Anaesthesia Management in a Case of Ludwig's Angina With Difficult Airway Managed by Emergency Tracheostomy.

Severe neck infections present significant challenges for anesthesiologists due to the complexities associated with managing difficult airways. Ludwig's angina, a rapidly progressing infection of the submandibular space, exemplifies these challenges due to the high risk of airway obstruction. This case report details an emergency procedure performed to drain Ludwig's angina, highlighting the difficulties encountered and the strategies employed. Awake fiberoptic intubation is demonstrated as an effective approach for maintaining the airway during such operations. The report underscores the critical nature of quick and effective management, emphasizing the importance of readiness for interventions such as tracheostomy in cases where oxygen saturation drops, thereby ensuring patient safety in precarious situations.

A Case of Ludwig's Angina Following Influenza in a 16-Year-Old Male.

This case report illuminates an instance of Ludwig's Angina in a 16-year-old male patient with concurrent Influenza A. Ludwig's Angina, a potentially fatal, rapidly spreading cellulitis, primarily affects the submandibular and sublingual spaces. This case emphasizes the importance of early detection, immediate intervention, and multidisciplinary management to prevent life-threatening complications. The patient presented with fever, sore throat, swelling under the tongue and submandibular region, and difficulty breathing following a family trip to Puerto Rico. Despite initial respiratory distress and severe soft tissue swelling, the patient responded positively to broad-spectrum antibiotics, with clinical improvement leading to discharge after five days. The report discusses the challenges in diagnosing and managing Ludwig's Angina, the potential role of the patient's environment in disease presentation, and the relevance of historical medical literature in contemporary clinical practice. This case underscores the need for vigilance in patients with influenza for potential secondary bacterial complications and the necessity of expedited airway management in patients with Ludwig's Angina.

Sonographic comparison of subcutaneous fat layer thickness in the scalp area in patients with androgenetic alopecia compared to healthy individuals: Cross-sectional.

INTRODUCTION: Androgenetic alopecia (AGA) is one of the most common alopecia among men and women worldwide. It is a nonscarring alopecia that has a characterized pattern. In female pattern AGA, the hairline is stable but general thinning occurs most notably in the frontal region. In male-pattern AGA, the hairline is receding and the thinning is most notable in the frontotemporal region. AGA has a complex pathogenesis and relation of subcutaneous fat in the scalp region and the miniaturization of terminal hair follicles is vague. In this study, subcutaneous fat in the frontal scalp an important region for AGA is compared to the occipital scalp that is spared in AGA. METHOD: Our study is a cross-sectional study that has four groups. Male patient, female patient, male control, female control. Every group has 15 individuals. All of the people in the study are those referred to Rasoul Akram's dermatology clinic. The severity of alopecia is classified by Norwood scaling for male pattern AGA and Ludwig scaling for female pattern AGA. Subcutaneous tissue in the frontal and occipital regions is measured by ultrasonography. For evaluating the effect of aging on subcutaneous fat thickness, we subdivided any group into more than 40 years old and between 20 and 40 years old and compared these two subgroups. RESULTS: The mean age of the three groups of male patient, female patient, and female control is 40 y/o and the mean age of male control is 41 y/o. The mean subcutaneous fat layer thickness in frontal region in male patients group is 6.0 mm (more than 40 y/o = 6.6 mm, between 20 and 40 y/o = 5.5 mm), in female patients group 5.1 mm (more than 40 y/o = 5.7 mm, between 20 and 40 y/o = 4.6 mm), in the male control group is 4.4 mm (more than 40 y/o = 4.7 mm, between 20 and 40 y/o = 4 mm) and in the female control group is 4.1 mm (more than 40 y/o = 4.5 mm, between 20 and 40 y/o = 3.6 mm). The mean subcutaneous fat layer thickness in the occipital region in the male patient's group is 6.4 mm (more than 40 y/o = 6.7 mm, between 20 and 40 y/o = 6 mm), in the female patient's group 6.1 mm (more than 40 y/o = 6.5 mm, between 20 and 40 y/o = 5.7 mm), in the male control group is 6.3 mm (more than 40 y/o = 6.8 mm, between 20 and 40 y/o = 5.7 mm) and in the female control group is 6.2 mm (more than 40 y/o = 6.6 mm, between 20 and 40 y/o = 5.8 mm). CONCLUSION: This study demonstrates that the subcutaneous fat layer in the frontal region in both males and females is thicker in AGA patients than healthy group and the more severe the AGA, the thicker is subcutaneous layer in the frontal region. In the male patients group, the subcutaneous fat layer in the frontal region is thicker than in the female patients group but in the male and female control groups is not so different. The subcutaneous fat layer in the occipital region is thicker in older individuals in both patients and control groups but is not different when compared to AGA patients and control individuals.

