Ludwig's angina in Somalia: clinical characteristics, emergency management, and outcomes from a tertiary academic referral center.

Abstract

Background and objectives: Ludwig's angina is a rapidly progressive cellulitis involving the submandibular, sublingual, and submental spaces bilaterally that can swiftly compromise the airway. Data on deep neck space infections in Somalia remain scarce. This study aimed to describe the demographic profile, etiology, clinical presentation, management, complications, length of hospital stay (LOS), and outcomes of patients with Ludwig's angina treated at Mogadishu Somali-Türkiye Recep Tayyip Erdoğan Training and Research Hospital over a one-year period.

Materials and methods: We conducted a retrospective review of 90 patients with clinically confirmed Ludwig's angina presenting between January 1, 2024, and December 31, 2024. Demographic variables, etiology, pre-admission symptom duration, referral source, treatment modality, hospital-acquired complications, LOS, and discharge outcomes were extracted from medical records and analyzed using descriptive and inferential statistics.

Results: The cohort was predominantly male (77.8%, n = 70), with a mean age of 39.1 \pm 21.4 years. Odontogenic infection was the primary etiology, accounting for 82.2% (n = 74) of cases, led by localized periodontal and periapical abscesses (65.5%, n = 59). Overall surgical intervention was required in 53.3% (n = 48) of patients-comprising deep operative decompression (38.9%, n = 35) and superficial drainage (14.4%, n = 13)-while 46.7% (n = 42) were successfully managed with conservative intravenous antibiotics and close airway observation. Inpatient complications occurred in 48.9% (n = 44) of cases, dominated by septicemia (36.7%, n = 33). Linear regression demonstrated that longer symptom duration prior to admission significantly predicted longer hospitalization (B = 0.500, p < 0.001). Institutional mortality was 0.0%.

Conclusion: Ludwig's angina in this Somali cohort was characterized by delayed presentation, a high complication burden, and predominantly odontogenic origin, but low overall mortality when managed with prompt airway surveillance, broad-spectrum antibiotics, and selective surgical drainage. These findings underscore the critical need to enhance primary dental care access and early referral pathways in resource-limited settings.

Clinical trial number: Not applicable.