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

ABSTRACT 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.