Incidence of Mortality and Its Relation to Comorbidity in Ludwig's Angina: A Retrospective Study.

Introduction: Ludwig's angina is a serious life-threatening infective condition of maxillofacial region due to odontogenic origin which is clinically diagnosed by its clinical signs and symptoms. Airway management and early surgical decompression is the main stay of management. The mortality rates in Ludwig's angina remains multivariate. There is a paucity in literature regarding the mortality rates of this disease. Aim and Objectives: Aim of this retrospective study is to describes the characteristics, probable cause of death and mortality rates of patients with co-morbidities presenting to the emergency department (ED) who were subsequently admitted with a primary diagnosis of Ludwig's angina. Materials and Method: Study was conducted in the department of maxillofacial surgery in a tertiary care teaching hospital from Jan 2011 to Dec 2022. Data of 17 patients who were clinically diagnosed as Ludwig's angina were included in the study. The comorbidity, source of odontongenic cause, mode of intubation and the outcome of the disease were evaluated. Result: Comparison of categorical variables was done using Fishers exact test. A p-value of <0.7 was considered statistically significant. The results suggested that Out of 17 patients 12 patients (70.5%), 7 male and 5 females had comorbidities and four cases (23.5%) had complication of death, all having co-morbidities. Summary: It concludes that associated comorbidity has a significant role in progress and outcome of the disease and incidence of death is more common in cases having associated comorbidity.

Case Report of the Use of an Intravascular Cooling Device in the Management of Malignant Hyperthermia.

Malignant hyperthermia (MH) is a rare, life-threatening condition caused by alterations in skeletal muscle calcium channels inherited through an autosomal dominant pattern. The use of specific agents in anesthesia such as inhaled anesthetics and succinylcholine can precipitate a hyperthermic crisis. Patients experience a rapid increase in muscle rigidity, secondary to skeletal muscle calcium dysregulation, leading to acute rhabdomyolysis and possible hyperthermia. Providers must have a high index of suspicion of this disease process because early diagnosis is critical to mortality reduction. Management centers around removal of the offending agent, dantrolene, and supportive care including cooling if hyperthermic. Intravascular cooling devices have been used in thermodynamic regulation after cardiac arrest and have shown to be more effective than dermal cooling techniques; however, they have not been well described in other disease processes. The following case report is the first to describe a patient suffering from MH to undergo invasive intravenous cooling in order to counteract the effects of this life-threatening disease.

Relato de caso clínico de infecção odontogênica resultando em complicação cervicofacial / Reporte de caso clínico de infección odontogênica com resultado de complicación cervicofacial / Clinical case reportof odontogenic infectionresulting cervicofacial complication

Introdução: A saúde bucal é um aspecto que não deve ser subestimado pelos pacientes, principalmente se considerar que as infecções odontogênicas podem levar a quadros graves, incluindo complicações cervicotorácicas, como Mediastinite e cervicofaciais, como Angina de Ludwig. Para tanto, é imprescindível que os profissionais da odontologia saibam reconhecer os principais sinais e sintomas dessas infecções, sua evolução, conhecer as complicações associadas e qual o manejo adequado. Objetivo: Assim, é objetivo deste trabalho, relatar, discutir um caso clínico de uma infecção odontogênica grave que acarretou em complicação cervical, com trajeto em direção ao mediastino, necessitando manejo multidisciplinar, e explorar os principais aspectos desse quadro e a conduta necessária, que exige, no mínimo, intervenção cirúrgica, antibioticoterapia e manutenção das vias aéreas. Relato de caso: O caso trata de um paciente com infecção odontogênica, iniciada como uma pericoronarite do dente 38 semieruptado, que evoluiu para a área cervical, demandando imediata drenagem nesta região pois encaminhava-se para uma mediastinite. Após a drenagem cervical e antibioticoterapia e, assim que houve redução do trismo, foi removido o dente 38, evoluindo para a cura.Conclusões:As infecções odontogênicas, principalmente as que acometem os espaços fasciais e cervicais profundos, são potencialmente graves e devem ter suas principais manifestações clínicas entre os domínios de conhecimento dos profissionais Bucomaxilofaciais, pois necessitam de diagnóstico preciso, manejo rápido e tratamento adequado e precoce, considerando a velocidade com que podem evoluir (AU).

