Management of Ludwig's Angina in Pregnancy: A Review of 10 Cases

BACKGROUND Ludwig's angina is a rapidly spreading cellulitis that may produce upper airway obstruction often leading to death. AIM The present paper reviews the management of Ludwig's angina in the third trimester of pregnancy. The inherent dangers to the mother and her unborn child are highlighted. MATERIALS AND METHODS The case files of pregnant patients who had emergent incision and drainage for life-threatening facial cellulitis at the maxillofacial unit of the Murtala Mohammed Specialist Hospital in Kano, Nigeria, over a 2 year period were retrieved and demographic and clinical characteristics were retrospectively obtained and analyzed descriptively using the statistical package for social sciences (SPSS version 13.0, for Windows, September 2004, Chicago, Illinois). Comparative statistics were determined using Pearson's Chi-square, Fisher's exact tests and independent t tests as appropriate. A P value of less than 0.05 was considered significant. RESULTS A total of 10 patients were seen within the study period, age ranges from 23 to 40 years, mean 29.5 (5.3) years. Majority of the women were in their third decade [60% (6/10)] while the remaining 40% (4/10) were in their fourth decade of life. Two of the patients presented within the period of less than 1 week of onset of symptoms while those who presented within the periods of 1-2 weeks and periods of over 2 weeks accounted for 50% (5/10) and 30% (3/10) respectively. All the patients presented during the third trimester of their pregnancy and odontogenic infections were responsible for 80% (8/10) of the Ludwig's angina. There were 20% mortality among the patients and this was significant for those with underlying systemic conditions (P = 0.02). The time of presentation was not significant for the survival rate of the gravid patient (P = 0.36) but was significant for survival of the fetus (P = 0.01). CONCLUSION During a life-threatening infectious situation such as Ludwig's angina, risks of maternal and fetal morbidity include both septicemia and asphyxia. Attending clinicians must consider the risks that the condition and the possible treatments may cause the mother and her unborn child.