Ludwig's angina of odontogenic origin: case report in a hospital emergency unit in Pernambuco.

Abstract

Introduction: Odontogenic infections, derived from dental problems, can spread to the underlying facial spaces, becoming complex. A potentially fatal diffuse cellulitis of the soft tissues, usually located in the second and third lower molars. Predisposing factors include recent tooth extraction and exposed fractures of the mandible, which are also related. The most affected patients are men, aged between six and seventy-eight years. Among the main complications is Ludwig's Angina. Objective: This article describes a clinical case report in which the two diseases are associated. Case report: A 73-year-old female patient with a history of hypertension and heart disease, without a previous diagnosis of diabetes, was admitted to the Oral and Maxillofacial Surgery and Traumatology service of a reference hospital in Pernambuco, presenting a serious clinical condition that had evolved over four days. Symptoms included intense pain, cervical edema, fever and progressive respiratory difficulty. The patient had an increase in volume in the submandibular and submental regions for four days. The intraoral clinical examination revealed the right lower alveolar bone as the focus of infection and intra- and extraoral floating point. Preoperative examinations and hospitalization were requested. The patient underwent surgery under general anesthesia and orotracheal intubation, under videolaparoscopy, for drainage of an abscess of odontogenic origin, bilateral mandibular osteoplasty and insertion of a Penrose drain. The patient received intensive treatment with surgical drainage, antibiotic therapy and respiratory support. During hospitalization, the patient presented episodes of clinical worsening, controlled with additional surgical interventions and pharmacological adjustments. Discussion: Ludwig's angina is a relatively uncommon gangrenous cellulitis and edema of the soft tissues of the neck and floor of the mouth. It begins with the invasion of the submandibular, sublingual and submental spaces by anaerobic bacteria, which can spread through the mediastinum. It requires early diagnosis and immediate treatment due to its rapid progression and high risk of respiratory complications. In elderly patients, the presence of comorbidities, such as hypertension, can make management difficult, increasing the complexity of treatment. Conclusion: Early diagnosis and surgical treatment require an assertive approach, especially in cases that evolve rapidly. Therefore, early symptoms are often nonspecific, and delayed treatment can lead to fatal complications.