Rong-Feng Chen, Chih-Hao Lu
Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
Abstract
Ludwig's angina is a rapidly progressive cellulitis involving the bilateral sub-mandibular spaces that may result in death by asphyxia. The etiology is most often odontogenic or periodontal in origin. However, we report here a rare case of Ludwig's angina induced by a migrating fish bone. The patient was a 58-year-old man who visited our emergency department with progressive tender swelling of the right submandibular region, trismus, drooling, and difficulty swallowing, which had lasted for 4 days. Computed tomography of the neck revealed a calcified lesion with abscess formation near the right submandibular region. When a transoral incision was made, a yellowish calcified fish bone, measuring 1.2 cm in length, was found in the abscess space and removed. After pus drainage and antibiotic therapy, the patient was discharged 6 days later. Among elderly patients with poor dental hygiene who are diagnosed with Ludwig's angina, the penetration of a foreign body in the submandibular space may be a possible etiology. An operation to extract the object, involving incision and drainage, is then necessary; antibiotic treatment alone cannot be relied on.
Keywords
Deep neck infection; Fish bone; Ludwig's angina