Introduction: Oral healthis an aspect that should not be underestimated by patients, especially considering that dental infections can lead to serious symptoms, including cervicothoracic complications, such as Mediastinitis and cervicofacial complications, such as Ludwig's Angina. Therefore, it is essential that dental professionals know how to recognize the main signs and symptoms of these infections, their evolution, know the associated complications and appropriate management.Objective: Thus, this work aims to report and discuss a clinical case of a serious odontogenic infection that resulted in a cervical complication, with a path towards the mediastinum, requiring multidisciplinary management, and to explore the main aspects of this condition and the necessary conduct, which requires, at least, surgical intervention, antibiotic therapy and airway maintenance.Case report: The case concerns a patient with odontogenic infection, which began as pericoronitis of semi-erupted tooth 38, which progressed to the cervical area, requiring immediate drainage in this region as it was heading towards mediastinitis. After cervical drainage and antibiotic therapy and, as soon as the trismus was reduced, tooth 38 was removed, progressing towards healing.Conclusions: Odontogenic infections, especially those that affect the fascial and deep cervical spaces, are potentially serious and should have their main clinical manifestations among the domains of knowledge ofOral and Maxillofacial professionals, as they require accurate diagnosis, rapid management and adequate and early treatment, considering the speed at which they can evolve (AU).

Introducción: La salud bucal es un aspecto que los pacientes no deben subestimar, especialmente considerando que las infecciones odontógenas pueden derivar en afecciones graves, incluidas complicaciones cervicotorácicas, como la mediastinitis, y complicaciones cervicofaciales, como la angina de Ludwig.Para ello, es fundamental que los profesionales odontológicos sepan reconocer las principales señalesy síntomas de estas infecciones, su evolución, conocer las complicaciones asociadas y el manejo adecuado.Objetivo: Así,el objetivo de este trabajo es reportar y discutir un caso clínico de infección odontogénica grave que resultó en una complicación cervical, con trayecto hacia el mediastino, que requirió manejo multidisciplinario, y explorar los principales aspectos de esta condicióny las medidas necesarias, que requiere, como mínimo, intervención quirúrgica, terapia con antibióticos y mantenimiento de las vías respiratorias.Reporte de caso: El caso se trata de un paciente con una infección odontogénica, que comenzó como pericoronaritis del diente 38 semi-erupcionado, la cual progresó hacia la zona cervical, requiriendo drenaje inmediato en esta región ya que se encaminaba para una mediastinitis.Después del drenaje cervical y la terapia antibiótica y, una vez reducido el trismo, se extrajo el diente 38, evolucijjonando hacia la cura.Conclusiones: Las infecciones odontogénicas, especialmente aquellas que afectan los espacios fasciales y cervicales profundos, son potencialmente graves y deben tener sus principales manifestaciones clínicas entre los dominios del conocimiento de los profesionales Orales y Maxilofaciales, pues requieren de un diagnóstico certero, un manejo rápido y un tratamiento adecuado y temprano, considerando la velocidad a la que pueden evolucionar (AU).

When and how did the names Bacteria and Eubacteria originate: Resurrected facts.

Here, I would like to overview an overlooked part of the nomenclatural history of the bacterial domain of life. The usage of the word Bacteria was quite wide before Ferdinand Cohn's famous 1872 work to which it is now ascribed. This word applied to microorganisms appeared 27 years before this (in 1845). Also, the name Eubacteria appeared three years earlier than is thought now (in 1883). Both arose thanks to persons other than Ferdinand Cohn and Joseph Schröter to whom they are now attributed.

It Ain't Necessarily So: Ludwig Boltzmann's Darwinian Notion of Entropy.

Ludwig Boltzmann's move in his seminal paper of 1877, introducing a statistical understanding of entropy, was a watershed moment in the history of physics. The work not only introduced quantization and provided a new understanding of entropy, it challenged the understanding of what a law of nature could be. Traditionally, nomological necessity, that is, specifying the way in which a system must develop, was considered an essential element of proposed physical laws. Yet, here was a new understanding of the Second Law of Thermodynamics that no longer possessed this property. While it was a new direction in physics, in other important scientific discourses of that time-specifically Huttonian geology and Darwinian evolution, similar approaches were taken in which a system's development followed principles, but did so in a way that both provided a direction of time and allowed for non-deterministic, though rule-based, time evolution. Boltzmann referred to both of these theories, especially the work of Darwin, frequently. The possibility that Darwin influenced Boltzmann's thought in physics can be seen as being supported by Boltzmann's later writings.

