Laryngospasm Complicating Awake Nasal Intubation in Ludwig's Angina

A 64-year-old man with Ludwig's angina developed laryngospasm during awake fiberoptic intubation despite mild supraglottic edema. Paralysis restored ventilation and allowed successful intubation. This case illustrates that even minimal laryngeal inflammation can trigger reflex airway closure, underscoring the need for preparedness for failed awake intubation and potential surgical airway intervention.