A 27-year-old man presented to hospital with neck swelling and difficulty breathing following a recent tooth extraction. He underwent uncomplicated surgical drainage of the submandibular region after which he became acutely short of breath and collapsed and was not able to be resuscitated. At autopsy the major findings were swelling of the neck due to diffuse cellulitis with edema and neutrophil infiltrates within connective tissue and marked submucosal edema of the epiglottis, glottic inlet and tonsils sufficient to cause airway obstruction. Cultures from the site of surgical intervention showed a mixed growth of Gram positive and negative bacilli and Gram positive cocci. Death was due to airway obstruction resulting from marked submucosal edema of the glottic inlet associated with submandibular cellulitis (Ludwig’s angina) following extraction of a right lower first molar tooth. Lethal Lugwig angina, although rare in current forensic practice, may still present as a cause of acute upper airway occlusion and must be considered in the differential diagnosis of significant upper airway compromise.

一名 27 岁男子因近期拔牙后颈部肿胀和呼吸困难就诊。他接受了简单的下颌下区引流手术，之后他变得急性呼吸急促并昏倒并且无法复苏。尸检的主要发现是由于弥漫性蜂窝织炎引起的颈部肿胀，结缔组织内有水肿和中性粒细胞浸润，会厌、声门入口和扁桃体的明显粘膜下水肿足以导致气道阻塞。来自手术干预部位的培养物显示出革兰氏阳性和阴性杆菌以及革兰氏阳性球菌的混合生长。死亡是由于在拔除右下第一磨牙后与下颌下蜂窝织炎（路德维希心绞痛）相关的声门入口明显粘膜下水肿导致气道阻塞。致命的 Lugwig 心绞痛，虽然在目前的法医实践中很少见，但仍可能是导致急性上气道闭塞的一个原因，并且必须在对显着上气道损害的鉴别诊断中加以考虑。