Pseudo-Ludwig's Angina: Spontaneous Sublingual Haematoma Elicited by Warfarin.

Spontaneous bleeding into the upper airways is a rare and potentially life-threatening complication of chronic anticoagulation. There are scarce cases in the literature demonstrating upper airway haematomas secondary to warfarin use, which is the predominant anticoagulant used by clinicians despite having a complex pharmacokinetic and pharmacodynamic profile. We report a compelling case featuring warfarin-induced sublingual haematoma, managed conservatively through the reversal of anticoagulation using fresh frozen plasma complemented by vigilant monitoring within the Intensive Care Unit (ICU). LEARNING POINTS: Sublingual haematomas, though uncommon, represent potentially serious complications arising from warfarin therapy.Distinguishing sublingual haematomas from infectious processes requires a high level of clinical suspicion and is crucial for prompt management.The preferred course of action involves reversing anticoagulation with a low threshold for implementing an artificial airway in cases of compromised airways.

Utilizing local likelihood in regression discontinuity design: Investigating the impact of antiretroviral therapy eligibility on retention in clinical HIV care in South Africa.

The regression discontinuity (RD) design is a widely utilized approach for assessing treatment effects. It involves assigning treatment based on the value of an observed covariate in relation to a fixed threshold. Although the RD design has been widely employed across various problems, its application to specific data types has received limited attention. For instance, there has been little research on utilizing the RD design when the outcome variable exhibits zero-inflation. This study introduces a novel RD estimator using local likelihood, which overcomes the limitations of the local linear regression model, a popular approach for estimating treatment effects in RD design, by considering the data type of the outcome variable. To determine the optimal bandwidth, we propose a modified Ludwig-Miller cross validation method. A set of simulations is carried out, involving binary, count, and zero-inflated outcome variables, to showcase the superior performance of the suggested method over local linear regression models. Subsequently, the proposed local likelihood model is employed on HIV care data, where antiretroviral therapy eligibility is determined by a CD4 count threshold. A comparison is made between the results obtained using the local likelihood model and those obtained using local linear regression.

Video-stylet vs. channeled hyperangulated videolaryngoscope: Efficacy in simulated Ludwig's angina randomized cadaver trial.

INTRODUCTION: Ludwig's angina (LA) is a life-threatening infection that can affect the floor of the mouth and neck, potentially causing serious airway obstruction. In such cases, rescue airway management and oxygenation can be challenging due to swelling of the mouth floor, trismus, and limited mouth opening. The aim of this study was to assess the efficacy of the Trachway video-stylet (VS) and Pentax AWS hyperangulated videolaryngoscope with channel (HAVL-C) compared to the standard geometric video-laryngoscope (SGVL, Macintosh 3, Trachway) in simulating Ludwig's angina with cadavers. METHODS: Three fresh frozen cadavers were prepared with varying degrees of difficulty to simulate the airway conditions of patients with LA, including mouth floor swelling, restricted mouth opening, and trismus. Fifty-five second-year resident physicians from various specialties participated in the study and received training in airway management using SGVL, VS, and HAVL-C devices. Participants were randomly assigned to intubate simulated LA with cadavers using the three devices in a random order, and intubation times and success rates were recorded. Participants also rated the difficulty of intubation using a visual analogue scale (VAS) score. The primary outcome assessed the first-pass intubation success or failure, while the secondary outcomes measured the intubation time and subjective difficulty using a visual analogue scale with different laryngoscopes. RESULTS: The success rates for intubation within 90 s were 40% for SGVL, 82% for VS, and 76% for HAVL-C. VS and HAVL-C had significantly higher success rates than SGVL, with hazard ratios of 3.4 and 2.7, and 95% confidence intervals (CI) of 2.0-5.7 and 1.6-4.6, p < 0.001, respectively. The odds ratios of successful intubation for VS and HAVL-C were 8.1 and 6.3, respectively, with a 95% CI of 3.7-17.8 and 2.4-16.7, p < 0.001, compared to SGVL. The VAS score was significantly correlated with intubation success rate and time. CONCLUSIONS: In cases of LA, the use of VS and HAVL-C is preferable over SGVL. These findings suggest that using VS and HAVL-C can improve intubation success rates and reduce intubation time in patients with LA.

