Intraoperative Finding of Potential Ludwig’s Angina Resulting from the Spread of Middle Ear Cholesteatoma Following Head Trauma: A Case Report

Abstract

Ludwig’s angina is a cellulitis involving multiple spaces in the floor of the mouth. It is mainly associated with odontogenic infections and head or facial trauma, which may result in death by asphyxiation due to sudden airway obstruction. By presenting a case of Ludwig’s pharyngitis secondary to middle ear cholesteatoma, it was aimed to alert otolaryngologists to the potential risks and management of this disorder. The patient was a 49-year-old woman with a 40-year history of middle ear cholesteatoma. Ten days prior to her admission, she sustained an ipsilateral punch injury to the tempo-lateral region, which was followed by postauricular erythematous swelling, pain, and postauricular subperiosteal abscess formation. Sudden mandibular swelling was found during postoperative extubation from middle ear cholesteatoma surgery. In order to prevent the occurrence of sudden acute asphyxia in the postoperative period, an immediate prophylactic tracheotomy was carried out to establish an artificial airway. The patient was subsequently treated with antibiotics and had an uneventful recovery. Prompt diagnosis and aggressive therapeutic interventions are essential for successfully managing Ludwig’s angina.

Cite this article as: Song X, Fei J, Li L. Intraoperative finding of potential Ludwig’s angina resulting from the spread of middle ear cholesteatoma following head trauma: A case report. J Int Adv Otol. 2025, 21(4), 1804, doi: 10.5152/iao.2025.241804.