Fatal airway obstruction due to Ludwig's angina from severe odontogenic infection during antipsychotic medication: A case report and a literature review

J Forensic Sci. 2021 Sep;66(5):1980-1985. doi: 10.1111/1556-4029.14740. Epub 2021 Apr 27.


Ludwig's angina is characterized by inflammation of the sublingual and submandibular spaces and is mainly caused by odontogenic infection, which leads to cellulitis of the soft tissues of the floor of the mouth and the neck. This causes asphyxia due to elevation and posterior deviation of the tissues of the floor of the mouth. We report a fatal case of airway obstruction due to Ludwig's angina. A woman in her forties who had no physical complications, but had a mental illness, was undergoing outpatient dental treatment for caries in the first premolar of the left mandible. She was admitted to a psychiatric hospital because of insomnia caused by pain, where she developed cardiopulmonary arrest while sleeping and died 14 days after onset of the dental infection. Postmortem computed tomography (PMCT) prior to autopsy showed swelling of the soft tissues-from the floor of the mouth to the oropharyngeal cavity, the supraglottic larynx, and the prevertebral tissue. Autopsy revealed a markedly swollen face and neck, an elevated tongue, and a highly edematous epiglottis and laryngopharyngeal mucosa. There was also cellulitis and abscess of the facial, suprahyoid, and neck musculature, which suggested that the cause of death was asphyxiation due to airway obstruction. This was an alarming case, with mental illness leading to risk of severe odontogenic infection, and in which obesity and use of antipsychotic medication might have acted synergistically leading to airway obstruction. This is also a case of Ludwig's angina captured by PMCT, which has rarely been reported.

Keywords: Ludwig's angina; airway management; autopsy; cellulitis; excess mortality; medical safety; mental disorder; postmortem computed tomography; severe odontogenic infection.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Airway Obstruction / etiology*
  • Antipsychotic Agents / adverse effects*
  • Asphyxia / etiology*
  • Cellulitis / etiology
  • Edema / etiology
  • Female
  • Focal Infection, Dental / complications*
  • Humans
  • Ludwig's Angina / etiology*
  • Obesity / complications
  • Psychotic Disorders / drug therapy


  • Antipsychotic Agents