Potentially Fatal Ludwig's Angina: A Case Report.

Ludwig's angina is a condition that could be fatal, causing severe diffuse cellulitis bilaterally that affects the submandibular, sublingual, and submental areas. It has an acute onset and progresses rapidly. A common and potentially deadly complication is airway impairment. Prompt diagnosis and treatment planning have the opportunity to save lives. An elective tracheostomy is recommended for the patient to maintain an open airway, followed by addressing potential affected spaces due to a widespread odontogenic infection. This infection has extended to the neck, causing elevation of the ventral surface of the tongue and floor of the mouth, leading to airway obstruction and the manifestation of stridor. In the latter stages of the illness, additional attention should be paid to maintaining the airway before surgical decompression and antibiotic treatment. In advanced cases, the usual protocol of care still includes surgical drainage of the infection, judicious administration of parenteral antibiotics, and airway management. A case report's objectives are to improve clinical knowledge, facilitate better diagnosis and treatment, and add to the body of medical research by offering a thorough and educational description of a particular patient's experience with this illness.

Ludwig's Angina: Higher Incidence and Worse Outcomes Associated With the Onset of the Coronavirus Disease 2019 Pandemic.

Background: Ludwig's angina (LA) is a diffuse cellulitis of the submandibular space and adjacent tissues. During the coronavirus disease 2019 (COVID-19) pandemic, odontogenic treatments were often delayed because of the implementation of safety measures to avoid the spread of the virus. We hypothesized that delayed odontogenic treatments associated with the onset of the COVID-19 pandemic would be associated with an increase in the incidence of LA and worse outcomes related to these infections. Patients and Methods: Patients from June 2018 to June 2022 with computed tomography images suggestive of LA and confirmed by ear, nose, throat (ENT) consult were included. We abstracted demographics, outcomes, clinical management, and microbiology. Patients were stratified into pre-COVID and COVID-onset. Our primary outcome, incidence of LA, was defined as: (new LA cases) ÷ (ED evaluations of oral or dental infections × 1.5 years). Results: In the pre-COVID group, we identified 32 of 1,301 patients with LA for an incidence of 0.02 per year. The COVID-onset group consisted of 41 of 641 patients, with an incidence of 0.04 per year. In the COVID-onset group, progression to necrotizing fasciitis was more likely (0% vs. 15%; p < 0.024), and they returned to the operating room for repeated debridement (3% vs. 22%; p < 0.020). Likewise, hospital length of stay, intensive care unit (ICU) length of stay, and ventilator days were higher (4.3 ± 3.5 vs. 9.5 ± 11.3; 1.1 ± 1.2 vs. 9.5 ± 7.1; 0.3 ± 1 vs. 3.6 ± 7.1; p < 0.001). Conclusions: Although the prognosis for dental infections diagnosed early is generally favorable, we observed a notable increase in the incidence of LA after the onset of the COVID-19 pandemic. Moreover, complications stemming from these infections became more severe in the COVID-onset era. Specifically, the likelihood of necrotizing fasciitis showed a substantial increase, accompanied by an increased risk of respiratory failure and mediastinitis.

Life-Threatening Airway Obstruction and Septic Shock Due to Submandibular Space Infection: A Case Report.

Submandibular space infection, a rare and aggressive form of cellulitis, affects the floor of the mouth and neck, potentially leading to life-threatening complications. Although commonly associated with oral trauma and contiguous abscesses, the severity of these odontogenic infections often escalates due to underlying comorbidities. This report presents a unique case of a 74-year-old man who developed severe complications following an outpatient oral procedure. The patient exhibited fever and mouth swelling within a short time, which quickly advanced to impending airway compromise and septic shock. Diagnostic imaging revealed extensive swelling from the left submandibular region extending to the anterior neck and parapharyngeal space, effacing the airway. This necessitated immediate nasotracheal intubation and mechanical ventilation. Medical management comprised emergent antibiotic administration, airway protection, and admittance to the intensive care unit. This case underscores the potential severity of complications arising from an odontogenic infection in the presence of multiple comorbidities following an oral procedure. It emphasizes the need for prompt symptom recognition, emergency airway management, and the initiation of antibiotic therapy. Furthermore, this case illustrates the critical role of various imaging modalities and the choice of intubation technique in patients with an anticipated difficult airway. Despite the severity of submandibular space infection, a timely, effective, and multidisciplinary approach can mitigate fatal outcomes and improve patient prognosis.

