Clinical Practice and Cases in Emergency Medicine

Case Presentation: A 30-year-old man presented to the emergency department with severe blunt facial trauma following a fall from height. Examination revealed extensive floor-of-mouth ecchymosis and a large tense sublingual hematoma causing tongue elevation, dysarthria, and swelling mimicking Ludwig’s angina, producing a traumatic pseudo-Ludwig appearance with marked airway crowding. Three-dimensional computed tomography demonstrated severely displaced bilateral mandibular fractures. Owing to pronounced segmental instability with mobile dentoalveolar fragments, temporary interdental bridle wire stabilization was performed in the emergency department. Despite the dramatic anatomical findings, serial airway reassessments confirmed sustained airway stability, permitting delayed definitive open reduction and internal fixation.

Discussion: Traumatic pseudo-Ludwig angina secondary to bilateral mandibular fractures is an uncommon presentation that may closely mimic life-threatening infectious floor-of-mouth swelling. Hemorrhage within the confined sublingual space can rapidly elevate and posteriorly displace the tongue, resulting in progressive airway compromise. This case highlights the importance of dynamic airway assessment, serial airway reassessment, and early multidisciplinary management, including temporary interdental bridle wire stabilization, in carefully selected patients with traumatic hemorrhagic floor-of-mouth emergencies.