Abstract / Summary
Ludwig’s Angina (LA) is an acute infection associated with the deep cervical region that can rapidly lead to airway obstruction. Unique problems arise in airway management due to trismus, an elevated floor of the mouth, abnormal airway anatomy, and sudden airway obstruction at the time of induction of anaesthesia when such infections are present. This report describes the perioperative management of a 46-year-old male who presented with progressively worsening submandibular swelling, dysphagia, and restricted mouth opening due to an odontogenic infection. He was scheduled for an urgent incision and drainage of a submandibular abscess. Given the anticipated difficult airway, the patient was intubated awake using a nasal fibreoptic technique while receiving dexmedetomidine sedation and nebulised lignocaine for airway topical anaesthesia, with spontaneous ventilation maintained throughout the procedure. Following successful airway management, he was subsequently given General Anaesthesia (GA) and a Superficial Cervical Plexus Block (SCPB) (performed by ultrasound guidance) to provide perioperative analgesia. Upon completion of the surgical procedure, the patient required elective postoperative ventilatory support due to airway swelling and was subsequently extubated with relative ease after demonstrating clinical stability. This case illustrates the significance of complete airway planning, maintenance of spontaneous ventilation during airway procedures, and the benefits of utilising several anaesthetic techniques to ensure the safe provision of required perioperative anaesthetic care for patients with LA.