Infection

Ludwig angina / floor-of-mouth swelling

Before / During / After / Pitfalls

Before

• Progressive floor-of-mouth/neck swelling is an airway emergency; call ENT/anesthesia/ICU early.
• Avoid agitation and avoid blind instrumentation that worsens swelling/bleeding.
• Prepare awake/fiberoptic/surgical airway pathway while treating sepsis/infection.

During

• Maintain spontaneous ventilation when appropriate; avoid a casual RSI in distorted anatomy.
• Suction and gentle technique; repeated attempts can worsen edema.
• Have surgical airway team and equipment in the room.

After

• Antibiotics, source control, ICU airway monitoring, and edema reassessment.
• Plan extubation with ENT/anesthesia input.
• Document anatomy and technique.

Pitfalls

• Waiting for imaging while airway is deteriorating.
• Paralyzing without a rescue plan.
• Underestimating how quickly edema progresses.