{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:07:14Z","timestamp":1772168834543,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.127242.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T00:00:00Z","timestamp":1719446400000}}],"reference-count":11,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T00:00:00Z","timestamp":1719446400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"\n Background:<\/ns3:bold>\n Ludwig's angina is a potentially life-threatening disease characterized by diffuse bilateral cellulitis with an odontogenic origin. This unique infection is now rare owing to the antibiotic era.\n Case:<\/ns3:bold>\n This patient presented to the emergency room with trismus, jaw and neck swelling, mild respiratory distress with tachypnea, hyperthermia, and panic. Clinical examination and radiographic evaluation confirmed the diagnosis of Ludwig's angina. As it is a quickly spreading infection, the patient was taken up for immediate surgical decompression leading to pus drainage, removal of the offending tooth, bacterial culture and sensitivity, and administration of empirical antibiotics. As we had operated promptly, there was no need for emergency airway intervention, and the patient had immediate relief from airway distress.\n Conclusions:<\/ns3:bold>\n Early accurate diagnosis with conservative surgical decompression, thereby negating the need for airway intervention, was vital to avoiding mortality which is always possible in such an expeditious infection.\n <\/ns3:p>","DOI":"10.12688\/f1000research.127242.2","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T11:11:30Z","timestamp":1720696290000},"page":"1511","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Case Report: Ludwig's angina - 'The Dangerous Space'"],"prefix":"10.12688","volume":"11","author":[{"given":"Satish","family":"Vasanth","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satheesh","family":"Chandran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak Abraham","family":"Pandyan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Padmashini","family":"Gnanam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sinouvassane","family":"Djearamane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling Shing","family":"Wong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7776-3335","authenticated-orcid":false,"given":"Siddharthan","family":"Selvaraj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2024,6,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1-5","DOI":"10.1016\/j.ajem.2020.12.030","article-title":"Diagnosis and management of Ludwig's angina: An evidence-based review.","volume":"41","author":"R Bridwell","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"103-110","DOI":"10.2344\/anpr-66-01-13","article-title":"Ludwig's Angina: Anesthetic Management.","volume":"66","author":"R Dowdy","year":"2019 Summer","journal-title":"Anesth. Prog."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"363-365","DOI":"10.1017\/S0022215106000806","article-title":"Did Ludwig's angina kill Ludwig?","volume":"120","author":"J Wasson","year":"2006","journal-title":"J. Laryngol. Otol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"102411","DOI":"10.1016\/j.amjoto.2020.102411","article-title":"Ludwig's angina and steroid use: A narrative review.","volume":"41","author":"A Tami","year":"2020","journal-title":"Am. J. Otolaryngol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"160-162","DOI":"10.1016\/j.ijid.2020.01.028","article-title":"Ludwig's angina: A diagnostic and surgical priority.","volume":"93","author":"M Vall\u00e9e","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"362-366","DOI":"10.1159\/000490740","article-title":"Comparison of Outcomes in Conservative versus Surgical Treatments for Ludwig's Angina.","volume":"27","author":"B Edetanlen","year":"2018","journal-title":"Med. Princ. Pract."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"453-456","DOI":"10.1177\/000348940111000511","article-title":"Ludwig's angina: report of a case and review of management issues.","volume":"110","author":"M Barakate","year":"2001","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref8","first-page":"31-37","article-title":"Ludwig's Angina: Diagnosis and Treatment.","volume":"38","author":"M David","year":"2002","journal-title":"Hosp. Physician."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"53-55","DOI":"10.1001\/archotol.1983.00800150057011","article-title":"Purulent mediastinal abscess secondary to Ludwig's angina.","volume":"109","author":"N Snow","year":"1983","journal-title":"Arch. Otolaryngol."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"327-333","DOI":"10.1016\/j.ijid.2008.07.007","article-title":"Submandibular space infection: a potentially lethal infection.","volume":"13","author":"P Boscolo-Rizzo","year":"2009","journal-title":"Int. J. Infect. Dis."