D

Securing the airway is the immediate priority in Ludwig’s angina because progressive floor-of-mouth swelling can rapidly obstruct ventilation; guidelines and case series recommend awake fiber-optic intubation or, if this is impossible, tracheostomy under local anesthesia as the first step before antibiotics or drainage [Ovassapian, 2005, PMID 15673898; Kulkarni, 2008, PMID 18577200; Al Harbi, 2016, PMID 29939705].