This case report illuminates an instance of Ludwig\'s Angina in a 16-year-old male patient with concurrent Influenza A. Ludwig\'s Angina, a potentially fatal, rapidly spreading cellulitis, primarily affects the submandibular and sublingual spaces. This case emphasizes the importance of early detection, immediate intervention, and multidisciplinary management to prevent life-threatening complications. The patient presented with fever, sore throat, swelling under the tongue and submandibular region, and difficulty breathing following a family trip to Puerto Rico. Despite initial respiratory distress and severe soft tissue swelling, the patient responded positively to broad-spectrum antibiotics, with clinical improvement leading to discharge after five days. The report discusses the challenges in diagnosing and managing Ludwig\'s Angina, the potential role of the patient\'s environment in disease presentation, and the relevance of historical medical literature in contemporary clinical practice. This case underscores the need for vigilance in patients with influenza for potential secondary bacterial complications and the necessity of expedited airway management in patients with Ludwig\'s Angina.

The \"double tongue sign\" is a characteristic finding in patients with Ludwig\'s angina, a potentially life-threatening infection due to airway compromise. Management primarily focuses on early airway protection and antibiotic administration. Submandibular sialolithiasis, on the other hand, could present with the double tongue sign without symptoms suggestive of airway involvement. Unlike Ludwig\'s angina, conservative treatment is usually the first-line approach for sialolithiasis. The importance of rapidly recognizing and distinguishing between the 2 conditions is emphasized through effective triage and risk stratification, particularly in rural areas where physicians are not readily available.

UNASSIGNED: Pregnancy is accompanied by several physiological changes such as altered salivary flow rate, mucosal immunity and altered microbial flora. This may predispose pregnant women to oral health problems. This could be accentuated by oral health neglect, polypharmacy and a host of other factors, including dietary modification. However, a very significant percentage of women are not counselled on oral health during pregnancy. Lack of proper oral healthcare and awareness predispose pregnant women to oral and odontogenic infections, which can lead to severe complications. The manuscript aims to present a rare case of Ludwig\'s angina (LA) in a full-term pregnant woman requiring immediate attention.

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Ludwig\'s angina is a severe diffuse cellulitis that presents an acute onset and spreads rapidly and bilaterally. It can affect the submandibular, sublingual or submental spaces resulting in a state of emergency. Early diagnosis and urgent management could be a life-saving procedure. We report a case of wide spread sialadenitis infection extending to the neck with trismus and elevation of the floor of the mouth that caused an obstruction of the airway and resulted in an inspiratory dyspnea and a stridor. The patient was directed to maintain the airway by elective tracheostomy. An appropriate use of parenteral antibiotics, airway protection techniques, and potential surgical drainage of the infection remain the standard protocol of treatment in advanced cases of Ludwig\'s angina. The aim of this case report is to emphasize on the importance of early diagnosis and appropriate management of Ludwig\'s angina.

Ludwig\'s angina is a condition that could be fatal, causing severe diffuse cellulitis bilaterally that affects the submandibular, sublingual, and submental areas. It has an acute onset and progresses rapidly. A common and potentially deadly complication is airway impairment. Prompt diagnosis and treatment planning have the opportunity to save lives. An elective tracheostomy is recommended for the patient to maintain an open airway, followed by addressing potential affected spaces due to a widespread odontogenic infection. This infection has extended to the neck, causing elevation of the ventral surface of the tongue and floor of the mouth, leading to airway obstruction and the manifestation of stridor. In the latter stages of the illness, additional attention should be paid to maintaining the airway before surgical decompression and antibiotic treatment. In advanced cases, the usual protocol of care still includes surgical drainage of the infection, judicious administration of parenteral antibiotics, and airway management. A case report\'s objectives are to improve clinical knowledge, facilitate better diagnosis and treatment, and add to the body of medical research by offering a thorough and educational description of a particular patient\'s experience with this illness.

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Ludwig\'s angina (LA) is a life-threatening infection that can affect the floor of the mouth and neck, potentially causing serious airway obstruction. In such cases, rescue airway management and oxygenation can be challenging due to swelling of the mouth floor, trismus, and limited mouth opening. The aim of this study was to assess the efficacy of the Trachway video-stylet (VS) and Pentax AWS hyperangulated videolaryngoscope with channel (HAVL-C) compared to the standard geometric video-laryngoscope (SGVL, Macintosh 3, Trachway) in simulating Ludwig\'s angina with cadavers.
Three fresh frozen cadavers were prepared with varying degrees of difficulty to simulate the airway conditions of patients with LA, including mouth floor swelling, restricted mouth opening, and trismus. Fifty-five second-year resident physicians from various specialties participated in the study and received training in airway management using SGVL, VS, and HAVL-C devices. Participants were randomly assigned to intubate simulated LA with cadavers using the three devices in a random order, and intubation times and success rates were recorded. Participants also rated the difficulty of intubation using a visual analogue scale (VAS) score. The primary outcome assessed the first-pass intubation success or failure, while the secondary outcomes measured the intubation time and subjective difficulty using a visual analogue scale with different laryngoscopes.
The success rates for intubation within 90 s were 40% for SGVL, 82% for VS, and 76% for HAVL-C. VS and HAVL-C had significantly higher success rates than SGVL, with hazard ratios of 3.4 and 2.7, and 95% confidence intervals (CI) of 2.0-5.7 and 1.6-4.6, p < 0.001, respectively. The odds ratios of successful intubation for VS and HAVL-C were 8.1 and 6.3, respectively, with a 95% CI of 3.7-17.8 and 2.4-16.7, p < 0.001, compared to SGVL. The VAS score was significantly correlated with intubation success rate and time.
In cases of LA, the use of VS and HAVL-C is preferable over SGVL. These findings suggest that using VS and HAVL-C can improve intubation success rates and reduce intubation time in patients with LA.

BACKGROUND Ludwig angina is a cellulitis of the soft tissues of the neck and floor of the mouth. It is most commonly caused by Viridans streptococcal species, but other bacterial species have been shown to lead to this severe infection. Clostridium sporogenes is an anaerobic gram-positive, spore-producing bacillus found in soil and the human gastrointestinal tract. This report is of a case of a 49-year-old HIV-positive man with alcoholism and poor dental hygiene leading to a molar abscess who presented with Ludwig angina due to C. sporogenes. CASE REPORT A 49-year-old man presented with severe left molar pain, fever, and worsening neck swelling for 5 days. His medical history was significant for AIDS; he was not on antiretroviral therapy. Computed tomography of the neck was positive for extensive subcutaneous emphysema of the left sublingual space. Ludwig angina was diagnosed, and he was taken urgently for incision and drainage of the bilateral neck fascial space. On day 6 of hospitalization, 1 of 2 blood cultures grew C. sporogenes. He left the hospital on day 13 and was readmitted 6 days later with progression of the disease and alcohol withdrawal. CONCLUSIONS This case illustrates the need for rapid diagnosis and treatment of Ludwig angina and the importance of considering commonly pathogenic and rarely pathogenic bacteria when considering the underlying bacterial cause of an infection in an immunocompromised patient. To the best of our knowledge, this is the first case of Ludwig angina caused by C. sporogenes reported in the medical literature.