DOI: https://doi.org/10.36347/sasjs.2026.v12i04.003

Pages: 267-270

Ludwig’s angina is a rapidly progressive cellulitis of the submandibular, sublingual, and submental spaces, most commonly originating from odontogenic infections. Although modern antibiotic therapy and airway management have reduced mortality, life-threatening complications such as descending necrotizing mediastinitis remain rare but serious. Case Presentation: We report the case of a 53-year-old female with a history of hypertension and type 2 diabetes mellitus, who presented with progressive dyspnea following a dental extraction in a non-medicalized setting. Physical examination revealed a swollen neck, hoarse voice, and inspiratory dyspnea. Laboratory studies showed leukocytosis [19,000/mm³] and CRP 397 mg/L. Cervicothoracic CT scan demonstrated multiple fluid collections in the submandibular, sublingual, and parapharyngeal spaces, causing pharyngeal lumen narrowing and extending along the right lateral cervical region into the anterior mediastinum, consistent with descending necrotizing mediastinitis. The patient was started on broad-spectrum intravenous antibiotics [ceftriaxone, metronidazole, vancomycin] with intravenous corticosteroids and nebulized adrenaline. Due to persistent dyspnea and high risk of airway obstruction, she underwent an urgent tracheotomy, followed by surgical drainage of the right submandibular collection with Delbet drainage strips. The patient was admitted to the intensive care unit for close monitoring. She gradually improved clinically and biologically over the following days. Conclusion: This case highlights the potential severity of Ludwig’s angina, particularly when complicated by mediastinal extension. Early recognition, prompt airway management, broad-spectrum antibiotics, and timely surgical intervention are essential to prevent life-threatening outcomes.