A case of descending necrotizing mediastinitis secondary to odontogenic infection

Publication date: Available online 23 November 2018

Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology

Author(s): Hideki Watanabe, Hitoshi Osano, Hiromi Iida, Hirosaka Hayashi, Akihiro Dohi, Yoshiyuki Mori

Abstract

We report a case in which an odontogenic infection developed into a deep neck abscess and descending necrotizing mediastinitis (DNM). The patient was a 43-year-old man with a chief complaint of swelling extending from the right submandibular region to the neck. He had experienced repeated episodes of swelling and pain in the right mandibular molar region starting 1 year prior to the initial visit. He was emergently transported to our department from the Dental and Oral Surgery Department of a general hospital. He was febrile with a temperature of 38.3 °C and exhibited obvious swelling and redness from the right submandibular region to the anterior part of the chest. The maximum opening of the mouth was 1 fingerbreadth, and swelling, redness and pus drainage were observed in the right mandibular molar region. Laboratory tests showed a leukocyte count of 15,590/μL and a C-reactive protein level of 21.6 mg/dL. Computed tomography scans showed periapical lesions at the right mandibular second and third molars, as well as a gas pattern extending from the area around the right submandibular gland to the common carotid artery and anterior mediastinum. The clinical diagnosis was a right-sided deep neck abscess and DNM. At the initial visit, tracheotomy was performed under general anesthesia, with incision and drainage of the deep neck abscess and extraction of the right mandibular second and third molars. In consultation with the Department of Respiratory Surgery, thoracoscopic cleaning and drainage were performed. The patient was discharged in comfortable condition on Day 38.

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