An Awake Flexible Scope Intubation for a Patient With Trisomy 21, COVID-19, and Ludwig's Angina.

For patients with known or suspected atlantoaxial instability, awake flexible scope intubation is often an attractive option for safely securing the airway. Due to the challenges of consent and cooperation, patients with trisomy 21 are generally considered to be poor candidates for this technique. However, in rare instances, such as the case of this patient with co-existing Ludwig's angina and COVID-19 pneumonia, the benefits of proceeding with an awake flexible scope intubation may outweigh the potential risks.

Introduction: Indology and Aryanism: Knowledge of India in Nazi Germany-An Invitation for New Research.

The introduction to our special issue offers a brief survey of the historical literature on knowledge about India in Nazi Germany and distinguishes three different, but interrelated layers of such knowledge: disciplinary knowledge of Indology as an academic field, knowledge fulfilling the needs of state agencies, and popular knowledge (and beliefs) about India.

Knowledge of India as an Instrument of Nazi Politics: Ludwig Alsdorf, German Indology and Indian Anti-Colonialism.

Ludwig Alsdorf (1904-1978) is primarily remembered as a scholar of ancient and medieval India. This paper examines a little known aspect of Alsdorf's career: his role as an expert of modern India in Nazi Germany. Alsdorf, who was in India from 1930 to 1932, joined the NSDAP and a few of its subsidiaries after 1933. Political contacts as well as his claims of having "first-hand experience" of India secured Alsdorf writing assignments that aimed to fulfil the regime's political objectives. In return, he gained professional advancement and the reputation of being an authority on modern India. This paper reviews Alsdorf's trajectory within the NS state by focussing on the following aspects: the ways in which Alsdorf offered his knowledge of India to the Nazi regime; the material and symbolic resources that he received in return; the relative importance of political affiliations, professional networks and academic accomplishments for Alsdorf's career; the "politics of the past" practised by Alsdorf and some of peers after 1945; and the (re)presentation of the "uses" of Indology in the "Third Reich" and in the Federal Republic of Germany by Alsdorf and his colleagues.

'The poetry of psychiatry': existential analysis and the politics of psychopathology in Franco's Spain.

This article examines the presence and influence of the work of Swiss psychiatrist Ludwig Binswanger and existential analysis (Daseinsanalyse) in Spanish psychiatry in the central decades of the 20th century. First, and drawing on various printed and archival sources, it reconstructs the important personal and professional ties that Binswanger maintained with numerous Spanish colleagues and describes the notable dissemination of his work in Spain through bibliographical reviews, scientific events, academic reports, university lectures and translations. Next, it reviews the incorporation of the postulates of existential analysis into the discourse of Spanish psychiatrists and assesses their most elaborate and original contributions to the foundations of 'anthropological-existential' psychiatry or the 'existential-analytical' interpretation of certain disorders or clinical conditions. And, finally, it tries to clarify the assessment according to which the (inevitable) instrumentalisation of existential analysis in the context of Franco's Spain first compromised the critical recognition of its true possibilities (and limits) and later contributed to the discrediting of psychopathological research among Spanish psychiatrists.

Ludwig's Angina and Treatment Considerations in the COVID-19 Pandemic.

Introduction: Ludwig's angina is a type of severe cellulitis that spreads rapidly and carries a significant risk of airway compromise. Previous complications with COVID-19 are poorly described within the literature. Case Presentation: This case report describes the complication of COVID-19 infection with suspected Ludwig's angina 2 days after admission, resulting in awake fibroscopic endotracheal intubation. Emergent treatment and establishing a secure airway are paramount in these cases. We discuss the role of antibiotics and adjunct treatment in these cases of potential airway compromise. Conclusion: Limited data demonstrate simultaneous infection of COVID-19 with these types of submandibular soft tissue infections in the literature. Previous explorations into this subject are limited, as COVID-19 is a relatively new condition with its own treatment guidelines. We discuss specifically the role of corticosteroid use and surgical intervention in these cases. We wish to highlight awareness and treatment considerations for COVID-19 patients with superimposed Ludwig's angina.