Pseudo-Ludwig ' s Phenomenon : A Case Report and Literature Review

Pseudo-Ludwig's phenomenon, a rare clinical entity, is characterized by non-infectious upper airway obstruction resulting from spontaneous hematoma in the sublingual area. We describe a case of pseudo-Ludwig's phenomenon in patient on anticoagulants with deranged coagulation profile. © 2018 Elixir All rights reserved. Elixir Physio. & Anatomy 117 (2018) 50503-50504 Physiology and Anatomy Available online at www.elixirpublishers.com (Elixir International Journal) I.Ezekari et al./ Elixir Physio. & Anatomy 117 (2018) 50503-50504 50504 Although the sublingual space is a highly vascular area, is rarely a site of spontenous hematomas [2]. Floor of mouth hematomas have been described after trauma, dental implant procedures angioedema or pseudoaneurysm [3]. There are rare reports of hematomas in this region complicating excessive anticoagulation [3]. The floor of the mouth is composed of multiple fascial spaces, covered by mucosa therefor a local oedema and hematoma can readily expand and lead to the elevation of tongue and floor of the mouth culminating in upper airway blockade [2,4]. The management of these cases required to secure the airway as a first step. The conservative management was reported in most cases in literature as a successful management in reducing the volume of the hematoma once the causative factors have been corrected. The surgical attempt to evacuate the hematoma is controversial and can cause more swelling [5,6]. The use of leeches has also been reported to aid in the resolution of the hematoma [7] . In our case there has been spontaneous resolution once the coagulation anomaly has been controlled. References: [1]M. Lepore Upper airway obstruction induced by warfarin sodium Arch. Otolaryngol. Head Neck Surg., 102 (1976), pp. 505-506 [2]George Sarin Zacharia,et al.Pseudo-Ludwig’s phenomenon:a rare clinical manifestation in liver cirrhosis ACG Case Rep. J., 2 (1) (2014), pp. 53-54 [3]Puri A, Nusrath MA, Harinathan D, Lyall J. Massive sublingual hematoma secondary to anticoagulant therapy complicated by a traumatic denture: A case report. J Med Case Rep. 2012;6: 105. [4]Cohen AF, Warman SP. Upper airway obstruction secondary to warfarin-induced sublingual hematoma.Arch Otolaryngol Head Neck Surg. 1989;115(6):718–720 [5]M.A. Bitar, M.A. Kamal, L. MahfoudSpontaneous sublingual haematoma: a rare entity BMJ Case Rep. (2012) [6]Shouvanik Satpathy Spontaneous sublingual space hematoma secondary to hypertension: a case report and review of literature Natl. J. Maxillofac. Surg., 6 (Jan–Jun (1)) (2015), pp. 96-98 [7]N.J. Lee, N.S.PeckittTreatment of a sublingual hematoma with medicinal leeches: report of case J. Oral Maxillofac. Surg., 54 (1996), pp. 101-103