},{"key":"ref11","first-page":"000344","article-title":"Ludwig\u2019s Angina- a Forgotten Crisis in the Field of Dentistry?","volume":"7","author":"S Vasanth","year":"2022","journal-title":"J. Dental Sci."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/11-1511\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/11-1511\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/11-1511\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T14:25:28Z","timestamp":1726669528000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/11-1511\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,27]]},"references-count":11,"URL":"https:\/\/doi.org\/10.12688\/f1000research.127242.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.127242.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.166856.r321293","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.166856.r321293","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,27]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/11-1511\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.139725.r158065, Abedelmalek Tabnjh, Department of Applied Dental Sciences, Jordan University of Science and Technology, Ar-Ramtha, 22 Dec 2022, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/11-1511\/v1#referee-response-158065","order":0,"name":"referee-response-158065","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.139725.r272616, Paramjot Kaur, Baba Jaswant Singh Dental College, Ludhiana, Punjab, 10 May 2024, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/11-1511\/v1#referee-response-272616","order":1,"name":"referee-response-272616","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Siddharthan Selvaraj<\/b>; \nPosted: 20 May 2024<\/i>; Dear Reviewers, We would like to thank the reviewers for taking their valuable time to provide their insightful queries, we have provided our explanation for the same. Once again thank you for your feedback.  1.The authors have failed to reference any established protocols for the management of Ludwig's angina. \nAnswer:  Although there are no current guidelines for managing acute Ludwig's angina, the mainstay of the treatment includes airway maintenance and following the principles of infection control which we have already discussed.<\/b> 2. What course of action should be pursued if the administration of steroids and epinephrine are contraindicated for a case of Ludwig's angina? \nAnswer: Maintaining patent airway is the most important consideration. Removing the source of infection, antibiotics and Incision and drainage would be course of action.<\/u><\/b> 3.The authors have neglected to include citations of recent publications. Is Ludwig's angina the most perilous type of facial and submandibular space infection? \nAnswer: yes, it is highly perilous but in this antibiotic era it has become a rare infection which makes recent publications little difficult.<\/b> 5.Justify the designation of 'dangerous space' in this context. \nAnswer:<\/b> \nIt can either lead to airway obstruction or, at a later stage, cause dissemination of the infection, which then spreads through several other adjacent spatial planes.<\/b> 5.The primary cause for the development of this condition in a 40-year-old male remains unspecified. \nAnswer: yes the patient wasn\u2019t immuno compromised or medically compromised at the time of diagnosis and it still happened<\/b> 6.Which specific diagnostic procedures were employed in the examination of this particular case? \nAnswer: <\/u>There is no specific diagnostic test which gives the diagnosis for Ludwigs angina. It\u2019s a combination of clinical examination, symptoms and radiographic examination.<\/b> \nThe patient reported hyperthermia (100° F), pulse rate of 99 beats per minute, respiratory rate of 25 breaths per minute, and oxygen saturation fluctuating between 88 to 90 SP02. On clinical examination, he reported a restricted mouth opening of only 19 mm (about 0.75 in), a tongue deviation [and evident dysphagia and dyspnea. Extra orally, the swelling was indurated, non-fluctuant, with bilateral involvement of the submandibular and sublingual spaces. His dentate status revealed root stumps in relation to 36 and 46 regions, which were tender on percussion. The obliteration of the mucogingival junction was also noted. Radiographic examination with orthopantomogram (OPG) revealed periapical radiolucency concerning 36,37 and 38 with locules in the submandibular region (more on the right side than the left side), indicating air or pus<\/b> 7.No details have been provided regarding the utilization of laboratory tests and radiographic imaging in the assessment. \nAnswer:<\/u><\/b> \nRadiographic examination with orthopantomogram (OPG) revealed periapical radiolucency concerning 36,37 and 38 with locules in the submandibular region (more on the right side than the left side), indicating air or pus. The pus was collected with a sterile swab and sent for culture and antibiotic sensitivity test. The culture sensitivity report revealed the sensitivity to prescribed empirical antibiotics; therefore, the same medicines were continued for a week.