Combined Postoperative Irrigation and Dual-Drain Suction Versus Single-Drain Suction in Ludwig's Angina: A Comparative Cohort Study

OBJECTIVES: To compare a combined irrigation-assisted dual-drain suction protocol with single-drain suction alone after surgical drainage of Ludwig's angina. DESIGN: Retrospective comparative cohort study with predefined quasi-randomised alternating allocation. SETTING: A tertiary referral otolaryngology department in Tuscany, Italy. PARTICIPANTS: Sixty adults with odontogenic Ludwig's angina and bilateral submandibular abscesses ≥ 4 cm on contrast-enhanced CT were selected from 118 patients screened between January 2015 and April 2025. Consecutive eligible patients were alternately allocated to the combined protocol (Group A, n = 30) or single-drain suction (Group B, n = 30). MAIN OUTCOME MEASURES: Length of hospital stay and a prespecified major-complication composite of surgical reintervention, imaging-confirmed mediastinitis, or new postoperative tracheostomy. Superficial wound infection was analysed separately. RESULTS: Mean hospital stay was shorter in Group A than Group B (6.1 ± 3.6 vs. 8.2 ± 3.4 days; mean difference, -2.1 days; 95% CI: -3.91 to -0.29; p = 0.024). The major-complication composite occurred in 2 of 30 patients (6.7%) and 7 of 30 (23.3%), respectively (RR: 0.29; 95% CI: 0.06-1.26; Fisher's exact p = 0.145). Superficial wound infection occurred in 2 of 30 and 5 of 30 patients, respectively. Several inflammatory markers declined more rapidly in Group A. CONCLUSIONS: The combined protocol was associated with shorter hospitalisation and a numerical, non-significant reduction in prespecified major complications. Because it combined irrigation with a dual-drain configuration, the independent contribution of irrigation cannot be determined.