title: Successful conservative management of Ludwig's angina in advanced pregnancy.
abstract: A 20 year-old female in her 32nd week of gestation presented to the Emergency Department with dysphonia and dysphagia associated to a recent recurrence of a periapical abscess. Her oral examination showed trismus, elevated tongue and neck swelling. A clinical diagnosis of Ludwig's angina was reached, and empirical antibiotic coverage was started. The decompression and drainage placement was performed successfully under local anesthesia without airway compromise. At the moment, no clear guidelines exist for the acute treatment of Ludwig's angina. Establishment of a secure airway has long been considered the gold standard, yet new literature suggests a more conservative management. Ascertaining an early diagnosis at the Emergency Department, and involvement of Anesthesia, Obstetrics, and, Ear, Nose and Throat specialist services is vital for materno-fetal wellbeing. Careful evaluation of the airway status in addition to prompt antimicrobial therapy with surgical decompression may represent a plausible alternative in pregnant patients.
authors.affiliation: Department of Emergency Medicine, UPR School of Medicine, Puerto Rico Health Science Center, San Juan PR.
authors.forename: Roxana
authors.initials: R
authors.lastname: Soltero
authors.forename: Joanna
authors.initials: J
authors.lastname: Mercado-Alvarado
mesh_terms: D000038:Abscess / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D000402:Airway Obstruction / Q000517:prevention & control; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004322:Drainage; D004630:Emergencies; D005260:Female; D006801:Humans; D008158:Ludwig's Angina / Q000175:diagnosis / Q000628:therapy*; D010102:Oxygen Inhalation Therapy; D010348:Patient Care Team; D010482:Periapical Abscess / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy*; D011263:Pregnancy Trimester, Third; D012466:Salivary Gland Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D013407:Sulbactam / Q000627:therapeutic use; D014081:Tooth Extraction; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D000667:Ampicillin; D013407:Sulbactam