<\/b> 8.What are the respective roles of the first and second authors in the execution of this research? \nAnswer: The first author did the surgical procedure while the second author provided assistance.<\/b> 9.Was consent obtained from the patient prior to the capture of clinical photographs? \nAnswer: yes. We obtained consent for treatment and for capturing clinical photographs.<\/b>","URL":"https:\/\/f1000research.com\/articles\/11-1511\/v2#referee-comment-11592","order":2,"name":"referee-comment-11592","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"Siddharthan Selvaraj<\/b>; \nPosted: 21 May 2024<\/i>; 1.The authors have failed to reference any established protocols for the management of Ludwig's angina. \nAnswer:  Although there are no current guidelines for managing acute Ludwig's angina, the mainstay of the treatment includes airway maintenance and following the principles of infection control which we have already discussed.<\/b> 2.What course of action should be pursued if the administration of steroids and epinephrine are contraindicated for a case of Ludwig's angina? \nAnswer: Maintaining patent airway is the most important consideration. Removing the source of infection, antibiotics and Incision and drainage would be course of action.<\/u><\/b> 3.The authors have neglected to include citations of recent publications. Is Ludwig's angina the most perilous type of facial and submandibular space infection? \nAnswer: yes, it is highly perilous but in this antibiotic era it has become a rare infection which makes recent publications little difficult.<\/b> 4.Justify the designation of 'dangerous space' in this context. \nAnswer:<\/b> \nIt can either lead to airway obstruction or, at a later stage, cause dissemination of the infection, which then spreads through several other adjacent spatial planes.<\/b> 5.The primary cause for the development of this condition in a 40-year-old male remains unspecified. \nAnswer: yes the patient wasn\u2019t immuno compromised or medically compromised at the time of diagnosis and it still happened<\/b> 6.Which specific diagnostic procedures were employed in the examination of this particular case? \nAnswer: <\/u>There is no specific diagnostic test which gives the diagnosis for Ludwigs angina. It\u2019s a combination of clinical examination, symptoms and radiographic examination.<\/b> T\nhe patient reported hyperthermia (100° F), pulse rate of 99 beats per minute, respiratory rate of 25 breaths per minute, and oxygen saturation fluctuating between 88 to 90 SP02. On clinical examination, he reported a restricted mouth opening of only 19 mm (about 0.75 in), a tongue deviation [and evident dysphagia and dyspnea. Extra orally, the swelling was indurated, non-fluctuant, with bilateral involvement of the submandibular and sublingual spaces. His dentate status revealed root stumps in relation to 36 and 46 regions, which were tender on percussion. The obliteration of the mucogingival junction was also noted. Radiographic examination with orthopantomogram (OPG) revealed periapical radiolucency concerning 36,37 and 38 with locules in the submandibular region (more on the right side than the left side), indicating air or pus<\/b> 7.No details have been provided regarding the utilization of laboratory tests and radiographic imaging in the assessment. \nAnswer:<\/u><\/b> \nRadiographic examination with orthopantomogram (OPG) revealed periapical radiolucency concerning 36,37 and 38 with locules in the submandibular region (more on the right side than the left side), indicating air or pus. The pus was collected with a sterile swab and sent for culture and antibiotic sensitivity test. The culture sensitivity report revealed the sensitivity to prescribed empirical antibiotics; therefore, the same medicines were continued for a week.<\/b> 8.What are the respective roles of the first and second authors in the execution of this research? \nAnswer: The first author did the surgical procedure while the second author provided assistance.<\/b> 9.Was consent obtained from the patient prior to the capture of clinical photographs? \nAnswer: yes. We obtained consent for treatment and for capturing clinical photographs.<\/b>","URL":"https:\/\/f1000research.com\/articles\/11-1511\/v2#referee-comment-11601","order":3,"name":"referee-comment-11601","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.166856.r321293, Marcelo Silva Monnazzi, S\u00e3o Paulo State University (Unesp) School of Dentistry (Araraquara), Sao Paulo, 17 Sep 2024, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/11-1511\/v2#referee-response-321293","order":4,"name":"referee-response-321293","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}