examination revealed a gross
swelling extending from the angle of jaw to suprasternal notch involving the anterior neck. There
was no mouth opening due to severe tongue angioedema with pus drooling from the oral cavity.
Neck examination was not possible due to non palpable landmarks and restricted movements.
Ultrasound and CT scan neck revealed heterogenous collection 3.8 and 1.1 cm involving sublingual,
submental and submandibular region.
She was taken to OR due to acute airway obstruction and respiratory distress. At this point, fetal
cardiotocography showed non reassuring fetal heart rate of pathological category. The possibility of
an awake nasal fibreoptic intubation appeared impossible due to continuous drool of pus and
difficulty in oxygenation. Patient was positioned supine with a slight left utreine dispalcement and
oxygen through nasal cannula was admnistered . An emergent awake tracheostomy was performed
under LA and baby was delivered by cesarean section with normal Apgar score. Postoperatively
patient received antiobiotics,steroids for airway edema and mechanical vetilation in ICU. She was
discharged following successful decannualtion after 15 days.
Discussion
This case highlights the importance of timely intervention to secure a lifethreatening airway
compromise due to ludwigs angina in a parturient. A emergency tracheostomy could salvage both
mother and the baby in this near miss event.